School of Psychology, University of Leeds, UK.
School of Psychology, University of Leeds, UK.
Psychoneuroendocrinology. 2024 Jan;159:106415. doi: 10.1016/j.psyneuen.2023.106415. Epub 2023 Oct 11.
Stress has a damaging impact on our mental and physical health, and as a result, there is an on-going demand for effective stress management interventions. However, there are no reviews or meta-analyses synthesising the evidence base of randomised controlled trials testing the effectiveness of psychological interventions on changing cortisol levels (the stress hormone) in non-patient groups. Therefore, the primary aim of this systematic review and meta-analysis was to address this gap. Six databases (Medline, PsychInfo, Embase, CINAHL, Cochrane and Web of Science) were searched (1171 studies identified) with 58 studies (combined N = 3508) included in the meta-analysis. The interventions were coded into one of four categories; mind body therapies, mindfulness, relaxation or talking therapies. A random effects meta-analysis on cortisol as measured in blood, saliva or hair found that stress management interventions outperformed pooled control conditions with a medium positive effect size (g = 0.282). The studies that utilised cortisol awakening measures (g = 0.644) revealed larger effects of stress management interventions than those that measured diurnal cortisol (g = 0.255). Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes. Additionally, studies that utilised an active control group (g = 0. 477) over passive control group (g = 0.129) were found to have stronger effects. Length of the intervention, study quality, risk of bias, age and gender did not influence the effectiveness of interventions and there was no evidence of publication bias. Overall, the current findings confirm that stress management interventions can positively influence cortisol levels. Future research should investigate the longer term implications for health and health outcomes.
压力对我们的身心健康有破坏性影响，因此，人们一直需要有效的压力管理干预措施。然而，目前还没有系统评价或荟萃分析综合随机对照试验的证据基础，这些试验测试了非患者群体中心理干预措施对改变皮质醇水平（应激激素）的有效性。因此，本系统评价和荟萃分析的主要目的是解决这一空白。我们检索了 6 个数据库（Medline、PsychInfo、Embase、CINAHL、Cochrane 和 Web of Science）（确定了 1171 项研究），其中 58 项研究（合并 N = 3508 人）纳入荟萃分析。将干预措施编码为四类之一：身心疗法、正念、放松或谈话疗法。一项关于血液、唾液或头发中皮质醇测量的随机效应荟萃分析发现，压力管理干预措施的效果优于 pooled 对照条件，具有中等积极的效应大小（g = 0.282）。使用皮质醇觉醒测量（g = 0.644）的研究发现，压力管理干预措施的效果大于测量日间皮质醇（g = 0.255）的研究。正念和冥想（g = 0.345）和放松（g = 0.347）干预措施在改变皮质醇水平方面最有效，而身心疗法（g = 0.129）和谈话疗法（g = 0.107）的效果较小且无统计学意义。此外，与使用被动对照组（g = 0.129）相比，使用主动对照组（g = 0.477）的研究发现效果更强。干预的长度、研究质量、偏倚风险、年龄和性别均不影响干预的有效性，且不存在发表偏倚的证据。总的来说，目前的研究结果证实，压力管理干预措施可以积极影响皮质醇水平。未来的研究应调查对健康和健康结果的长期影响。
