Gaab J, Sonderegger L, Scherrer S, Ehlert U
Institute of Psychology, University of Zürich, Clinical Psychology and Psychotherapy Zürichbergstr 43, CH-8044 Zürich, Switzerland.
Psychoneuroendocrinology. 2006 May;31(4):428-38. doi: 10.1016/j.psyneuen.2005.10.005. Epub 2005 Dec 5.
It is assumed that chronic or extensive release of cortisol due to stress has deleterious effects on somatic and psychological health, making interventions aiming to reduce and/or normalize cortisol secretion to stress of interest. Cognitive-behavioral stress management (CBSM) has repeatedly been shown to effectively reduce cortisol responses to acute psychosocial stress. However, the effects of CBSM on psychoneuroendocrine responses during "real-life" stress have yet not been examined in healthy subjects. Eight weeks before all subjects took an important academic exam, 28 healthy economics students were randomly assigned to four weekly sessions of cognitive behavioral stress management (CBSM) training or a waiting control condition. Psychological and somatic symptoms were repeatedly assessed throughout the preparation period. Salivary cortisol (cortisol awakening response and short circadian cortisol profile) was repeatedly measured at baseline and on the day of the exam. In addition, cognitive appraisal was assessed on the day of the exam. Subjects in the CBSM group showed significantly lower anxiety and somatic symptom levels throughout the period prior to the exam. On the day of the exam, groups differed in their cortisol awakening stress responses, with significantly attenuated cortisol levels in controls. Short circadian cortisol levels did not differ between groups. Interestingly, groups differed in their associations between cortisol responses before the exam and cognitive stress appraisal, with dissociation in controls but not in the CBSM group. The results show that CBSM reduces psychological and somatic symptoms and influences the ability to show a cortisol response corresponding to subjectively perceived stress. In line with current psychoneuroendocrine models, the inability to mount a cortisol response corresponding to the cognitive appraisal in controls could be a result of a dysregulated HPA axis, probably as a consequence of longlasting stress.
假定由于压力导致的皮质醇长期或大量释放会对身心健康产生有害影响，这使得旨在减少和/或使皮质醇分泌恢复正常以应对相关压力的干预措施备受关注。认知行为压力管理（CBSM）已多次被证明能有效降低对急性心理社会压力的皮质醇反应。然而，CBSM对“现实生活”压力下心理神经内分泌反应的影响尚未在健康受试者中进行研究。在所有受试者参加重要学术考试前八周，28名健康的经济学专业学生被随机分配到接受四周的认知行为压力管理（CBSM）训练或等待控制组。在整个准备期间反复评估心理和躯体症状。在基线和考试当天反复测量唾液皮质醇（皮质醇觉醒反应和短昼夜皮质醇曲线）。此外，在考试当天评估认知评价。CBSM组的受试者在考试前整个期间的焦虑和躯体症状水平显著较低。在考试当天，两组的皮质醇觉醒应激反应不同，对照组的皮质醇水平显著降低。两组的短昼夜皮质醇水平没有差异。有趣的是，两组在考试前皮质醇反应与认知应激评价之间的关联不同，对照组存在解离现象，而CBSM组则没有。结果表明，CBSM可减轻心理和躯体症状，并影响对应主观感知压力产生皮质醇反应的能力。与当前的心理神经内分泌模型一致，对照组无法产生与认知评价相对应的皮质醇反应可能是下丘脑-垂体-肾上腺（HPA）轴失调的结果，可能是长期压力的后果。
