Endogenous Cortisol Levels, Sleep or Vigilance: Which Factors Contribute to Better Exposure Therapy Outcomes in the Morning?

IF 2.8 3区心理学 Q2 PSYCHOLOGY, CLINICAL

Cognitive Therapy and Research Pub Date : 2024-02-20 DOI:10.1007/s10608-023-10463-9

Marie Roxanne Sopp, Sarah K. Schäfer, Tanja Michael, Monika Equit, Diana S. Ferreira de Sá, Johanna Lass-Hennemann

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Abstract

Background

Research suggests that exposure therapy delivered in the morning is more successful than delivered in the evening, which is often explained by higher diurnal endogenous cortisol levels. However, this “morning exposure effect” might also be explained by other factors such as sleep or vigilance.

Methods

The current study aimed to disentangle these effects by assessing the impact of video-based exposure therapy delivered in the morning or in the evening, whilst considering pre-exposure sleep quality, vigilance, and cortisol levels. To this end, 80 snake fearful individuals were randomly assigned to receive exposure treatment in the morning or evening.

Results

Contrary to previous findings, groups did not differ in their pre-post and post-follow up decrease of snake anxiety. However, higher vigilance was found to be associated with a greater pre-post and post-follow-up decrease in snake anxiety. Moreover, pre-exposure sleep efficiency moderated the post-follow-up decrease in snake anxiety across groups: In individuals with high pre-exposure sleep efficiency, those receiving exposure in the morning were estimated to show a stronger decrease in snake anxiety than those receiving exposure in the evening. The opposite pattern was found in individuals with low pre-exposure sleep efficiency.

Conclusions

The results of this study illustrate that diurnal effects on exposure therapy might be more complex than previously assumed.

Trial Registration

The study was prospectively preregistered at the German Clinical Trial Register (https://drks.de/search/en/trial/DRKS00016183).

Abstract Image

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内源性皮质醇水平、睡眠还是警觉性？哪些因素有助于在早晨获得更好的暴露疗法效果？

背景研究表明，早上进行暴露疗法比晚上进行暴露疗法更成功，这通常是由于昼夜内源性皮质醇水平较高所致。方法本研究旨在通过评估早上或晚上进行视频暴露疗法的影响，同时考虑暴露前的睡眠质量、警惕性和皮质醇水平，来区分这些影响。结果与之前的研究结果相反，各组在暴露前和暴露后蛇焦虑的降低程度上并无差异。然而，研究发现，警觉性越高，暴露前和暴露后的蛇焦虑下降幅度越大。此外，暴露前的睡眠效率也调节了各组追踪后蛇焦虑的下降：据估计，对于暴露前睡眠效率较高的人来说，与晚上接受暴露的人相比，早上接受暴露的人的蛇焦虑下降幅度更大。结论本研究结果表明，暴露疗法的昼夜效应可能比之前假设的更为复杂。试验注册本研究在德国临床试验注册中心（https://drks.de/search/en/trial/DRKS00016183）进行了前瞻性预先注册。

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来源期刊

Cognitive Therapy and Research PSYCHOLOGY, CLINICAL-

CiteScore

5.30

自引率

0.00%

发文量

期刊介绍： Cognitive Therapy and Research (COTR) focuses on the investigation of cognitive processes in human adaptation and adjustment and cognitive behavioral therapy (CBT). It is an interdisciplinary journal welcoming submissions from diverse areas of psychology, including cognitive, clinical, developmental, experimental, personality, social, learning, affective neuroscience, emotion research, therapy mechanism, and pharmacotherapy.