Salivary cortisol output before and after cognitive behavioural therapy for chronic fatigue syndrome.
Roberts, Amanda D L, Papadopoulos, Andrew S, Wessely, Simon et al. · Journal of affective disorders · 2009 · DOI
Quick Summary
This study looked at whether cognitive behavioural therapy (CBT)—a type of talk therapy—could help fix a hormone imbalance found in ME/CFS patients. Researchers measured a stress hormone called cortisol in the saliva of 41 patients before and after 15 sessions of CBT. They found that cortisol levels increased after therapy, suggesting that CBT may help restore this hormone to healthier levels.
Why It Matters
This study provides evidence that one of the biological abnormalities found in ME/CFS—low cortisol levels—may be partially reversible through targeted psychological therapy. If lowered cortisol contributes to maintaining ME/CFS symptoms, this finding suggests CBT might work partly by correcting this hormonal dysfunction, offering a potential mechanistic explanation for treatment benefit.
Observed Findings
Significant clinical response to CBT was observed in the 41 patients studied.
Salivary cortisol output measured between 0800-2000 hours increased significantly after CBT.
Changes were documented following 15 sessions or approximately 6 months of therapy.
Measurements were taken at baseline and post-treatment in a specialist tertiary outpatient clinic.
Inferred Conclusions
Hypocortisolism in CFS may be a reversible condition rather than a fixed biological trait.
CBT may work partly by correcting hormonal dysfunction related to inactivity, sleep disruption, stress, and deconditioning.
Normalising cortisol through CBT could represent a mechanism by which this therapy addresses maintaining factors in CFS.
Remaining Questions
Does the rise in cortisol directly cause symptom improvement, or is it simply associated with recovery?
Would cortisol levels remain elevated long-term, or do they decline again without ongoing intervention?
How do cortisol changes in responders compare to non-responders to CBT, and can cortisol changes predict treatment outcome?
What This Study Does Not Prove
This study does not prove that CBT directly causes cortisol increases, as there was no untreated control group to account for the passage of time or natural recovery. It also does not establish whether cortisol normalization is essential for symptom improvement or merely associated with it. Finally, the findings may not generalise to all ME/CFS patients, particularly those with more severe disease.
Tags
Symptom:Fatigue
Biomarker:Blood Biomarker
Method Flag:PEM Not DefinedNo ControlsSmall Sample