Imagining a positive future reduces cortisol response to awakening and reactivity to acute stress.

The positive influence of optimism on health is thought to be due in part to a reduced physiological response to stress, as manifested for instance in activity of hypothalamic-pituitary-adrenal (HPA) systems. Results of previous studies support the notion that dispositional optimism can influence diurnal cortisol secretion as well as cortisol reactivity. The aim of the present study was to examine whether induced optimism can similarly affect HPA activity and thereby potentially have beneficial health effects. We assigned 66 university students to either the Best Possible Self (BPS) or an active control condition, respectively entailing two weeks of daily visualization of a positive future or time management exercises. Before and after the intervention, we assessed diurnal cortisol levels, response to awakening (CAR), and reactivity to the Trier Social Stress Task (TSST), as well as optimism, affect, negative cognitions, perceived stress, and threat appraisal. Effects of the BPS intervention were tested with repeated measures ANOVA (psychological outcomes) and multilevel regression (cortisol outcomes). The BPS intervention was associated with decreases in both the CAR and cortisol responses to acute stress. Compared to controls, BPS participants showed decreased worrying and increased positive affect post-intervention; however, they did not show the expected greater increase in optimism. Within-person decreases in worrying were associated with decreased CARs, whereas both decreased worrying and increased PA were linked to attenuated stress reactivity. Results suggest that the BPS intervention can influence HPA axis reactivity, with effects on well-being variables likely mediating the process. More research is needed to determine longer-term neuroendocrine and health effects of such interventions in at-risk as well as healthy populations.

Gender moderates diurnal cortisol in relation to trauma and PTSD symptoms: A study in Sri Lankan adolescents.

Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to aspects of diurnal cortisol secretion in adolescents, but little is known about gender differences in these associations. A school-based sample of Sri Lankan adolescents aged 13-16 years took part in this study 4.5 years after the 2004 tsunami had impacted many of their lives to varying degrees. Saliva samples were obtained 4 times a day for 3 days in 84 participants, who also completed measures of lifetime trauma, current stressors, and posttraumatic stress symptoms (PTSS). We used multilevel regression to estimate effects of trauma exposure and symptoms on cortisol level, diurnal slope, and awakening response (CAR). Results indicated higher cortisol in girls and older adolescents. Although trauma, PTSS, and recent PTSD had non-significant main effects, these three variables interacted with gender, with higher cortisol in girls than in similarly traumatized or symptomatic boys. Co-occurrence of internalizing symptoms and PTSS was also associated with higher cortisol. The 28 adolescents with recent PTSD displayed flatter diurnal slopes, reflecting relatively low morning cortisol. Among the 56 trauma-exposed participants, negative trauma appraisals were associated with higher cortisol. Girls were more likely than boys to display elevated cortisol in relation to re-experiencing and hyperarousal symptoms. In contrast to significant findings for cortisol level and diurnal slope, the CAR showed no association with either trauma or PTSS, irrespective of gender. Findings, viewed in light of normative gender differences in HPA activity during adolescence, can contribute to understanding heightened female vulnerability to posttraumatic stress disorder.

Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery.

OBJECTIVES: The primary aim of the study was to assess the convergent validity of the Surgical Fear Questionnaire (SFQ) with other self-report instruments and biological indices of stress. Secondary aims were the examination of predictors of the level and time course of fear and preferences for fear treatment. METHODS: In a prospective observational cohort study SFQ short-term (SFQ-s) and long-term (SFQ-l) scores were assessed one week, one day, and the morning before cataract surgery, together with salivary cortisol and alpha-amylase (sAA) levels, and numeric rating scale (NRS) fear score. SFQ-scores were also assessed before second eye surgery. Expected pain and recovery, and sociodemographic and medico-psychological predictors of fear were assessed at baseline. RESULTS: Data of 98 patients were analyzed. Scores of both SFQ-subscales (range 0-40) were generally low, all mean ≤ 9.0. SFQ-s and SFQ-l correlated significantly with the other self-report instruments: NRS fear .83 and .89, expected pain .49 and .54, expected recovery -.27 and -.44. No association was found between SFQ-scores and cortisol or sAA level. Predictors of the level of fear were baseline pain and stress. Additional effects of time were found for subgroups based on educational level, antidepressant use, and presurgical stress (SFQ-l). SFQ-scores were significantly lower before the second cataract surgery than before the first, and higher in patients who would have appreciated treatment of fear. DISCUSSION: Convergent validity of the SFQ with other self-report measures is shown. The sensitivity of the SFQ permits the detection of small variations in fear caused by time or other factors.

The Relative Impact of Traumatic Experiences and Daily Stressors on Mental Health Outcomes in Sri Lankan Adolescents.

Prior trauma, current stress, and poor social support contribute to youth mental health problems. As daily stressors often increase in the aftermath of traumatic events, trauma could plausibly impact psychopathology not only directly but also indirectly via ongoing stress. In this study, we examined the relative roles of trauma and daily stressors in mental health outcomes in 753 Sri Lankan adolescents residing in areas impacted by the 2004 tsunami. In 2008, participants completed measures of trauma exposure, daily stressors, social support, posttraumatic stress symptoms (PTSS), emotional and behavioral problems (EBP), and functional impairment; a subsample (n = 89) repeated these assessments 16 months later. Regression models revealed positive associations between cumulative trauma and all three mental health measures. Significant variance in these associations could be explained indirectly, via daily stressors. For PTSS, the indirect effect accounted for 26.1% of the total effect of trauma, unstandardized coefficient ab = 0. 739, 95% CI [0.459, 1.122]. For EBP this percentage was 42.4%, ab = 0.287, 95% CI [0.189, 0. 404], and for functional impairment 70.0%, ab = 0.072, 95% CI [0.049, 0.121]. Indirect effects on impairment were strongest when perceived social support was low. Although we also present evidence that pathways between stressors and psychopathology may have been bidirectional, findings support the notion that adolescents' daily stressors are important transmitters of the impact of traumatic events and highlight the need for interventions focused not only on trauma processing but also on reducing current stress and improving social support.

Negative Trauma Appraisals and PTSD Symptoms in Sri Lankan Adolescents.

The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

The association between cortisol and the BOLD response in male adolescents undergoing fMRI.

MRI participation has been shown to induce subjective and neuroendocrine stress reactions. A recent aging study showed that cortisol levels during fMRI have an age-dependent effect on cognitive performance and brain functioning. The present study examined whether this age-specific influence of cortisol on behavioral and brain activation levels also applies to adolescence. Salivary cortisol as well as subjective experienced anxiety were assessed during the practice session, at home, and before, during and after the fMRI session in young versus old male adolescents. Cortisol levels were enhanced pre-imaging relative to during and post-imaging in both age groups, suggesting anticipatory stress and anxiety. Overall, a negative correlation was found between cortisol output during the fMRI experiment and brain activation magnitude during performance of a gambling task. In young but not in old adolescents, higher cortisol output was related to stronger deactivation of clusters in the anterior and posterior cingulate cortex. In old but not in young adolescents, a negative correlation was found between cortisol and activation in the inferior parietal and in the superior frontal cortex. In sum, cortisol increased the deactivation of several brain areas, although the location of the affected areas in the brain was age-dependent. The present findings suggest that cortisol output during fMRI should be considered as confounder and integrated in analyzing developmental changes in brain activation during adolescence.

Moment-to-moment transfer of positive emotions in daily life predicts future course of depression in both general population and patient samples.

OBJECTIVE: Positive affect (PA) is closely linked to prevention of, and recovery from, depression. Previous studies have investigated PA reactivity to pleasant situations with respect to its protective properties in relation to mood disorder. The purpose of this study was to examine, and replicate, whether moment-to-moment transfer of PA in daily life (PA persistence) is relevant to the prediction of future course of depression. METHOD: Individuals from three different studies (one general population sample (n=540), and two patient samples (n=43 and n=50) with matching controls (n=39 and n=21, respectively)) participated in an Experience Sampling Method (ESM) study. Time-lagged multilevel analyses were used to assess the degree of transfer (or persistence) of momentary positive affective states over time, in relation to naturalistic outcome (study 1) or treatment outcome (studies 2 and 3). Depressive symptoms were measured using the Symptom Checklist (SCL-90R) in sample 1 and the Hamilton Depression Rating Scale (HDRS) in samples 2 and 3. RESULTS: In study 1, participants with greater momentary PA persistence were less likely to show depressive symptoms at follow-up. In study 2, patients were more likely to respond to treatment if they displayed greater momentary PA persistence, particularly in those with recurrent depression. In study 3, patients with greater momentary PA persistence were similarly more likely to respond to treatment, especially when treated with imipramine rather than placebo. CONCLUSION: The ability to transfer PA from one moment to the next is an important factor in the prevention of and recovery from depressive symptoms. Patients with recurrent depression and those who receive antidepressants rather than placebo may benefit most from this effect. The results suggest that treatment-induced improvement in depression is mediated by increased levels of momentary transfer of PA in daily life, acquisition of which may be contingent on duration of exposure to depressive experience.

Cortisol and induced cognitive fatigue: effects on memory activation in healthy males.

We investigated the relationship between individual differences in acute fatigue and endogenous cortisol changes elicited by the sustained performance of cognitively demanding tasks (fatigue condition). Healthy males provided salivary cortisol measurements and subjective fatigue ratings, and were scanned (functional magnetic resonance imaging) during memory encoding and recognition tasks in fatigue and control conditions. A group of 15 'responders' showed significantly higher cortisol levels in the fatigue condition than 12 'non-responders'. Responders showed higher subjective fatigue and reduced encoding and recognition activation than non-responders in the fatigue condition. An interaction in activation changes in the right hippocampus during encoding reflected decreased activation in responders, but somewhat increased activation in non-responders in the fatigue compared to control condition. Moreover, decreased hippocampal activation in responders was associated with increased subjective fatigue. Findings are consistent with a central role for the hippocampus in differences between responders and non-responders and also implicate the right hippocampus in individual differences in induced cognitive fatigue effects.

Salivary cortisol and psychopathy dimensions in detained antisocial adolescents.

UNLABELLED: Previous research revealed hypothalamic-pituitary-adrenal (HPA) axis abnormalities in relation to antisocial and aggressive behavior. Some evidence suggests that low cortisol levels may serve as a biological marker for a severe antisocial subgroup with pronounced callous-unemotional (CU) traits. Children displaying the combination of severe antisocial behavior and CU traits appear to be particularly at risk of developing adult psychopathy. Given the lack of studies on the relationship between cortisol levels and CU traits in antisocial adolescents, the current study investigates whether cortisol levels are uniquely associated with CU traits as compared to other psychopathy dimensions (i.e., narcissism and impulsivity). Detained antisocial adolescents (n=63) and a community comparison group (n=62) completed diaries and collected three saliva samples daily on two days, with compliance monitored electronically. Psychopathy dimensions were assessed through self-report questionnaires. Externalizing symptoms were assessed by structured clinical interview. Multilevel regression analyses indicated no differences in cortisol levels or diurnal slopes between the two groups. Overall, cortisol levels were not significantly related to psychopathy dimensions. However, greater impulsivity was associated with lower cortisol levels in the community sample, but not in the antisocial group. CONCLUSION: Results cast doubt on the notion of low cortisol levels as a biological marker for CU traits. Low basal cortisol levels appear to be more closely related to a general deficit in behavioral regulation. Implications for future research are discussed.

The dynamic interplay between negative and positive emotions in daily life predicts response to treatment in depression: a momentary assessment study.

OBJECTIVES: Although the treatment of depressive illness aims to restore the imbalance between an excess of negative affect (NA) and a shortage of positive affect (PA), no study has examined how NA and PA may influence each other in depression. This study examines how NA and PA dynamically influence each other in depression and how this may impact on treatment response. DESIGN: Depressed help-seeking individuals participated in the Experience Sampling Method (ESM), which enables visualization of subtle dynamic alterations of momentary affective states over time. Thereafter, participants received a combination of antidepressant treatment and psychotherapy, and were followed up each month. METHODS: NA and PA were assessed during ESM at 10 random moments per day for 6 days. Depressive symptoms were assessed at baseline and at monthly intervals during treatment. RESULTS: Future response to treatment was associated with altered baseline NA-PA dynamics in individuals with previous depressive episodes. Their daily life boosts of PA were followed by a stronger suppression of NA over subsequent hours than in other depressed groups or controls. CONCLUSIONS: Subtle individual differences in daily life emotional dynamics predict future treatment outcome in depression.

Solitude and cortisol: associations with state and trait affect in daily life.

The social context can impact psychological and physiological functioning. Being alone, in particular, is experienced as more negative on average than being with others, in both normative and pathological populations. This study investigates whether daily solitude is associated with changes in cortisol and, if so, whether momentary and trait affect can explain this relationship. Forty-four female college students used the Experience Sampling Method during a week, completing questionnaires and collecting saliva 8 times daily. Effects of current solitude, affect, and trait affectivity on cortisol were tested with multilevel regression. Cortisol levels were significantly higher when individuals were alone. Although momentary affective states changed during solitude and were also associated with cortisol, they did not fully explain the effects of solitude on cortisol. Trait affectivity moderated the association between solitude and cortisol. Findings may help clarify how daily experience may heighten risk of depression or other negative health outcomes in vulnerable individuals.

Patterns of salivary cortisol secretion and responses to daily events in patients with remitted bipolar disorder.

Previous studies on bipolar disorder revealed abnormalities in the function of the HPA axis, including disturbed patterns of cortisol secretion, during depressive and manic episodes. It is less clear whether these abnormalities persist after symptomatic recovery. In the present study we used the experience sampling method with intensive salivary cortisol sampling to study patterns of cortisol secretion in relation to negative and positive daily events during the normal daily life of a group of 36 patients with remitted bipolar disorder and 38 healthy controls. Results of multilevel regression analysis indicated that daytime cortisol levels and reactivity to daily events were similar in remitted bipolar patients and healthy controls, but bipolar patients showed flatter diurnal slopes and larger cortisol fluctuations over successive measures. Patients with many previous episodes had higher overall cortisol levels, reduced cortisol reactivity to negative daily events, and flatter diurnal slopes than patients with fewer episodes. These results provide additional evidence of subtle HPA axis dysregulation in remitted bipolar patients, especially in those with many recurrent episodes.

Early improvement in positive rather than negative emotion predicts remission from depression after pharmacotherapy.

Knowledge on mechanisms involved in early prediction of response to antidepressant medication may help optimize clinical decision making. Recent studies regarding response to pharmacotherapy implicate resilience-like mechanisms and involvement of positive, rather than negative emotions. The aim of the current study is to examine the contribution of early change in positive affect to the prediction of response to pharmacotherapy. Positive and negative emotions were measured at baseline and during the first week of pharmacotherapy, using experience sampling techniques. The association between early change in positive and negative emotions and severity of depressive symptoms at week six was examined in a sample of 49 depressed patients. The added benefits of measuring early change in positive emotions compared to early Hamilton Depression Rating Scale (HDRS) change alone were evaluated through model comparisons. Early improvement in positive affect during the first week of treatment predicted the continuous HDRS score (ß=-0.64, p<0.001), response (50% reduction; OR=4.32, p<0.01), and remission (HDRS≤7; OR=9.29, p<0.001) at week six with moderate to large effect sizes. Effects of early change in negative emotions were only half as large and disappeared when evaluated simultaneously with early change in positive emotions. When early change in positive emotions was added to the models including early HDRS change only, all three models improved significantly. In conclusion, early change in positive rather than negative emotions best predicted response to treatment, supporting the notion that antidepressants activate resilience-like mechanisms. Moreover, monitoring of positive emotions in early stages of treatment may improve clinical decision making.

Ambulatory emotional reactivity to negative daily life events predicts remission from major depressive disorder.

Major depressive disorder (MDD) is often associated with altered emotional reactivity. However, the functional significance of altered emotional reactivity in MDD is uncertain. This study was the first to examine the predictive relationship between intensely sampled ambulatory emotional reactivity and the clinical course of MDD. Forty-six outpatients who met criteria for MDD underwent six days of experience sampling of their ambulatory reactivity to everyday negative and positive life events. After experience sampling, all outpatients received pharmacotherapy with supportive psychotherapy and were followed clinically for 18 months. At one month, less emotional reactivity to negative and positive daily events predicted higher depressive symptom severity. Importantly, patients who exhibited less negative emotional reactivity to daily negative life events were less likely to recover from MDD over the 18 month follow-up. Relationships between ambulatory emotional reactivity and MDD course were not accounted for by the duration or the severity of initial MDD symptoms. Diminished ambulatory emotional reactivity appears to be functionally significant in depression. Intensive sampling of ambulatory emotions may have utility for predicting the clinical course of MDD.

Childhood maltreatment and diurnal cortisol patterns in women with chronic pain.

OBJECTIVE: To assess whether alleged childhood maltreatment is associated with daily cortisol secretion in women with chronic pain. METHOD: Women with fibromyalgia (FM group, n = 35) or with osteoarthritis only (OA group, n = 35) completed diaries and collected three saliva samples daily for 30 days, with compliance monitored electronically. Childhood abuse and neglect were assessed by self-report (Childhood Trauma Questionnaire-short form [CTQ-sf]). Multilevel regression analyses estimated associations between maltreatment and diurnal cortisol levels and slopes, controlling for depressive symptoms, posttraumatic stress disorder (PTSD), and daily experience variables. RESULTS: Women reporting more severe childhood maltreatment had higher cortisol throughout the day. The estimated effect of CTQ on log cortisol (beta = 0.007, p = .001) represents a 0.7% increase in raw cortisol level for every unit increase in maltreatment score, which ranged from 25 (no maltreatment) to 106 in this sample. Although different forms of maltreatment were interrelated, emotional and sexual abuse were most closely linked to cortisol levels. Fibromyalgia and osteoarthritis groups showed similar secretory patterns, and maltreatment was associated with elevated cortisol in both. Although maltreatment was related to symptoms of depression, PTSD, and averaged daily reports of positive and negative affect, none of these variables mediated the link between maltreatment and cortisol. CONCLUSIONS: In women with chronic pain, self-reported childhood maltreatment was associated with higher diurnal cortisol levels. These results add to the evidence that abuse in childhood can induce long-term changes in hypothalamic-pituitary-adrenocortical activity. They further underscore the importance of evaluating childhood maltreatment in fibromyalgia and other chronic pain conditions.

Mood reactivity to daily events in patients with remitted bipolar disorder.

Information about mood reactions to naturally occurring stress in remitted bipolar patients may help elucidate the mechanism by which stressors influence the propensity to manic or depressive relapse in these patients. Using the experience sampling method (ESM), we therefore investigated negative and positive mood states and their reactivity to daily hassles and uplifts in 38 outpatients with remitted bipolar disorder and 38 healthy volunteers. Multilevel regression analyses confirmed that mean levels of negative affect (NA) were higher and positive affect (PA) lower in bipolar patients. Reactivity of NA and PA to hassles and uplifts in bipolar patients was similar to controls and was unrelated to the number of previous episodes. Bipolar patients with subsyndromal depressive symptoms, however, showed particularly large NA responses to daily hassles, which they also rated as more stressful. Subsyndromal depressive symptoms in patients with remitted bipolar disorder thus appear to increase sensitivity to everyday stressors.

Daily hassles, uplifts, and time use in individuals with bipolar disorder in remission.

Although life stress has been shown to trigger relapse in bipolar disorder, little is known about how bipolar patients perceive daily hassles or their positive counterparts, uplifts. We used the experience sampling method to investigate the daily experience of hassles and uplifts in 38 patients with remitted bipolar disorder and 38 healthy controls. Largely because of current unemployment, patients were more often alone and at home and spent less time working and more time in passive leisure activities. Contrary to expectations, the groups did not differ in total frequencies or appraisals of events. Within the patient group, however, those patients with current depressive symptoms and more previous depressive episodes experienced negative events as more stressful. These findings are consistent with hypothesized processes linking depressive symptoms to the generation of stressful conditions or to the reactivation of negative cognitive schemas.

Interferon-alpha-induced depressive symptoms are related to changes in the cytokine network but not to cortisol.

OBJECTIVE: Proinflammatory cytokines have the potential to activate the hypothalamo-pituitary-adrenocortical (HPA) axis, and HPA axis hyperactivity is also encountered in depression. Therefore, the induction of depressive symptoms by interferon-alpha (IFN-alpha) may be mediated by changes in the cytokine network and the HPA axis. METHODS: In 17 hepatitis C patients undergoing IFN-alpha treatment, depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS). In addition, serum cytokine concentrations were measured. Saliva was collected five times over the course of a day in order to assess daily average cortisol (DAC) and awakening response. Assessments were carried out at baseline and six later time points after starting treatment. RESULTS: During treatment, the increases in the MADRS were significantly and positively correlated with soluble interleukin (IL)-2 receptor, tumor necrosis factor alpha (TNF-alpha), and IL-6. There were no significant associations between the DAC or cortisol awakening response with the MADRS score. CONCLUSION: Results suggest a clear connection between IFN-alpha-induced depressive symptoms and cytokine concentrations, but not cortisol.

Diurnal mood variation in major depressive disorder.

Depression disturbs mood, but a clear picture of diurnal mood rhythms in depression has yet to emerge. This study examined variations in positive affect (PA) and negative affect (NA), two dimensions of mood that generate diurnal patterns among healthy individuals. Repeated measurements of NA and PA in daily life were obtained over 6 days from 47 depressed outpatients and 39 healthy individuals using the Experience Sampling Method. Relative to healthy individuals, depressed individuals exhibited increasing PA levels during the day with a later acrophase. In contrast, depressed persons' NA exhibited a more pronounced diurnal rhythm and was more variable from moment to moment than healthy individuals'. Ambulatory mood measurements in depression suggest distinct diurnal disturbances of positive and negative affect.

Mood reactivity to daily negative events in early adolescence: relationship to risk for psychopathology.

Emotional responses to negative daily experiences in young adolescents may provide important clues to the development of psychopathology, but research is lacking. This study assessed momentary mood reactivity to daily events as a function of risk profile in a school sample, ages 11-14. High-risk (HR, n=25) and low-risk (LR, n=106) subgroups completed frequent self-reports of mood and events for 5 days. HR adolescents reported more negative events involving family and peers. Multilevel modeling results showed that negative events, especially if stressful, were associated with increased negative and decreased positive affects, with heightened responses in HR adolescents. HR adolescents with greater stress over the last 3 months showed additional increases in depressed mood following negative events. Altered reactivity to and dysfunctional appraisals of daily events may link adolescent risk profiles to later mental health problems.