Abstract
Background: Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs. conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6, IL-12-p70), anti-inflammatory cytokines (IL1ra, IL-4, IL-10), and stress hormones (urinary cortisol, epinephrine, norepinephrine) were assessed at baseline, 12 weeks, and 24 weeks. Differential effects of baseline religiosity on treatment response were also examined, along with effects of religiosity on changes in biomarkers over time independent of treatment group. Biomarker levels were log transformed where possible to normalize distributions. Mixed models were used to examine trajectories of change. Results: CRP increased and IL-4, IL-10, and epinephrine decreased over time, mostly in the opposite direction expected (except epinephrine). No significant difference between RCBT and CCBT was found on average trajectory of change in any biomarkers. Religiosity interacted with treatment group in effects on IL-6, such that CCBT was more effective than RCBT in lowering lL-6 in those with low religiosity whereas RCBT appeared to be more effective than CCBT in those with high religiosity. Higher baseline religiosity also tended to predict an increase in pro-inflammatory cytokines INF-γ and IL-12 (p70) and urinary cortisol over time. Conclusions: RCBT and CCBT had similar effects on stress biomarkers. CCBT was more effective in reducing IL-6 levels in those with low religiosity, whereas RCBT tended to be more effective in those with high religiosity. Unexpectedly, higher baseline religiosity was associated with an increase in several stress biomarkers.
Highlights
Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines such as IL-6, IL-12, IFN-γ, IL-1, and TNF-α [1]-[3], a reduction in anti-inflammatory cytokines such as IL-4 and IL-10 [4] [5], and an increase in stress hormones [6]
The present analysis examines the effects of religious vs. conventional CBT (RCBT vs. CCBT) on stress biomarkers over 24 weeks during the course of a randomized clinical trial focused on treating persons with major depressive disorder (MDD) and chronic medical illness who were at least somewhat religious or spiritual
Median levels of baseline C-reactive protein (CRP), pro-inflammatory cytokines, and stress hormones tended to be higher in this sample compared to those in a community sample of non-depressed persons enrolled in the Midlife in the United States Study (MIDUS) [34]
Summary
Depressive disorder is often accompanied by physiological changes that may adversely affect the course of medical illness, including an increase in pro-inflammatory cytokines such as IL-6, IL-12, IFN-γ, IL-1, and TNF-α [1]-[3], a reduction in anti-inflammatory cytokines such as IL-4 and IL-10 [4] [5], and an increase in stress hormones [6]. Methods: We examine the effects of religious cognitive behavioral therapy (RCBT) vs conventional CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory cytokines TNF-α, How to cite this paper: Berk, L.S., et al (2015) Effects of Religious vs Conventional Cognitive-Behavioral Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial. Higher baseline religiosity was associated with an increase in several stress biomarkers
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