Copyright 2007 by the American Psychological Association
Psychoneuroendocrine Effects of Resource-Activating Stress Management
Maja Storch, Jens Gaab, Yvonne Ku¨ttel, Ann-Christin Stu¨ssi, and Helmut Fend
Objective: The stress-induced release of cortisol has been linked to detrimental health outcomes. Therefore, strategies to attenuate cortisol stress responses are of interest for prevention and treatment of stress-related symptoms and problems. Previous studies have found protective effects of cognitive– behavioral stress management training—which focuses on the modification of stress-inducing cogni- tions— on cortisol stress responses; however, the effects of resource-oriented interventions on cortisol stress responses are unknown. Design: The longitudinal effects of resource-oriented stress management training (Zurich resource model training) on cortisol stress responses and cognitive appraisal of a standardized psychosocial stress test were evaluated in 54 healthy male participants assigned randomly to treatment and control groups. The Trier Social Stress Test (TSST; C. Kirschbaum, Wust, & Strasburger, 1992) was administered to all participants 3 months after the treatment group underwent stress management training. Main Outcome Measures: Saliva cortisol samples were taken before, during, and after the TSST, and cognitive stress appraisal was assessed before the test. Results: The treatment group had significantly attenuated cortisol responses and stress appraisals in comparison to the control group. The endocrine differences were mediated by differences in cognitive appraisals. Discus- sion: These results indicate that resource-oriented stress management training effectively reduces endocrine stress responses to stress in healthy adults. Keywords: Zurich resource model, stress management training, resource, cortisol
Psychosocial stress can be conceptualized as incongruence be-
standing release of HPA axis hormones has been shown to have
tween the abilities and needs of a person and the environment. At
detrimental effects on somatic and emotional well-being (Mc-
the individual level, psychosocial stress is the result of a cognitive
Ewen, 1998; Seeman, McEwen, Rowe, & Singer, 2001).
appraisal of what is at stake and what can be done about it
As to the processes involved in the activation of the HPA axis
(Lazarus, 2005; Lazarus & Folkman, 1984). It is assumed that the
during stress, it has been shown that besides genetic (Wust et al.,
result of this subjective appraisal influences the emotional, behav-
2004), endocrine (Kirschbaum, Kudielka, Gaab, Schommer, &
ioral, and biological response to stress. People with higher opti-
Hellhammer, 1999), and habitual (Kirschbaum, Wust, & Stras-
mism scores report fewer sick days and faster recovery after a
burger, 1992) factors, situation-specific anticipatory cognitive ap-
specific life stress event (Kivima¨ki et al., 2005). The effect of
praisal, but not general personality variables, substantially account
optimism, in turn, is supposed to be dependent on the person’s
for the extent of the biological response in the face of stress (Gaab,
belief and/or capacity to manage stress effectively (Penedo et al.,
Rohleder, Nater, & Ehlert, 2005). This finding is congruent with
2003). As Richman et al. (2005) stated, work in health psychology
the results of a recent meta-analysis of 208 studies, which shows
has emphasized risk factors more than protective factors when
that the perception of threat to the social self is a major situational
trigger of an HPA axis activation in response to stress (Dickerson
With regard to biological responses to psychosocial stress, hor-
mones of the hypothalamus–pituitary–adrenal (HPA) axis have
& Kemeny, 2004). Thus, threat to social status, social esteem,
been examined extensively. Although the activation of the HPA
respect, and/or acceptance that is judged as not controllable by the
axis in response to stress and its effects on cardiovascular, im-
person leads to a biological stress response. Therefore, from an
mune, and metabolic as well as emotional, behavior, and cognitive
individual–subjective as well as a situational perspective, interven-
processes helps to maintain equilibrium during and after stress
tions aiming to influence perceived social threat could be used to
(Sapolsky, Romero, & Munck, 2000), extensive and/or long-
prevent adverse consequences of biological stress responses.
A number of studies have shown that cognitive– behavioral
stress management (CBSM) effectively reduces basal cortisol lev-
Maja Storch, Yvonne Ku¨ttel, Ann-Christin Stu¨ssi, and Helmut Fend,
els shortly after the intervention in clinical as well as nonclinical
Department of Educational Psychology, Institute of Education Sciences,
populations (HIV: Antoni et al., 2000, and Cruess et al., 1999;
University of Zurich, Zurich, Switzerland; Jens Gaab, Department of
breast cancer: Cruess et al., 2000; athletes: Perna, Antoni, Kumar,
Clinical Psychology and Psychotherapy, Institute of Psychology, Univer-
Cruess, & Schneiderman, 1998). Also, in healthy participants,
CBSM was observed to attenuate cortisol responses to a standard-
Correspondence concerning this article should be addressed to Maja
ized stress test 2 weeks as well as 4 months after training (Gaab et
Storch, Department of Educational Psychology, University of Zurich,Freiestrasse 36, 8032, Zurich, Switzerland. E-mail: storch@paed.unizh.ch
al., 2003; Hammerfald et al., 2006).
PSYCHONEUROENDOCRINE EFFECTS OF STRESS MANAGEMENT
All of the interventions mentioned above have in common that they
condition receiving ZRM training before the stress test, and
aim to address explicit, conscious levels of self-evaluation. Thus,
Groups 3 and 4 were assigned to the control condition, receiving
individuals reflect on their experiences, evaluate the contents of con-
ZRM training after the completion of the stress test. As all four
sciousness, and introspect about the causes and meanings of stressful
groups did not differ significantly on any of the assessed demo-
situations. Dealing with implicit aspects of the self is not the direct
graphic or psychometric variables at baseline (data not shown), the
focus of these interventions. However, it is important to differentiate
respective groups were joined to form a treatment and a control
between implicit and explicit self-esteem as distinct constructs, from
group for statistical analyses (for comparison between treatment
both a psychological and a neural perspective (Cunningham, Johnson,
and control group, see Results section and Table 1). Three months
Gatenby, Gore, & Banaji, 2003; Greenwald & Farnham, 2000). In this
after the treatment group completed ZRM training, all participants
regard, it has been assumed that implicit aspects of the self have an
took a standardized psychosocial stress test (the TSST; Kirsch-
important impact on social cognition and self-evaluation and that this
baum, Pirke, & Hellhammer, 1993). To evaluate the effects of the
implicit mode of self-evaluation dominates when the capacity to
ZRM training on perceived stress levels, the Perceived Stress Scale
engage in conscious self-reflection is lacking (for a review, see Devos
(PSS) was administered at baseline and after the intervention in the
treatment group or before intervention in the control group.
On the basis of these assumptions, Storch and colleagues de-
veloped a self-management training that focuses on implicit self-
aspects by combining psychoanalytic with cognitive– behavioralmethods (Zurich resource model [ZRM] training; for review, see
The TSST has repeatedly been found to induce profound endo-
Storch, 2004a, 2004b; Storch & Krause, 2002; see also the Method
crine and cardiovascular responses in 70%– 80% of the persons
section for details). The goal of ZRM training is to help partici-
tested (Kirschbaum et al., 1993). In our study, after a saliva sample
pants use personal resources in order to maintain the integrity of
was collected for basal levels of free salivary cortisol, the partic-
the social self in situations that are otherwise perceived as threat-
ipants were given an introduction to the standardized TSST (2
ening the social self. Because resource activation has been dis-
min). They then went to a different room, where they were given
cussed as a crucial prerequisite for psychotherapeutically induced
10 min to prepare and to complete a questionnaire designed to
change (Gassmann & Grawe, 2006; Grawe, 2002), ZRM training
assess cognitive appraisal processes (the Primary Appraisal Sec-
focuses on the participants’ personal resources rather than prob-
ondary Appraisal Scale, or PASA; see below) regarding the stress
situations in the TSST. Afterward, the participants returned to the
In summary, the majority of studies on the effects of stress
TSST room, where they took part in a simulated job interview (5
management training are based on a problem-oriented rather than
min) followed by a mental arithmetic task (5 min) in front of an
a resource-oriented model. Therefore, the present study set out to
audience of two people. To assess salivary cortisol levels, a saliva
test the effects of resource-focused intervention focusing on psy-
sample was taken immediately before and after the TSST, with
chological and biological stress responses during a standardized
further samples taken at 10, 20, 30, 45, and 60 min after the TSST.
psychosocial stress test, using a methodological approach similar
The TSST was administered between 2 p.m. and 6 p.m. All
to that used in previous CBSM studies (Gaab et al., 2003; Ham-
participants received 300 ml of a drink with high glucose content
to raise blood glucose levels, as low glucose levels have beenshown to blunt stress-induced increases of cortisol (Kirschbaum etal., 1997). Also, participants were asked not to eat in the 2 hr
preceding the TSST. The TSST protocol used differs from the
protocol used in other TSST studies in terms of the 10 min ofpreparation time before the TSST (and after the introduction),
Participants were recruited by e-mail. All students at the Swiss
during which the participants in the current study completed the
Federal Institute of Technology, Zurich, Switzerland, were sent an
e-mail message that contained a link to an Internet site thatdescribed the study in brief. Interested persons had the opportunity
to enroll in the study online. Exclusion criteria were assessed usinga screening questionnaire. The exclusion criteria were being fe-
All participants attended group-based ZRM training. Groups of
male (Kirschbaum et al., 1999) and being a smoker (Kirschbaum
16 participants met separately on two alternate, consecutive week-
et al., 1992), both of which are confounding factors that have been
ends (Friday to Sunday). Daily sessions lasted from 9 a.m. to
shown to affect physiological dependent measures. Also, persons
5 p.m. Eight weeks after the ZRM training, all participants at-
were excluded if they reported acute or chronic somatic or psy-
tended a booster session that lasted 2 hr. Two experienced ZRM
chiatric disorders. All students who were eligible for the study
trainers (Yvonne Ku¨ttel and Ann-Christin Stu¨ssi) conducted the
obtained a complete description of the study, gave written in-
ZRM training sessions according to the ZRM training manual
formed consent, and completed a set of questionnaires (see below
(Storch, 2004b; Storch & Krause, 2002). The ZRM training is
for details), which allowed us to obtain comprehensive descrip-
manualized and is equally suitable for work with individuals and
tions of relevant sample characteristics. Of 165 students who
enrolled, 66 returned the screening questionnaire. Of these, 64
The purpose of the ZRM training is to foster personal resources
students fulfilled participation criteria. Because the optimal group
in successfully coordinating personal needs with the urges of the
size for the ZRM trainings is 15–17, participants were randomized
environment. In this regard, personal resources are defined as
in four groups: Groups 1 and 2 were assigned to the treatment
personal means that, when activated, put the person in the state
Table 1Psychometric Characteristics of All Participants at Baseline
FKK ϭ Questionnaire for Competence and Control Orientations; MESA ϭ Measure for Assessment of General Stress Susceptibility; ADS–K ϭ
Center for Epidemiological Studies Depression Scale, German version; PSS ϭ Perceived Stress Scale.
required for well-being. As recommended by dual-process theories
3. Once a personal goal has been established, individual re-
(for review, see Strack & Deutsch, 2004), the formation of these
sources, defined as helpful means to achieve the personal goal, are
personal resources is organized according to the person’s explicit
built up around this goal. To enhance the facilitation of goal
motives as well as implicit needs. According to Damasio (1994),
achievement, psychodramatic embodiment techniques are used.
somatic markers as evaluative signals stem from an experience-
Embodiment work in the ZRM training is based on facial and
based part of the brain that has an implicit mode of information
postural feedback theories (Ekman, 2003; Neumann & Strack,
processing. Thus, the ZRM training uses somatic markers as
2000). To do so, participants develop their individual goal-related
diagnostic indicators of activated implicit needs. In this under-
embodiment; this is a posture and/or a movement that, subjectively
standing, somatic markers function as indicators of personal au-
perceived by the participant, expresses the attitude, information-
thorship, adding an embodied quality to the experience of will
processing style, emotion, and behavior that facilitates the attain-
ment of the personal goal. The physical, emotional, and cognitive
To achieve this purpose, the ZRM training aims to enhance the
experiences of the individual goal-related embodiment are then
proprioception of somatic markers to become aware of important
implicit needs and to develop cognitions and behaviors that syn-
4. In Phase 4, the goal-oriented use of these resources in pre-
chronize implicit needs and explicit motives. ZRM training con-
dictable as well as unpredictable situations is prepared and prac-
sists of five phases (for further details, see Storch, 2004b; Storch
ticed in role-plays. An emphasis in the fourth phase is placed on
the identification and knowledge of precursors (so-called warning
1. The first phase is designed to activate personal resources. To
signals, e.g., “I turn away and a strong feeling of being powerless
activate these resources, participants are presented with a set of
rushes through me”) of problematic or unwanted emotions, cog-
pictures showing positive content (flowers, friendly encounters,
nitions, or behaviors (e.g., “I begin to stutter and, then, black out”).
beautiful landscapes, animals, etc.) and encouraged to select the
On the basis of these warning signals, strategies to stop the
picture that evokes positive somatic responses, such as pleasant
unwanted emotions, cognitions, or behaviors are sought and prac-
bodily feeling (e.g., “Picture of a running dog” 3 somatic re-
ticed, such as positive self-instructions and thought-stop tech-
sponse: “Rush of blood to the head, feeling strong and capable of
doing things, wanting to jump and run”). Then the participants are
5. In the last phase, the contents and results of ZRM training
asked to explore why the respective pictures produced positive
are revised and discussed. Also, observed changes are discussed in
responses. This process is facilitated through group participation in
small groups of 2 persons, with the aim of integrating these
the form of questions and hypotheses.
changes into the self-concept of one’s own abilities and to allow
2. In the second step, action-oriented personal goals are devel-
oped on the basis of activated controllability by the participantsand their motivational properties. To do so, personal goals are
proposed and discussed in small groups of 3 (e.g., personal re-source [“Picture of a running dog”] 3 personal goal: “To be active
Sampling methods and biochemical analyses.
and to take risks”). After the formulation of a personal goal,
collected saliva using a device called the Salivette (manufac-
participants are asked to write down a definition and operational-
tured by Sarstedt AG, Sevelen, Switzerland). Saliva samples
ization of this goal with regard to its application and its anticipated
were stored at room temperature until completion of the ses-
sion. Samples were then stored at –20 °C until biochemical
PSYCHONEUROENDOCRINE EFFECTS OF STRESS MANAGEMENT
analysis. The Salivettes were then centrifuged at 3,000 rpm for5 min, which resulted in a clear supernatant of low viscosity. Salivary free cortisol concentrations were measured using acommercially available kit (Cortisol LIA; IBL, Hamburg,Germany) for chemiluminescence assay with high analyticalsensitivity of 0.16 ng/ml.
vant parameters at baseline (Questionnaire for Competence andControl Orientations; Measure for Assessment of General StressSusceptibility; Center for Epidemiological Studies DepressionScale, German version; and PSS) in the TSST (PASA) and beforeand after the intervention (PSS), we used the following question-naires:
• Questionnaire for Competence and Control Orientations
(Fragebogen zur Kontrollu¨berzeugungen und Kompetenzerwar-tung, or FKK; Krampen, 1989)—This 32-item questionnaireassesses the following personality traits (Cronbach’s ␣): self-
Cortisol responses in the Trier Social Stress Test (TSST)
concept of one’s own competence (␣ ϭ .76), internality (␣ ϭ
between groups (means and standard deviations). Treatment group ϭ white
.70), powerful others control (␣ ϭ .73), and chance control
circle; control group ϭ black circle. Note: Absolute levels are depicted.
• Measure for Assessment of General Stress Susceptibility
(Messinstrument zur Erfassung der Stressanfa¨lligkeit, or MESA;Schulz, Jansen, & Schlotz, in press)—This instrument assesses
stress susceptibility on six scales (Cronbach’s ␣): Sensitivity to
Analyses of covariance and variance for repeated measures were
Failure (␣ ϭ .81), Tolerance of Work Load (␣ ϭ .87), Tolerance
computed to analyze endocrine responses between groups, con-
of Social Conflicts (␣ ϭ .56), Sensitivity to Criticism (␣ ϭ .80),
trolling for differences in endocrine baseline levels when indi-
Tolerance of Uncertainty (␣ ϭ .88), and Ability to Relax (␣ ϭ
cated. All reported results were corrected by the Greenhouse-
.81). The MESA yields information on the duration and magnitude
Geisser procedure where appropriate (violation of sphericity
of cognitive, physical, social, and emotional reactions that a person
assumption). Regression analysis was used to assess associations
typically shows in response to a stressful event. Although the
between psychological and cortisol parameters. For cortisol pa-
single scales provide information about distinct aspects of stress
rameters, areas under the response curve were calculated with
susceptibility, the total test score serves as a measure of general
respect to increase (AUCi) and ground (AUCg), using the trape-
zoidal method as an indicator for the integrated cortisol response in
• Center for Epidemiological Studies Depression Scale, Ger-
the TSST (Pruessner, Kirschbaum, Meinlschmid, & Hellhammer,
man version (Allgemeine Depressions Skala—Kurzform, or
2003). Data were tested for normal distribution and homogeneity
ADS–K; Hautzinger & Bailer, 1993)—The ADS–K is a German
of variance using the Kolmogorov-Smirnov test and Levene’s test
version of the Center for Epidemiological Studies Depression
before statistical procedures were applied. The optimal total sam-
Scale (Radloff, 1977). It was developed specifically for use in
ple size of 64 to detect an expected multivariate effect size of .25
investigations in nonclinical samples to screen for depressive
(representing a medium to large effect size) with a power of .85
affect and negative thought patterns. Cronbach’s alpha for this
and equal to .05 was calculated a priori with the statistical software
G-Power (Buchner, Faul, & Erdfelder, 1997). For all analyses, the
• PSS (Cohen, Kamarck, & Mermelstein, 1983)—A German
significance level was .05. Unless indicated, all results are shown
translation of the PSS was used to assess the degree to which
situations in life experienced during the previous month are ap-praised as stressful. The PSS was designed to assess with 14 items
how predictable, uncontrollable, and overloading participants findtheir lives. Cronbach’s alpha is .85.
As a result of dropout, not all allocated participants participated
• PASA (Gaab et al., 2005)—This instrument was specifically
in the ZRM training (treatment condition, n ϭ 26; control condi-
constructed to assess cognitive appraisal processes in the TSST
tion, n ϭ 28). Reasons for dropout were as follows: inability to
according to transactional stress theory. The PASA is composed of
attend intervention dates (n ϭ 7), lost interest in participating in
four situation-specific subscales assessing (primary appraisal)
study (n ϭ 2), or no reasons provided (n ϭ 1). Groups did not
Challenge (␣ ϭ .64) and Perceived Threat (␣ ϭ .85) as well as
differ in their proportion of dropouts, and dropouts did not differ
(secondary appraisal) Self-Concept of One’s Own Competence
in any baseline variable from participants (data not shown).
(␣ ϭ .79) and Control Expectancy (␣ ϭ .76). The primary scales
Groups did not differ significantly in mean age in years (treatment
can be summarized to form two secondary scales (Primary Ap-
group M ϭ 24.8, SD ϭ 2.5; control group M ϭ 24.8, SD ϭ 2.8),
praisal, ␣ ϭ .80, and Secondary Appraisal, ␣ ϭ .74). Scales range
F(1, 52) ϭ 0.001, p ϭ .98; body mass index (treatment group M ϭ
from 1 (very little) to 6 (very much). To be able to assess antici-
22.1, SD ϭ 1.9; control group M ϭ 21.7, SD ϭ 1.7), F(1, 52) ϭ
patory cognitive appraisals, the PASA was administered between
0.7, p ϭ .41; or in any of the descriptive and pretreatment psy-
the introduction to the TSST and the actual TSST (see Figure 1).
The TSST resulted in a significant cortisol response, time effect
(a) regressing the mediator (PASA Primary Appraisal scale) on the
F(2.10, 109.41) ϭ 83.51, p Ͻ .001 (Figure 1). Groups showed a
independent variable (grouping), (b) regressing the dependent vari-
trend to differ in their basal cortisol levels before the TSST, F(1,
able (AUCg) on the independent variable (grouping), and (c)
52) ϭ 3.27, p ϭ .07 (Figure 1); therefore, baseline cortisol levels
regressing the dependent variable (AUCg) on the independent
were treated as covariates in the following repeated measures
variable (grouping) and the mediator (PASA Primary Appraisal
analysis. Controlling for baseline cortisol levels, which signifi-
scale) variable. Results of these regression analyses indicated that
cantly influenced cortisol responses over time, Baseline Cortisol
all three conditions were needed for the mediation of the primary
Level ϫ Time interaction effect F(1, 52) ϭ 10.59, p Ͻ .001, stress
appraisal between the grouping and the cortisol responses held in
responses over time differed significantly between groups,
the predicted direction: (a) The independent variable (grouping)
Group ϫ Time Interaction effect F(2.00, 102.33) ϭ 3.81, p ϭ .03,
affected the mediator (PASA Primary Appraisal scale), adjusted
effect size f 2 ϭ 0.28 (Figure 1), with participants in the treatment
R2 ϭ .12, F(1, 51) ϭ 8.16, p ϭ .006,  ϭ 0.37, t(50) ϭ 2.86, p ϭ
group showing a lower cortisol response curve. When baseline
.006; (b) the independent variable (grouping) affected the depen-
cortisol level differences were not controlled for, groups showed a
dent variable (AUCg), adjusted R2 ϭ .16, F(1, 51) ϭ 11.12, p ϭ
trend to differ in their cortisol stress response over time, Group ϫ
.002,  ϭ 0.42, t(50) ϭ 3.34, p ϭ .002; and (c) the mediator
Time interaction effect F(2.10, 109.41) ϭ 2.25, p ϭ .10; effect size
(PASA Primary Appraisal scale) affected the dependent variable
f 2 ϭ 0.22 (Figure 1). Groups differed significantly in the overall
(AUCg), and the effect of the independent variable (grouping) is
cortisol response, group effect F(1, 52) ϭ 10.83, p ϭ .002, and the
lower in the third equation than in the second, adjusted R2 ϭ .22,
integrated cortisol responses, as indicated by the AUCg, F(1,
F(1, 51) ϭ 8.59, p ϭ .001 (grouping  ϭ 0.31, t(50) ϭ 2.86, p ϭ
52) ϭ 4.41, p ϭ .04, effect size d ϭ 0.83 (Figure 2, left), and
.02; PASA Primary Appraisal  ϭ 0.30, t(50) ϭ 2.27, p ϭ .02).
AUCi, F(1, 52) ϭ 11.11, p ϭ .002, effect size d ϭ 0.55 (Figure 2,
With regard to the level of perceived stress, groups showed a
trend toward differences over time, Group ϫ Time interaction
Groups differed significantly in their anticipatory cognitive ap-
effect F(1, 49) ϭ 3.5, p ϭ .07, effect size f 2 ϭ .06, with a
praisal of the TSST, as assessed by the PASA (see Table 2). To
moderate reduction of PSS levels in the treatment group (treatment
assess whether group differences in cognitive appraisal of the
group: pretreatment M ϭ 22.7, SD ϭ 4.4; posttreatment M ϭ 20.0,
TSST (see below) had an influence on the cortisol stress response,
SD ϭ 4.5; and control group: pretreatment M ϭ 21.5, SD ϭ 6.6;
the PASA scales were included in the calculations as covariates.
posttreatment M ϭ 21.9, SD ϭ 5.1).
Analysis of covariance results indicated that primary stress ap-praisal showed a trend to influence the cortisol stress response,
time effect F(2.07, 105.44) ϭ 2.25, p ϭ .10, effect size f 2 ϭ .15. The inclusion of this psychological factor eliminated the observed
This study set out to evaluate the effectiveness of a resource-
trend toward significance of group differences in the cortisol
focused intervention to reduce psychobiological stress responses in
response over time, Group ϫ Time interaction effect F(2.07,
healthy participants. Randomization yielded two groups with com-
parable baseline stress susceptibility, levels of perceived stress,
The possible mediation of the intervention effects on the cortisol
depressive symptoms, and personality profile, with the exception
response through primary stress appraisal was also tested by the
of a single personality scale (the FKK’s Chance Control). Both
statistical approach described by Baron and Kenny (1986, p.
groups also had inconspicuous scores on these scales, making it
1177). Therefore, we ran the following three regression equations:
unlikely that the participants were particularly stressed or stressprone.
Three months after receiving ZRM training, participants in the
treatment group showed a decreased cortisol stress response in thestandardized stress test. As indicated by analysis of covariance andthe regression analyses, the endocrine response differences wereinfluenced by differences in participants’ stress appraisal of thesituation, which was lower in the treatment group than in thecontrol group. The participants trained in ZRM also showed atrend toward a modest reduction in the level of perceived stress. However, it should be mentioned that study participants had al-ready low levels of perceived stress at baseline, so that chances tofurther diminish perceived stress were restricted.
In summary, the results show that resource-activating self-
management training has beneficial effects on the psychobiologi-cal stress response. The results are comparable in direction andmagnitude to those seen in previous studies with similar designsand methods using CBSM techniques but focusing on problem-oriented procedures (Gaab et al., 2003; Hammerfald et al., 2006).
Area under the cortisol response curve in the Trier Social Stress
The fact that the treatment had an effect on primary but not
Test (means and standard deviations). Treatment group ϭ white bars;
secondary appraisal needs to be addressed. From an anatomical
control group ϭ black bars; AUCg ϭ area under the response curve withrespect to ground; AUCi ϭ area under the response curve with respect to
perspective, psychosocial stress is assumed to be processed
through limbic forebrain circuits, with stress-inhibiting inputs from
PSYCHONEUROENDOCRINE EFFECTS OF STRESS MANAGEMENT
Table 2Group Differences in Anticipatory Cognitive Appraisal in the Trier Social Stress Test
PASA ϭ Primary Appraisal Secondary Appraisal Scale.
prefrontal cortex areas and stress-enhancing inputs from the amyg-
extrapolated directly to elderly individuals (Kudielka, Buske-
dala (Herman et al., 2003). This anatomical differentiation may
Kirschbaum, Hellhammer, & Kirschbaum, 2004) or to patient
reflect the distinction between implicit, affective evaluation
populations with preexisting HPA axis dysregulations (see, e.g.,
through limbic system areas, such as the amygdala, and the ex-
Gaab et al., 2002; Heim et al., 2000). Further studies are clearly
plicit, mnemonic functions of the frontal cortex and the hippocam-
needed to replicate the reported effects in other populations before
pus. In line with these anatomical assumptions, a recent study
definite conclusions are drawn. Also, it needs to be noted that the
reported the interesting finding that primary appraisal, reflecting
described inclusion and exclusion criteria were solely assessed
the affective evaluation of a given situation, is an important pre-
through self-report. As our study protocol did not include a med-
dictor of consecutive cortisol responses, whereas secondary ap-
ical examination, we cannot rule out the possibility that study
praisal processes were of lesser importance in this regard (Gaab et
participants did not meet the described criterion for participation.
al., 2005). The observed differences between primary and second-
Second, we did not assess cortisol levels under resting condi-
ary appraisal could also be a result of differences in the importance
tions. Therefore, we cannot rule out that the response differences
of these two aspects of cognitive appraisal. As Slovic, Peters,
were caused by preexisting HPA axis differences. Likewise, be-
Finucane, and MacGregor (2005) stated, the implicit affective
cause cortisol responses in the TSST habituate in the majority of
evaluation may serve as a cue for judgment—in our case, for
people (Kirschbaum et al., 1995), it was not possible to assess
judging a situation as not stressful. Meichenbaum and Fitzpatrick
cortisol stress responses before and after the intervention. How-
(1993) discussed that primary appraisal is specifically needed in
ever, groups did not differ in their baseline cortisol levels before
the face of oncoming stressors, whereas secondary appraisal pro-
the stress test, but they clearly differed in their total integrated
cesses are useful for coping with past stressors. Consequently, to
cortisol responses. Furthermore, both groups showed similar
proactively buffer people against the stresses of daily life, it may
scores on the pretreatment personality and stress scales. For this
be crucial to address primary appraisal processes. Here, implicit
reason, we are confident that the results are not due to preexisting
self-enhancement might be the way to go.
endocrine or psychological differences between treatment and
It should be noted that, with regard to possible psychological
mediators between the intervention and the observed endocrine
Third, we did not include a direct comparison with other treat-
responses, we did only assess the results of a seemingly effortful
ments, such as CBSM. This makes it difficult to determine what
cognitive evaluation process of the oncoming situation. However,
treatment component or combination of components, respectively,
we did not attempt to assess processes that might have been more
was responsible for modification of the cortisol response.
directly related to the type of intervention in use. Here, other
Fourth, our findings focus on the TSST, a standardized labora-
procedures and approaches need to be addressed in future research.
tory stressor, that has been shown to be a potent and reliable
For example, Ellenbogen, Schwartzman, Stewart, and Walker
activator of the HPA axis response (Kirschbaum et al., 1993).
(2006) recently reported that effortful and automatic processing
However, changes in cortisol levels in response to naturalistic
regulate different aspects of the stress response. It would be very
daily stressors and negative affect are clearly of a smaller magni-
interesting to examine the effect of psychotherapeutic interven-
tude (Smyth et al., 1998). Also, there are no studies as yet available
tions on these different aspects of stress processing and to study
with direct comparisons between the psychobiological stress re-
possible differences between different psychotherapeutic ap-
sponses to the TSST and to naturalistic daily stressors.
proaches to influence these processes.
The results of this study have implications for future research.
Several limitations to this research warrant comment. First, the
This is the first study to report that resource-activating self-
sample consisted of healthy, highly educated young men. Al-
management training has effects on endocrine and psychological
though the restrictive exclusion criteria used helped to guarantee a
responses to acute laboratory stress. More important, the effects
high internal validity and comparability to previous studies, they
were observed 3 months after the participants had been trained in
limit the generalizability of the findings. For example, stress
ZRM. Compared with CBSM, ZRM training has potentially ad-
responses seen in young, male, and healthy participants cannot be
vantageous elements, as working with individually developed
resource-activating methods may have a beneficial impact on the
ful and unsuccessful therapeutic interactions. Clinical Psychology and
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www.toyobo.co.jp/e/bio Instruction manual Blunting high 0810 F0990K Blunting high [1] Introduction [2] Components [3] Protocol [4] Troubleshooting [5] References C AUTION All reagents in this kit are intended for research purposes. Do not use for diagnosis or clinical purposes. Please observe general laboratory precautions and follow safety guidelines while using