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Randomized Controlled Trial
. 2020 Aug:118:104714.
doi: 10.1016/j.psyneuen.2020.104714. Epub 2020 May 15.

Cortisol awakening response in PTSD treatment: Predictor or mechanism of change

Sheila A M Rauch  1 , Anthony King  2 , H Myra Kim  3 , Corey Powell  3 , Nirmala Rajaram  4 , Margaret Venners  5 , Naomi M Simon  6 , Mark Hamner  7 , Israel Liberzon  8
Affiliations
Randomized Controlled Trial

Cortisol awakening response in PTSD treatment: Predictor or mechanism of change

Sheila A M Rauch et al. Psychoneuroendocrinology. 2020 Aug.

Abstract

PTSD is associated with abnormalities in hypothalamic-pituitary-adrenal (HPA) axis activity. This includes enhanced HPA axis negative feedback, attenuated cortisol awakening response, and attenuated cortisol response to personal trauma script. Whether HPA axis function predicts treatment response or treatment related symptom reduction in PTSD remains unclear. In addition, the relative effects of different treatment modalities (i.e., medication and psychotherapy) on HPA axis is unclear. To address this gap in knowledge, the PROGrESS study examined cortisol awakening response across treatment in Veterans with chronic PTSD randomized to receive Prolonged Exposure + Placebo (PE + PLB), Sertraline + PE (SERT + PE) or Sertraline + Enhanced Medication Management (SERT + EMM). Salivary cortisol awakening response (CAR) was assessed at baseline, mid-treatment (week 6 and 12), post-treatment (week 24) and follow-up (week 36 and 52). Among males at baseline, combat veterans with PTSD showed lower CAR Area Under the Curve Increase (AUCi; M = 3.15, SD = 9.57) than Combat controls (M = 7.63, SD = 9.07; p = .02), demonstrating combat veterans with PTSD have a less responsive system than combat controls. Higher PTSD severity was also related to lower CAR AUCi (r = -0.52, p = .03). When controlling for PTSD severity, higher baseline CAR AUCi was related to attenuated reduction in PTSD and lower likelihood of high treatment response over treatment (z = -2.06, p = .04).

Trial registration: ClinicalTrials.gov NCT01524133.

Keywords: Cortisol; DHEA; Exposure therapy; PTSD; Sertraline; Treatment.

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References

    1. Bentz D, Michael T, De Quervain DJF, Wilhelm FH, 2010. Enhancing exposure therapy for anxiety disorders with glucocorticoids: from basic mechanisms of emotional learning to clinical applications. J. Anxiety Disordders 24, 223–230. - PubMed
    1. Elzinga BM, Schmahl CG, Vermetten E, van Dyck R, Bremner JD, 2003. Higher cortisol levels following exposure to traumatic reminders in abuse-related PTSD. Neuropsychopharmacology 28 (9), 1656–1665. - PubMed
    1. Foa EB, Hembree EA, Rothbaum BO, 2007. Prolonged Exposure Therapy for PTSD: Therapist Guide. Oxford University Press, New York, NY.
    1. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL, 2004. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N. Engl. J. Med 351 (1), 13–22. - PubMed
    1. Keane T, Fairbank J, Caddell J, Zimering R, Taylor K, Mora C, 1989. Clinical evaluation of a measure to assess combat exposure. Psychol. Assess 1, 53–55.

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