Response rates to first line treatments for affective disorders remain unsatisfactory (Loerinc et al., 2015). Identification of moderators and mediators that can facilitate treatment success is of great scientific and clinical interest. One such candidate could be stress-induced cortisol reactivity. For instance, higher cortisol reactivity to a pretreatment presentation of combat-related stimuli related to significantly worse outcome at post-treatment following 6-sessions of virtual reality exposure therapy in individuals with PTSD (Norrholm et al., 2016). By contrast, greater cortisol reactivity to an acute stressor predicted greater treatment response in not only depressive symptoms (Dieleman et al., 2016) but also anxiety symptoms (Wichmann et al., 2017). Given the varying findings, the aim of present study was to further examine the role of stress-induced cortisol reactivity as a predictor of outcome in individuals undergoing therapy for affective disorders. The sample consisted of 34 participants who underwent a 38-minute intermittent stress induction tasks prior to a 15-session treatment for affective disorders. The stressors included a mental arithmetic task and a fear potentiated startle task. Cortisol was collected at five time points with reactivity being quantified as peak levels during the task minus basal levels of cortisol the evening before the assessment. Using multilevel modeling we examined the associations between cortisol reactivity and slopes of improvement in affective symptoms (Depression, Anxiety, and Stress Scale). There was a trend toward significance in the interaction between cortisol reactivity and treatment outcome, b= -4.21, t(43)= -2.010, p=0.051. That is, high levels of stress-induced cortisol response was related to significantly decreasing slopes across treatment. Literature suggest that higher levels of cortisol during exposure sessions moderate better clinical improvement (Meuret et al., 2015). Moreover, cortisol reactivity assessed during an acute stressor before treatment can also predict treatment outcome in affective disorders (Dieleman et al., 2016; Wichmann et al., 2017) symptoms. The current study also supports that higher levels of cortisol reactivity before treatment predicts better outcomes across affective symptoms.

Degree Date

Spring 5-18-2019

Document Type


Degree Name





Alicia Meuret, Ph.D.

Second Advisor

Thomas Ritz, Ph.D.

Third Advisor

David Rosenfield, Ph.D.



Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License