Cortisol as a marker for improvement in mindfulness-based stress reduction

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Abstract

While much attention has been devoted to examining the beneficial effects of Mindfulness-Based Stress Reduction programs on patients' ability to cope with various chronic medical conditions, most studies have relied on self-report measures of improvement. Given that these measures may not accurately reflect physiological conditions, there is a need for an objective marker of improvement in research evaluating the beneficial effects of stress management programs. Cortisol is the major stress hormone in the human organism and as such is a promising candidate measure in the study of the effects of Mindfulness-Based Stress Reduction programs. In conjunction with other biological measures, the use of cortisol levels as a physiological marker of stress may be useful to validate self-reported benefits attributed to this program. In the current manuscript, we review the available literature on the role of cortisol as a physiological marker for improvement with regards to mindfulness practice, and make recommendations for future study designs.

Section snippets

Cortisol production in relation to stressors and the stress response

The term “homeostasis” was coined to capture an organism's capacity to maintain certain bodily functions (e.g., body temperature, oxygen) within a narrow range via coordinated physiological mechanisms, despite disturbances in its internal and/or external environment.1 The process by which this regulation is achieved is complex and our understanding of it has evolved markedly over the last century. Initially, Selye posited that, when the integrity of an organism is threatened by exposure to a

The Mindfulness-Based Stress Reduction (MBSR) model

The MBSR program, developed by Kabat-Zinn and colleagues at the University of Massachusetts Stress Reduction Clinic three decades ago, was designed to teach patients how to cope effectively with various chronic medical conditions (e.g., irritable bowel syndrome, chronic pain, cancer). Mindfulness is defined as a refined, systematic, attention-based strategy that focuses on the promotion of present moment awareness, in which thoughts, feelings and/or sensations that arise in the attentional

Benefits of practicing mindfulness

From the program's inception, patients enrolled in MBSR programs at the University of Massachusetts Stress Reduction Clinic completed pre- and post-intervention questionnaires to assess efficacy.16, 17, 18, 19 Patient outcomes have been favorable, with self-reported reductions in physical (i.e., pain and other medical symptoms) and psychological symptomatology (e.g., decreases in depression, anxiety, perceived stress) reported following participation in MBSR programs in various centers around

Can salivary cortisol be an objective marker for stress reduction?

Various physiological responses have been studied in relation to the practice of MBSR including cardiovascular, brain, immune, and endocrine functions.20, 21, 23, 45, 46, 47, 48 Given that cortisol is a hormone secreted in response to stress, we have chosen to evaluate the potential role of this hormonal mediator of the stress response as an objective marker for improvement in those who participate in a MBSR program by reviewing the extant literature on the subject. We acknowledge that cortisol

Summary and critique of existing research on cortisol and MBSR

Table 1 summarizes the literature evaluating the effects of participation in a MBSR program on cortisol levels, systematically identifying variations in the sample, in the intervention, and in the methodology of cortisol assessment, along with the main research findings. There is accumulating evidence indicating that cortisol levels decrease following participation in a MBSR program. Carlson et al. related the effects of participation in a MBSR program on mood, quality of life, stress symptoms,

Conclusions

Herein we examined the potential role of cortisol as an objective marker for improvement in those who complete a MBSR program. When collected using rigorous methods, cortisol is a promising candidate to assess the effectiveness of interventions intended to reduce stress, such as MBSR, as this hormone is secreted by the adrenal glands in response to stress, has been found to be a reliable biological marker of adrenocortical activity, and has generally been found to be responsive to interventions

Conflict of interest

None.

Role of the funding source

The authors would like to acknowledge the Jewish General Hospital of Montreal Segal Center and the Weekend to End Breast Cancer for supporting this research. Additionally, Dr. R. Matousek gratefully acknowledges support from the Strategic Training Program in Palliative Care Research of the Canadian Institutes of Health Research (CIHR).

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