Changes in Diurnal Salivary Cortisol Secretion following Cognitive-Behavioral Therapy in Patients with Panic Disorder

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  • パニック障害患者における認知行動療法実施に伴う日中の唾液中コルチゾール分泌の変化
  • パニック ショウガイ カンジャ ニ オケル ニンチ コウドウ リョウホウ ジッシ ニ トモナウ ニッチュウ ノ ダエキ チュウ コルチゾール ブンピ ノ ヘンカ

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Abstract

The use of salivary cortisol is an active research area receiving much interest with implications for basic and clinical purposes. In this study, changes in salivary cortisol following cognitive-behavioral therapy (CBT) were investigated in patients with panic disorder. Nine patients with panic disorder with agoraphobia participated in a six-session CBT program. Panic disorder severity, avoidance behaviors, anxiety, depressive symptoms, and general self efficacy were evaluated before and after the program. Moreover, saliva samples for cortisol assessment were obtained 6 times (awakening, 15 and 30 minutes after awakening, 3 and 8 hours after awakening, and bedtime) before and after the program. Three cortisol parameters, the diurnal slope (changes in cortisol from awakening to bedtime), awakening response (the increase in cortisol secretion over the first 30 minutes after awakening), and total cortisol output over the day (cortisol area under the curve for the 8 hour periods after awakening) were computed for each day. Patients showed improvements in panic disorder severity, avoidance behaviors, and general self efficacy ratings following the CBT program. Analyses of cortisol parameters showed that the diurnal slope increased after completing the program (t[7]=2.51, p<0.05). Correlation analyses also demonstrated that an improvement in the panic disorder severity rating was associated with decreased total cortisol output (rs=0.71, p<0.05) and that decreased levels of anxiety were associated with decreased total cortisol output (rs=0.78, p<0.05) and awakening response (rs=0.81, p<0.05). These results suggest that salivary cortisol could be a useful tool for evaluating the effects of CBT programs. It is likely that the use of salivary cortisol will continue to expand, thus being applied in a variety of clinical settings.

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