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 the December issue of 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 three 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 authors write.

The study was funded by the Behavior Therapy Research Foundation.

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Meuret AE, Rosenfield D, Bhaskara L, et al. Timing matters: endogenous cortisol mediates benefits from early-day psychotherapy. Psychoneuroendocrinology. 2016;74:197-202.