Pre-treatment cortisol awakening response predicts symptom reduction in posttraumatic stress disorder after treatment

Are treatment successes in PTSD associated with changes in cortisol secretion, assessed by HPA-axis function, before & after trauma therapy?

Article Abstract

“Dysfunction of the HPA-axis has frequently been found in the aftermath of trauma exposure with or without PTSD. Decreasing HPA-axis reactivity to different stress cues has been reported during PTSD treatment. The cortisol awakening response (CARi) is a well-validated, standardized measure of HPA-axis reactivity which can be easily acquired in the clinical setting. Whether CARi changes over time in traumatized individuals are specific to PTSD treatment is unknown. Furthermore, a possible role for the baseline CARi in predicting symptom reduction after treatment in PTSD has not been examined before. To answer these questions, a cohort study was conducted in which the awakening cortisol was measured in both PTSD (N = 41) and non-PTSD (N = 25) combat-exposed male subjects. Measurements took place at inclusion and 6–8 months after inclusion for both the PTSD and the non-PTSD group. During the 6–8 months interval, PTSD patients received trauma-focused focused psychotherapy, whereas non-PTSD patients received no treatment. We found a decrease in the CARi over time in both groups, suggesting it was not specific to PTSD or the effect of treatment. Therefore, caution is warranted when attributing diminished HPA-axis reactivity over time to effects of PTSD treatment. Second, CARi prior to treatment predicted PTSD symptom reduction (CAPS score change) after treatment, and accounted for 10% of the variance, even when adjusted for changes in depressive symptoms and medication use during the study period. A putative role emerges for CARi as a predictive biomarker of symptom reduction in male individuals with combat-related PTSD.

Highlights

• HPA-axis reactivity was measured in veterans with PTSD.
• Veterans with PTSD received trauma focused psychotherapy for 6–8 months.
• CARi before and after treatment was compared.
• CARi accounted for 10% of the treatment effect.
• CARi can be used to predict symptom reduction in PTSD.”

—Description from publisher

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Rapcencu, A. E., Gorter, R., Kennis, M., van Rooij, S. J. H., & Geuze, E. (2017). Pre-treatment cortisol awakening response predicts symptom reduction in posttraumatic stress disorder after treatment. Psychoneuroendocrinology, 82, 1-8. https://doi.org/10.1016/j.psyneuen.2017.04.010