April 11, 2016
1 min read

Increased salivary cortisol reactivity indicates worse PTSD treatment response

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PHILADELPHIA — Increased reactivity in hypothalamic-pituitary adrenal axis during psychotherapy indicated worse treatment response, according to data presented at the Anxiety and Depression Association of America annual conference.

“Convergent evidence suggests that hypothalamic-pituitary adrenal axis is disrupted in PTSD and that normalization of [hypothalamic-pituitary adrenal axis (HPA)] may be associated with symptom improvement. However, little research has examined how HPA axis function changes over the course of treatment,” Sheila Rauch, PhD, of Emory University School of Medicine, and colleagues wrote.

Shelia Rauch, PhD

Sheila Rauch

To address this research gap, Rauch and colleagues randomly assigned 30 Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans to 10 to 12 sessions of prolonged exposure therapy or present centered therapy. Salivary cortisol was collected at three time points during three sessions.

The significant effect of session number indicated linear increases in cortisol output over the course of treatment (P = .02), according to researchers.

Responder status was a significant predictor of the slope of cortisol level across sessions (P = .04).

Low responders exhibited an average increase of 1.35 in cortisol level between sessions, compared with high responders.

Responder status accounted for 6% of previously unexplained variance in cortisol level.

“Interestingly, low responders showed increased salivary cortisol across therapy sessions while high responders showed no significant change suggesting the possibility of sensitization for this low response group,” Rauch told Healio.com/Psychiatry. “Of note, rates of clinically significant response to treatment were very high in this study. So, even those who are characterized as low responders did show symptoms improvement that was clinically meaningful and stable. Thus, the sensitization did not result in the treatment not being effective but did appear to make the magnitude of change less for this group.” – by Amanda Oldt


Rauch S, et al. Within-session salivary cortisol reactivity during psychotherapy is associated with treatment outcome for PTSD. Presented at: Anxiety and Depression Association of America Conference; March 31-April 3, 2016; Philadelphia.

Disclosure: The study was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development (VA-CDA_2-010-06F; PI: Rauch, Clinical Trials identifier NCT00475241).