Effects of the cortisol stress response on the psychotherapy outcome of panic disorder patients

Wichmann, Susann; Kirschbaum, Clemens; Lorenz, Thomas H.; Petrowski, Katja

doi:10.1016/j.psyneuen.2016.11.030

Cited by 25 publications

(24 citation statements)

References 61 publications

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“…Regarding psychotherapy success, those patients with higher cortisol concentrations upon CRH-injection showed percental increases in disease severity after CBT, therefore the least improvement by psychotherapy. We thus confirm former findings of an inverse correlation between cortisol concentrations and therapy success 12 , 13 . It seems that those patients who show inadequate hormonal responses show less improvement from psychotherapy.…”

Section: Discussionsupporting

confidence: 91%

“…This study was part of a trial on psychotherapy success in patients diagnosed with PD with or without agoraphobia previously published 13 . The patient sample was recruited from May 2008 to May 2013 from the University Hospital of the Technische Universität Dresden, Germany, before the start of cognitive behavioural psychotherapy.…”

Section: Methodsmentioning

confidence: 99%

“…To date, psychotherapy outcome research has put little emphasis on biological correlates of the therapy outcome but has focused primarily on symptom severity itself as negative predictor 7 , 8 , for comorbid mental disorders 9 – 11 and motivation for psychotherapy 8 , both with no impact on the therapy success. Studies examining biological correlates within psychotherapy success prediction showed that PD patients with the lowest cortisol stress response showed the least improvement from psychotherapy (in response to individually feared situations 12 , and in response to the Trier Social Stress Test 13 ). Until now, it has been uncertain if the cortisol stress response to the combined dexamethasone suppression/corticotropin-releasing hormone challenge (DEX–CRH) test, which is more cost-efficient than the Trier Social Stress Test (TSST), may be predictive of the psychotherapy outcome as well.…”

Section: Introductionmentioning

confidence: 99%

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Stress hormone response to the DEX–CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia

et al. 2018

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This study tested whether the hormonal stress response to the DEX–CRH test may be predictive of the psychotherapy success for panic disorder (PD). Thirty-four patients diagnosed either with agoraphobia with PD or PD without agoraphobia were subjected to cognitive behavioural therapy (CBT). Patients (pre-therapy) and healthy volunteers were exposed to the DEX–CRH test. Blood samples were taken for cortisol and adrenocorticotropic hormone (ACTH) assessment. Established panic-specific questionnaires were handed out for the pre-therapy and post-therapy evaluation of disease severity (with reference to panic beliefs and agoraphobic cognitions, fear of bodily sensations, agoraphobic avoidance behaviour). Repeated measures ANCOVA were conducted for the analysis of the pre-therapy hormonal response, and Pearson’s correlation analysis to test for associations with the psychotherapy outcome. Data analyses revealed large effect sizes for CBT in the clinical measures (η2 ≥ 0.321), main effects of time for cortisol and ACTH with no differences between both groups, and significant associations between cortisol release and agoraphobic cognitions for the patients. PD diagnosis had no impact on the hormonal response. However, those patients with higher cortisol release showed less improvement after CBT (significantly for agoraphobic cognitions). Clinical implications of these findings are the prediction of the therapy success from a potential endocrine correlate whose persistency (if assessed repeatedly) during the treatment may predict (non-)response to the current treatment, possibly representing a decision support for a change in treatment to avoid the continuation of an inefficient treatment.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stress hormone response to the DEX–CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia

et al. 2018

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“…Wichmann et al [ 39 ] recently showed that an overall postintervention (ie, face-to-face CBT) decrease in the total PAS score of about 4 to 5 points represents a clear clinical change in terms of quality of life and functioning. This is slightly smaller than the change we observed in our study (6 points) for end point PAS scores compared with baseline.…”

Section: Resultsmentioning

confidence: 99%

Two Novel Cognitive Behavioral Therapy–Based Mobile Apps for Agoraphobia: Randomized Controlled Trial

Christoforou¹,

Fonseca²,

Tsakanikos³

2017

J Med Internet Res

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BackgroundDespite the large body of literature demonstrating the effectiveness of cognitive behavioral treatments for agoraphobia, many patients remain untreated because of various barriers to treatment. Web-based and mobile-based interventions targeting agoraphobia may provide a solution to this problem, but there is a lack of research investigating the efficacy of such interventions.ObjectiveThe objective of our study was to evaluate for the first time the effectiveness of a self-guided mobile-based intervention primarily targeting agoraphobic symptoms, with respect to a generic mobile app targeting anxiety.MethodsA Web-based randomized controlled trial (RCT) compared a novel mobile app designed to target agoraphobia (called Agoraphobia Free) with a mobile app designed to help with symptoms of anxiety in general (called Stress Free). Both interventions were based on established cognitive behavioral principles. We recruited participants (N=170) who self-identified as having agoraphobia and assessed them online at baseline, midpoint, and end point (posttreatment) over a period of 12 weeks. The primary outcome was symptom severity measured by the Panic and Agoraphobia Scale.ResultsBoth groups had statistically significant improvements in symptom severity over time (difference –5.97, 95% CI –8.49 to –3.44, P<.001 for Agoraphobia Free and –6.35, 95% CI –8.82 to –3.87, P<.001 for Stress Free), but there were no significant between-group differences on the primary outcome (difference 0.38, 95% CI –1.96 to 3.20, P=.64).ConclusionsThis is, to our knowledge, the first RCT to provide evidence that people who identify as having agoraphobia may equally benefit from a diagnosis-specific and a transdiagnostic mobile-based intervention. We also discuss clinical and research implications for the development and dissemination of mobile mental health apps.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 98453199; http://www.isrctn.com /ISRCTN98453199 (Archived by WebCite at http://www.webcitation.org/6uR5vsdZw)

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“…Additional analyses showed no impact of comorbid depressiveness on the cortisol stress response. Major depressive disorder patients did not differ in the hormonal stress response neither compared to the healthy participants nor to the PD patients [37]. Additionally, patients with moderate to severe major depressive disorder are rather linked to heightened HPA axis activity and cortisol hyperresponsiveness to stressors [38, 39].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Cortisol Stress Response in Patients with Panic Disorder, Cannabis-Induced Panic Disorder, and Healthy Controls

Petrowski

Conrad

2019

Psychopathology

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Background/Aims: Little research effort has so far been dedicated to the analysis of the hypothalamic-pituitary-adrenal axis of aetiologically differing subgroups of patients with panic disorder (PD). The current study aimed at a deeper understanding of the cortisol stress response in cannabis-induced PD (CIPD) patients. Methods: Matched groups of 7 PD patients (mean age ± SD: 32.95 ± 9.04 years), 7 CIPD patients (31.94 ± 8.40 years), and 7 healthy controls (HC) (31.13 ± 8.57 years) were included in the study. The Trier Social Stress Test (TSST) was used for stress induction. Salivary cortisol samples were collected and panic- and depression-related questionnaires were applied. Results: A stress response to the TSST was found in 28.6% of PD patients, in 51.1% of CIPD patients, and in 100% of HC subjects. Statistical analyses revealed a cortisol hyporesponsiveness in PD and CIPD patients. While cortisol values of PD patients and HC participants differed significantly, CIPD patients’ cortisol courses balanced between those of PD patients and HC subjects. Conclusions: Current findings show a distinctive pattern of the stress-induced cortisol reaction in CIPD patients, which is markedly different from the hormonal response in PD patients as well as HC subjects. Previous findings of cortisol hyporesponsiveness in PD patients compared to HC subjects were confirmed.

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Effects of the cortisol stress response on the psychotherapy outcome of panic disorder patients

Cited by 25 publications

References 61 publications

Stress hormone response to the DEX–CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia

Stress hormone response to the DEX–CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia

Two Novel Cognitive Behavioral Therapy–Based Mobile Apps for Agoraphobia: Randomized Controlled Trial

Comparison of Cortisol Stress Response in Patients with Panic Disorder, Cannabis-Induced Panic Disorder, and Healthy Controls

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