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.

中文翻译：

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暴露相关的皮质醇可预测具有抗药性的创伤后应激障碍的退伍军人的心理治疗结局。

背景

下丘脑-垂体-肾上腺轴功能与创伤后应激障碍（PTSD）的治疗结果有关。先前的研究主要集中在一个疗程之前和之后的皮质醇水平，研究结果尚未完全一致。这项研究调查了在新型运动辅助虚拟现实暴露疗法过程中具有抗药性PTSD的退伍军人的与会话相关的皮质醇水平，旨在确定皮质醇水平是否与PTSD症状严重程度的变化有关。

方法

退伍军人（N = 22）接受了六次暴露时段，在赛前，赛后和赛后的傍晚收集唾液皮质醇样品。PTSD症状严重程度在治疗前和治疗后通过结构化临床访谈进行评估。比较反应者和非反应者的平均皮质醇水平。进行线性回归分析，以PTSD症状变化为标准变量，平均皮质醇水平作为预测变量，采样时间和基线PTSD症状为协变量。

结果

与无反应者相比，治疗前的反应者在治疗前（p  = 0.064）和治疗后（p  = 0.050）的平均皮质醇水平较高。术前和术后平均皮质醇水平越高，预示的PTSD症状改善越大（前：b = −1.83，p  = 0.009；后：b = −3.57，p  = 0.004）。

结论

这项研究提供了与会话相关的皮质醇作为对PTSD的基于暴露疗法的反应的生物标志物的初步证据。较高的皮质醇水平可能促进了恐惧的消退和巩固，并且可能表明增加适当的治疗参与所必需的生理应激激活。鼓励开展涉及可比方法的进一步工作，以建立与会话相关的皮质醇作为生物标志物，并确定其与治疗结果相互作用的机制。