Exposure-related cortisol predicts outcome of psychotherapy in veterans with treatment-resistant posttraumatic stress disorder

Marieke J van Gelderen; Mirjam J Nijdam; Friso de Vries; Onno C Meijer; Eric Vermetten

doi:10.1016/j.jpsychires.2020.08.011

Exposure-related cortisol predicts outcome of psychotherapy in veterans with treatment-resistant posttraumatic stress disorder

J Psychiatr Res. 2020 Nov:130:387-393. doi: 10.1016/j.jpsychires.2020.08.011. Epub 2020 Aug 18.

Authors

Marieke J van Gelderen¹, Mirjam J Nijdam², Friso de Vries³, Onno C Meijer³, Eric Vermetten⁴

Affiliations

¹ ARQ Centrum'45, ARQ National Psychotrauma Centre, Nienoord 5, 1112XE, Diemen, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. Electronic address: m.van.gelderen@centrum45.nl.
² ARQ Centrum'45, ARQ National Psychotrauma Centre, Nienoord 5, 1112XE, Diemen, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
³ Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
⁴ ARQ Centrum'45, ARQ National Psychotrauma Centre, Nienoord 5, 1112XE, Diemen, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Military Mental Health-Research, Ministry of Defense, Lundlaan 1, 3584 EZ, Utrecht, the Netherlands.

PMID: 32889356
DOI: 10.1016/j.jpsychires.2020.08.011

Abstract

Background: Hypothalamic-pituitary-adrenal axis functioning has been related to treatment outcome in posttraumatic stress disorder (PTSD). Previous studies have primarily focused on cortisol levels before and after a course of therapy and findings have not been fully consistent. This study investigated session-related cortisol levels in veterans with treatment-resistant PTSD over the course of a novel motion-assisted virtual reality exposure therapy and aimed to determine whether cortisol levels were related to changes in PTSD symptom severity.

Methods: Veterans (N = 22) received six exposure sessions during which salivary cortisol samples were collected pre-session, post-session and in the late afternoon following sessions. PTSD symptom severity was assessed by structured clinical interviews at pre- and post-treatment. Average cortisol levels were compared between responders and non-responders. Linear regression analyses were conducted with PTSD symptom change as criterion variable, average cortisol levels as predictor, and timing of sampling and baseline PTSD symptoms as covariates.

Results: Responders to treatment tended to have higher average cortisol levels at pre-session (p = 0.064) and post-session (p = 0.050) compared to non-responders. Higher average pre-session and post-session cortisol levels predicted greater PTSD symptom improvement (pre: b = -1.83, p = 0.009; post: b = -3.57, p = 0.004).

Conclusion: This study provides preliminary evidence for session-related cortisol as biomarker of response to exposure-based therapies for PTSD. Higher cortisol levels may have facilitated fear extinction and reconsolidation, and may indicate increased physiological stress activation necessary for appropriate treatment engagement. Further work involving comparable methodology is encouraged to establish session-related cortisol as biomarker and to determine the mechanisms through which it interacts with treatment outcome.

Keywords: 3MDR; Cortisol; Posttraumatic stress disorder; Treatment; Veterans.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Extinction, Psychological
Fear
Humans
Hydrocortisone
Hypothalamo-Hypophyseal System
Pituitary-Adrenal System
Stress Disorders, Post-Traumatic* / therapy
Treatment Outcome
Veterans*

Substances

Hydrocortisone