RESUMO
BACKGROUND: Cortisol is one of the most extensively studied biomarkers in the context of trauma/posttraumatic stress disorder (PTSD). For more than a decade, hair cortisol concentrations (HCC) have been measured in this context, leading to a two-staged dysregulation model. Specifically, an elevated secretion during/immediately after trauma exposure eventually reverts to hyposecretion with increasing time since trauma exposure has been postulated. OBJECTIVE: The aim of our systematic review was to re-evaluate the two-staged secretion model with regard to the accumulated diagnostic, prognostic, and intervention-related evidence of HCC in lifetime trauma exposure and PTSD. Further, we provide an overview of open questions, particularly with re- spect to reporting standards and quality criteria. METHOD: A systematic literature search yielded 5,046 records, of which 31 studies were included. RESULTS: For recent/ongoing (traumatic) stress, the predictions of cortisol hypersecretion could be largely confirmed. However, for the assumed hyposecretion temporally more distal to trauma expo- sure, the results are more ambiguous. As most studies did not report holistic overviews of trauma his- tory and confounding influences, this may largely be attributable to methodological limitations. Data on the prognostic and intervention-related benefits of HCC remain sparse. CONCLUSION: Over the last decade, important insights could be gained about long-term cortisol secretion patterns following lifetime trauma exposure and PTSD. This systematic review integrates these insights into an updated secretion model for trauma/PTSD. We conclude with recommendations for improving HCC research in the context of trauma/PTSD in order to answer the remaining open questions.
RESUMO
OBJECTIVE: Parenting during pandemic restrictions places extreme demands on everyday family life, leading to increased stress levels for parents and distressed parent-child interactions. This RCT aimed to investigate whether cognitive reappraisal and self-compassion are helpful emotion regulation (ER) strategies to reduce individual and parental stress during the COVID-19 pandemic. METHOD: An online intervention for parents was developed focusing on the application of ER strategies to pandemic requirements of families. A sample of 265 parents were randomly assigned to either cognitive reappraisal (CR; n = 88), self-compassion (SC; n = 90) or wait-list control (WLC; n = 87) group. Interventions included two video sessions (day 1 and day 3) and three email reminders to transfer the application of ER strategies to daily family life (days 2, 4, 5). Parents' perceived individual stress and parental stress were assessed at baseline (T0), at T1 prior to the booster session on day 3, and at T2 (7 days after baseline). RESULTS: Significant decreases from T0 to T2 emerged for both primary stress outcomes in both intervention groups. Individual stress significantly decreased in CR compared to WLC at T2, but not compared to SC. No time × group interactions for parental stress were found. However, mediation analyses suggested that parental stress was indirectly decreased via reductions in individual stress for CR compared to WLC at both time points. CONCLUSIONS: COVID-19 will not be the last pandemic to affect family life. Cognitive reappraisal as a brief online intervention can ease acute stress and strengthen the mental health of parents in acute crises.
