Stress-induced cortisol reactivity as a predictor of success in treatment for affective dimensions.
Stress-induced cortisol reactivity as a predictor of success in treatment for affective dimensions.
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DOI：
10.1016/j.psyneuen.2020.104646
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发表时间：
2020-06
影响因子：
3.7
通讯作者：
Meuret AE
中科院分区：
文献类型：
--
作者：
Roque AD;Craske MG;Treanor M;Rosenfield D;Ritz T;Meuret AE
对抑郁症和焦虑症的一线治疗的应答率仍然不令人满意。确定能够优化治疗匹配的预测因子或调节因子具有重要的科学和临床意义。这项研究考察了实验室诱导的长期应激皮质醇反应性作为情感维度(TAD)治疗结果预测因子的作用。患者接受了15个疗程的治疗，目标是减少负面情绪或增加积极情绪。第二个目的是检查治疗类型是否会缓和皮质醇反应性和治疗结果之间的联系。35名参与者在治疗开始前一周接受了36分钟的间歇性应激诱导任务，包括心算任务和恐惧增强惊吓任务。在五个时间点收集皮质醇，将反应性量化为任务期间的峰值减去评估前一晚的皮质醇基础水平。使用多水平模型，我们检验了皮质醇反应性和症状改善斜率之间的关系。皮质醇反应性与治疗结果有关，平均水平和更高水平的应激诱导的皮质醇反应预示着在整个治疗和6个月的随访中症状会有更大的缓解。皮质醇反应性对症状的影响没有观察到治疗条件的差异(适度)。我们的研究结果表明，更大的皮质醇应激反应对治疗结果的影响。未来的研究应该探索如何通过利用内源性昼夜波动或外源性皮质醇操纵来增强这种治疗益处。
Response rates to first-line treatments for depression and anxiety remain unsatisfactory. Identification of predictors or moderators that can optimize treatment matching is of scientific and clinical interest. This study examined the role of prolonged laboratory-induced stress cortisol reactivity as a predictor of outcome for a treatment of affective dimensions (TAD). Patients received 15-sessions of a treatment targeting reductions in negative affect or increases in positive affect. A second aim was to examine whether treatment type would moderate the association between cortisol reactivity and treatment outcome. Thirty-five participants underwent a 36-minute intermittent stress induction task composed of a mental arithmetic task and a fear-potentiated startle task one week before treatment initiation. Cortisol was collected at five-time points with reactivity being quantified as peak during the task minus basal level of cortisol the evening before the assessment. Using multilevel modeling, we examined the associations between cortisol reactivity and slopes of symptom improvement. Cortisol reactivity was related to treatment outcome, with average and higher levels of stressinduced cortisol response predicting greater decreases in symptoms throughout treatment and 6-month follow-up. Treatment condition differences (moderation) were not observed in the effect of cortisol reactivity on symptoms. Our findings demonstrate the impact of greater cortisol stress reactivity on treatment outcome. Future studies should investigate how to enhance this therapeutic benefit through capitalizing on endogenous diurnal fluctuations or exogenous cortisol manipulation.
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