Faculty of Psychology, Technische Universität Dresden, Germany.
Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany.
Psychoneuroendocrinology. 2021 Sep;131:105326. doi: 10.1016/j.psyneuen.2021.105326. Epub 2021 Jun 16.
Psychological treatments of posttraumatic stress disorder (PTSD) are associated with non-response rates of up to 50%. This fact highlights the need to identify characteristics of poorer treatment outcome. Among others, previous evidence focused on the role of dysfunctional cortisol secretion which has been related to the development, maintenance and treatment of PTSD. Particularly, promising evidence stems from research using hair cortisol analysis which allows for a reliable assessment of cortisol secretion over several months. Another variable that has been linked to both HCC and non-response to treatment is childhood maltreatment (CM). In order to examine the predictive value of pre-treatment hair cortisol concentrations (HCC), treatment-related changes in HCC as well as CM for changes in PTSD symptomatology, we set up a prospective study in which we followed 52 female PTSD patients over the course of a trauma-focused inpatient treatment. Specifically, 3-month integrated HCC were assessed at treatment entry, at discharge and on average five months later accompanied by assessments of PTSD, overall and depressive symptomatology. CM was measured at treatment entry. Self-report indices improved following inpatient treatment. No evidence for pre-treatment HCC to be associated with changes in PTSD symptoms was revealed. However, attenuated pre-treatment HCC predicted less improvement in overall symptomatology from treatment entry to discharge. This effect lost significance after adjusting for baseline dissociative symptoms. Neither changes in HCC nor CM were predictive of treatment response. Pre-treatment cross-sectional analyses revealed no association between HCC and CM. The current hair cortisol data provided little evidence for a predictive role of lower long-term integrated cortisol secretion for poorer inpatient treatment outcome. If corroborated by further research in larger PTSD samples with much more methodological rigor, these data might be a valuable basis for future tailored research projects.
创伤后应激障碍（PTSD）的心理治疗与高达 50%的无反应率相关。这一事实凸显了识别较差治疗结果特征的必要性。其中，先前的证据集中在功能失调的皮质醇分泌上，皮质醇分泌与 PTSD 的发展、维持和治疗有关。特别是，使用毛发皮质醇分析的研究提供了有希望的证据，该研究可以可靠地评估数月的皮质醇分泌。另一个与 HCC 和治疗无反应相关的变量是儿童期虐待（CM）。为了研究治疗前毛发皮质醇浓度（HCC）、HCC 治疗相关变化以及 CM 对 PTSD 症状变化的预测价值，我们进行了一项前瞻性研究，其中我们对 52 名女性 PTSD 患者进行了创伤聚焦的住院治疗。具体而言，在治疗开始时、出院时和平均五个月后评估了 3 个月的综合 HCC，并评估了 PTSD、总体和抑郁症状。在治疗开始时测量了 CM。住院治疗后，自我报告指标有所改善。没有证据表明治疗前 HCC 与 PTSD 症状变化有关。然而，治疗前 HCC 水平降低预示着从治疗开始到出院，整体症状改善程度较低。在调整基线分离症状后，这种影响失去了意义。HCC 和 CM 的变化都不能预测治疗反应。治疗前的横断面分析显示 HCC 与 CM 之间没有关联。当前的毛发皮质醇数据几乎没有证据表明长期综合皮质醇分泌水平较低与住院治疗结果较差有关。如果在更大的 PTSD 样本中进行更严格的研究得到进一步证实，这些数据可能为未来的定制研究项目提供有价值的基础。
