HealthDay News — For patients with panic disorder with agoraphobia, cortisol mediates the effect of the time of day on subsequent outcome, with greater clinical improvement seen for earlier exposure sessions, according to a study published in Psychoneuroendocrinology.

Alicia E. Meuret, PhD, from the Southern Methodist University in Dallas, and colleagues examined the role of cortisol levels as a mediator between time of day and therapeutic gains in 24 participants meeting Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for panic disorder with agoraphobia. Patients received 3 weekly in-vivo exposure sessions, yielding 72 total sessions, whose start times were distributed evenly throughout the day.

The researchers observed a correlation for sessions starting earlier in the day with superior therapeutic gains by the next therapy session. There was also a correlation for earlier sessions with higher pre-exposure cortisol levels, which in turn correlated with greater clinical improvement by the subsequent session.

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“The data suggest that early-day extinction-based therapy sessions yield better outcomes than later-day sessions, partly due to the enhancing effect of higher cortisol levels,” the researchers wrote.

Disclosures: The study was funded by the Behavior Therapy Research Foundation.

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  1. Meuret AE, Rosenfield D, Bhaskara L, et al. Timing matters: Endogenous cortisol mediates benefits from early-day psychotherapy. Psychoneuroendocrinology. 2016;74:197-202. doi:10.1016/j.psyneuen.2016.09.008.