Patient and Therapist In-Session Cortisol as Predictor of Post-Session Patient Reported Affect.

Eyal Levi,Hadar Fisher,Roee Admon,Sigal Zilcha-Mano,Susanne Fischer

doi:10.3390/brainsci11111483

Eyal Levi, Hadar Fisher + Show 3 more

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https://doi.org/10.3390/brainsci11111483

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Journal: Brain sciences	Publication Date: Nov 10, 2021
Citations: 5	License type: CC BY 4.0

Affiliation: University of Haifa, University of Zurich

Abstract

The importance of the role of affect in psychotherapy for major depressive disorder (MDD) is well established, but the common use of self-reported measures may limit our understanding of its underlying mechanisms. A promising predictor of patient affect is the stress hormone cortisol. To date, no studies have studied in-session changes in cortisol in psychotherapy for MDD. We investigated whether an increase in patient cortisol over the course of a session correlated with higher negative and lower positive affect. Given previous findings on healthy individuals on the contagious nature of stress, an additional aim was to examine whether these relationships are moderated by therapist cortisol. To this end, 40 dyads (including 6 therapists) provided saliva samples before and after four pre-specified sessions (616 samples). After each session, the patients provided retrospective reports of in-session affect. We found no association between patient cortisol and affect. However, increases in patient cortisol predicted negative affect when the therapists exhibited decreases in cortisol, and increases in patient cortisol predicted positive affect when the therapists showed increases. Our study provides initial evidence for the importance of the social context in the cortisol–affect relationship in MDD.

Highlights

To test whether changes in patients’ cortisol predict negative affect (NA) and PA reported by the patients following each session, the following Level-1 equation was estimated: PA/NAsp = β0 + β1 × Pcortisolsp + β2 × Logtimesp + esp where patients negative or positive affect reported at the end of session s by patient p was predicted by (a) patient’s intercept (β0 ); (b) the difference score of patients’ cortisol (Pcortisol = patients’ cortisol, calculated as post-session minus pre-session cortisol) at session s (β1 ); (c) the effect of time in treatment (β2 ); and a Level-1 residual error
The may serve as conjoint predictors of patient affect as experienced in psychotherapeutic may serve as conjoint predictors of patient affect as experienced in psychotherapeutic sessessions
Wewe did support for a general effect of cortisol change during sessions on patient post-session negative affect (Hypotheses 1–2; Figure 1A), we found a significant moderating effect of therapist cortisol change during therapy sessions (Figure 1B)

Summary

Introduction

A wide research array is devoted to study psychotherapy for MDD, a standard first-line treatment for depressive disorders [3–5]. Studies have nominated affect as a fundamental agent of change in psychotherapy, either as a predictor for therapeutic processes [6] or treatment outcome [7]. One study reported that the smaller the ratio of momentary positive to momentary negative affect at the beginning of psychotherapy, the less likely patients were to make progress in the initial five sessions of psychotherapy [8]. A meta-analysis attested to a significant decline in negative and a significant rise in positive affect over the course of psychotherapy for MDD [9]. These findings highlight the importance of learning more about the underpinnings of affective states in psychotherapy

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