Persistent Effects of Cognitive-Behavioral Stress Management - Essay Example

Critical Review: Persistent effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthysubjects-A randomized controlled trial K. Hammerfald, C. Eberle, M. Grau, A. Kinsperger, A. Zimmermann,U. Ehlert, J. Gaab* Introduction: In the present scenario, stress is the inevitable part of life. It could be physiological or psychological. Cortisol is an important hormone, it is not only released during the condition of stress but also in fight or flight responses. This hormone brings various stress-related changes as well. It is evident that body's relaxation response must be activated to combat stress. The condition of the stress cannot be prolonged as it could be devastating and induce chronic stress worsening cognitive performance, suppressed thyroid function, hyperglycemia, reduction in bone density and muscle tissues, increased blood pressure and lowered immunity, increased abdominal fat and hence invites all linked (Scott, E). Psychological stress brings release of cortisol, a stress hormone that maintains physiological and psychological equilibrium. If cortisol is released in embellished magnitude, it brings harmful effects not only on somatic health but also impairs cognitive functioning. It is apparent that stress-induced variations of hypothalamus-pituitary adrenal (HPA) axis functioning are implicated in the commencement and upholding of both somatic and psychiatric conditions, these and also comparable arbitrations could be used for anticipation and rehabilitation of these deleterious stress effects. The view is the focus of the article, it is the study carried out to examine the long-term effects of cognitive-behavioral stress management (CBSM) training on cortisol stress management in healthy men and women. The article emphasizes the impact of CBSM training to attenuate cortisol stress responses in both men and women. The article presents a sight that there is a slight variation between the sexes in response to the CBSM training. Any change in the execution of HPA axis activity alters the circadian rhythm of cortisol secretion and also high plasma cortisol levels (Touitou et al). Various laboratory and environmental stressors are linked to HPA axis response causing upper respiratory tract infection (Cohen et al, 2002) and long-term implications on cardiovascular-related incidences and also type 2 diabetes in men (Rosmond et al , 2003) and also incriminated turned down memory performance in women (Seeman et al,1997 or fractures in men and women (Greendale et al, 1999). Knowing these impacts and their devastating consequences the article throws light on the modulation of cortisol levels by conducting randomized controlled trial study. The study also explains an examination of stability over time and generalizability with regards to gender of endocrine effects of CBSM in healthy individuals. Analysis: The subjects taken in this study were three hundred and fifteen II year psychology students, with due care to reduce individual differences and any external academic stressors. After the primitive screening, selection criterion and questionnaire provided, only 83 subjects were left for the analysis. These participants were randomly selected and assigned in eight groups as per the CBSM group sessions with restricted N=12. Of these groups 1-4 were under the treatment (N=42) and rest 5-8 were categorized as control groups (N=41). The article has the advantage of selecting the participants for both control and treated groups of negligible demographic variables (including age, gender, habitual smoking, use of oral contraceptives and body mass). The treatment was performed for four months and all the subjects underwent a standardized psychological stress test (Trier Social Stress Test, TSST, Kirschbaum et al, 1993). In this study, TSST was performed for treated CBSM group every 2-week period whereas for the controls it is for 4-week period. The article does not imply about the fact that the participant were provided the same kind of external environment as well, if they are living with the family, hostel, and the means of transport or any kind of financial , emotional conditions the participants are provided as these are the conditions inducing release of cortisol. Some of the participants were not able to undergo TSST, the article states that the subjects not performing the TSST did not differ in the baseline variables from the performers. Thirty nine subjects under the category of CBSM and 37 subjects of control group performed the TSST. The article states that CBSM treatment was given to controls also. This is a good measurement so as to provide the benefit of the study to all the participants. Psychological stress test was also performed where hob interview and also arithmetic tasks were given in front of the committee. The analysis of the study was done with the saliva samples collected immediately before and one, 10, 20, 30, 45, 60 mins after TSST. It is said that the TSST was performed in a separate room than CBSM. It is good practice to have a separate environment for the quality analysis and participants will not be diverted to any other situation(s). The study analyzes the psychometric measures with Primary Appraisal Secondary Appraisal Scale (PASA). It this study the items for Primary and Secondary Appraisals are not clear. The article says there are 16 situation-specific items but only 4 items (challenge, threat, self-concept of own competence and control expectancy) for PA and 2 for SA have been depicted. The study provide the basis that primary scales can be summed up to a general stress index and can be calculated as Stress Index= PA- SA. Groups for CBSM met on two alternate Saturdays or Sundays and in total N=11 received 10h CBSM conducts as per the norms by the two clinical psychologists. The article focused on four cognitive-behavioral stress-reducing techniques namely, cognitive restructuring, problem-solving, self-instruction, progressive muscle relaxation. It also mentions about the training manual and flash cards describing CBSM technique, but the readers of this cannot get the benefit of the knowledge and amendments in CBSM technique adopted in this study they will have to refer the previous article (Gaab et al, 2003). Biochemical analysis of saliva samples were performed with Salivette (Sarstedt, Rommelsdorf, Germany), samples were stored at -20 C and saliva-free cortisol was analyzed with chemiluminescence immunoassay with precision to minimize error and statistical analysis was done using ANOVA and ANCOVA tests. The methodology adopted for the analysis of samples were very tedious and time consuming and highly error prone as there are chances of mixing of results. The results signify that baseline cortisol levels were not different but differ significantly in their endocrine stress response over time. Subjects in the CBSM group show an attenuated salivary cortisol response as compared to controls. The study has additional grouping variable of gender, gender has significantly interacted with group effects on cortisol response over time, and moreover use of oral contraceptives were treated as an additional grouping variable in females. Conclusion: The study is conducted to examine the stability and the generalizability of CBSM effect on cortisol stress responses in healthy subjects, the results indicate that the attenuation of cortisol stress responses just after 2-weeks of CBSM training (Gaab et al, 2003) the same can be observed after 4 months in both men and women, with a smaller magnitude in women than men. The findings of the study indicate that subjects in the CBSM group showed a diminished cognitive stress appraisal in the TSST. The study articulates the fact that primary appraisal had a stronger impact on cortisol stress responses than secondary appraisal. The article mentions about the threat predominance and also decrease in HPA axis stress responses but the methodology is not clear. The study also finds that there is a decline in the ability to retrieve and implement CBSM training. The study is totally based on saliva cortisol as an indicator or endocrine stress reactivity which is closely associated with plasma cortisol and ACTH levels but blood samples can also be tested for the confirmation of results, BFS (Benefit Finding Scale) and POMS (Profile of Mood States) (Dean, G et al ,2000) are not mentioned. A layman cannot derive much benefit to distress himself by reading this article. There are various other methods to keep the cortisol levels under control, self-hypnosis, exercise, yoga, listening to music, breathing exercises, meditation, journaling and outings and changes in lifestyle or place of work. The level of cortisol varies between the individuals which is not stated in the study as every individual react to different level and with different outlook to stress and hence the release of cortisol may vary (Scott, E). thus further studies can be conducted using this article as a base line for evaluation and to frame the hypothesis and more innovations can be added. References: 1. Touitou Y, Bogdan A, Levi F, Benavides M, Auzeby A. Disruption of the circadian patterns of serum cortisol in breast and ovarian cancer patients: relationships with tumour marker antigens. Br J Cancer 1996; 74: 1248-52. 2. Scott, Elizabeth, Cortisol and Stress: How to StayHealthy: Cortisol and Your Body About.com, Updated: February 5, 2008 Health's Disease and Condition content is reviewed by the Medical Review Board 3. Dean G. Cruess, PhD, Michael H. Antoni, PhD, Bonnie A. McGregor, MS, Kristin M. Kilbourn, PhD, Amy E. Boyers, MS, Susan M. Alferi, MS, Charles S. Carver, PhD and Mahendra Kumar, PhD, Cognitive-Behavioral Stress Management Reduces Serum Cortisol By Enhancing Benefit Finding Among Women Being Treated for Early Stage Breast Cancer Psychosomatic Medicine 62:304-308 (2000). 4 Gaab, J., Blattler, N., Menzi, T., Pabst, B., Stoyer, S., Ehlert, U.,. Randomized controlled evaluation of the effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology, 28, 767-779 (2003). 4. Cohen, S., Hamrick, N., Rodriguez, M.S., Feldman, P.J., Rabin, B.S., Manuck, S.B., Reactivity and vulnerability to stress-associated risk for upper respiratory illness. Psychosom. Med. 64, 302-310, 2002 5. Kirschbaum, C., Kudielka, B.M., Gaab, J., Schommer, N.C., Hellhammer, D.H.,. Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis. Psychosom. Med. 61,154-162, 1999 6. Rosmond, R., Wallerius, S., Wanger, P., Martin, L., Holm, G., Bjorntorp, P., A 5-year follow-up study of disease incidence in men with an abnormal hormone pattern. J. Intern. Med. 254, 386-390, 2003. 7. Seeman, T.E., McEwen, B.S., Singer, B.H., Albert, M.S., Rowe, J.W., Increase in urinary cortisol excretion and memory declines: MacArthur studies of successful aging. J Clin. Endocrinol. Metab. 82, 2458-2465 1997. Read More