title: The impact of PTSD treatment on the cortisol awakening response.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is associated with abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis; however, limited research has examined whether cortisol levels change following successful PTSD treatment. The current study examined the impact of successful PTSD treatment on the cortisol awakening response (CAR).
  
  
  METHODS
  Twenty-nine adults participating in a treatment trial for chronic PTSD provided saliva samples (upon waking, and 30-, 45-, and 60 min postwaking) before and after receiving either prolonged exposure therapy or sertraline. PTSD responder status (i.e., loss or retention of a PTSD diagnosis) served as the predictor variable. Outcome measures included area under the curve with respect to ground and increase, reflecting total cortisol output and HPA axis reactivity, respectively.
  
  
  RESULTS
  A series of hierarchical regressions revealed no significant main effects of PTSD responder status for either CAR outcome. However, a significant gender by treatment response interaction for cortisol reactivity revealed that female treatment nonresponders displayed higher cortisol reactivity following treatment than female responders, whereas cortisol reactivity did not change pre- to posttreatment for male responders. Findings remained after controlling for age, trauma history, baseline medication status, baseline PTSD, and baseline depressive symptoms.
  
  
  CONCLUSIONS
  Loss of a PTSD diagnosis may contribute to decreased cortisol reactivity in females. Neuroendocrine changes following treatment may emerge only for specific subgroups, highlighting the importance of exploring treatment moderators.
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Pacella
authors.forename: Norah
authors.initials: N
authors.lastname: Feeny
authors.forename: Lori
authors.initials: L
authors.lastname: Zoellner
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Delahanty
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D007171:Implosive Therapy; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism; D012463:Saliva / Q000737:chemistry; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000378:metabolism / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006854:Hydrocortisone; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
keywords: cortisol; gender; posttraumatic; prolonged exposure; sertraline; stress disorders; treatment