Journal of Behavioral Medicine

, Volume 23, Issue 2, pp 107–122 | Cite as

Reductions in Salivary Cortisol Are Associated with Mood Improvement During Relaxation Training Among HIV-Seropositive Men

  • Dean G. Cruess
  • Michael H. Antoni
  • Mahendra Kumar
  • Neil Schneiderman


This study examined salivary cortisol and mood during relaxation training in 30 symptomatic, HIV+ gay men participating in a 10-week, group-based cognitive-behavioral stress management intervention. Cortisol levels and mood were assessed within these sessions just before and after 45-min relaxation exercises given as part of each session. Participants also recorded their stress level and compliance with daily home relaxation practice. Presession cortisol levels decreased across the 10-week period and were related to decreases in global measures of total mood disturbance and anxious mood. Reductions in presession cortisol levels were also associated with decreases in self-reported stress level during home practice. Greater reductions in cortisol during the first three sessions were associated with more frequent relaxation practice at home. These findings suggest that salivary cortisol represents an objective neuroendocrine marker for changes in anxiety and distress observed during relaxation training in symptomatic, HIV-seropositive men.

salivary cortisol relaxation HIV mood 


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  1. Antoni, M. H., Baggett, L., Ironson, G., August, S., LaPerriere, A., Klimas, N., Schneiderman, N., and Fletcher, M. A. (1991). Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity. J. Consult. Clin. Psychol. 59: 906-915.Google Scholar
  2. Antoni, M. H., Schneiderman, N., and Ironson, G. (1998). Stress management for HIV-infection. Unpublished manuscript, University of Miami, Coral Gables.Google Scholar
  3. Baum, A., and Grunberg, N. (1995). Measurement of stress hormones. In Cohen, S., and Kessler, R. (eds.), Measuring Stress: A Guide for Health and Social Scientists, Oxford University Press, New York, pp. 175-192.Google Scholar
  4. Bernstein, B., and Borkovec, T. (1973). Progressive Relaxation Training: A Manual for the Helping Professions, Research Press, Champaign, IL.Google Scholar
  5. Benson, H., and Klipper, M. (1976). The Relaxation Response, Avon, New York.Google Scholar
  6. Biglino, A., Limone, P., Forno, B., Pollono, A., Cariti, G., Molinatti, G., and Gioannini, P. (1995). Altered adrenocorticotropin and cortisol response to corticotropin-releasing hormone in HIV-1 infection. Eur. J. Endocrinol. 133: 173-179.Google Scholar
  7. Bohnen, N., Terwel, D., Twijnstra, J., and Markerink, M. (1992). Effects of apprehension of lumbar puncture procedure on salivary cortisol, plasma vasopressin and osmolality in man. Stress Med. 8: 253-257.Google Scholar
  8. Buchanan, T. W., al'Absi, M., and Lovallo, W. R. (1999). Cortisol fluctuates with increases and decreases in negative affect. Psychoneuroendocrinology 24: 227-241.Google Scholar
  9. Centers for Disease Control (CDC) (1992). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults.MMWR, 41: 1-19.Google Scholar
  10. Davis, M., Eshelman, E., and McKay, M. (1988). The Relaxation and Stress ReductionWorkbook, 3rd ed., New Harbinger, Oakland, CA.Google Scholar
  11. Dean, J. E., Whelan, J. P., and Meyers, A. W. (1990). An incredibly quick way to assess mood states: The incredibly short POMS. Paper presented at the annual conference of the Association for the Advancement of Applied Sport Psychology, San Antonio, TX.Google Scholar
  12. Deinzer, R., Kirschbaum, C., Gresele, C., and Hellhammer, D. H. (1997). Adrenocortical responses to repeated parachute jumping and subsequent h-CRH challenge in inexperienced healthy subjects. Physiol. Behav. 61: 507-511.Google Scholar
  13. Enwonwu, C. O., Meeks, V. I., and Sawaris, P. G. (1996). Elevated cortisol levels in whole saliva in HIV infected individuals. Eur. J. Oral Sci. 104: 322-324.Google Scholar
  14. Field, T., Ironson, G., Scafidi, F., and Nawrocki, T. (1996). Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. Int. J. Neurosci. 84: 197-206.Google Scholar
  15. Gorman, J., Kertzner, R., Cooper, T., Goetz, R., Lagomasino, I., Novacenko, H., Williams, J., Stein, Y., Mayeux, R., and Ernhart, A. (1991). Glucocorticoid level and neuropsychiatric symptoms in homosexual men with HIV infection. Am. J. Psychiatry 148: 41-45.Google Scholar
  16. Hamilton, M. (1960). A rating scale for depression. J. Neurol. Neursurg. Psychiatry 23: 56-62.Google Scholar
  17. Hellhammer, K. H., Buchtal, J., Gutberlet, I., and Kirschbaum, C. (1997). Social hierarchy and adrenocortical stress reactivity in men. Psychoneuroendocrinology 22: 643-650.Google Scholar
  18. Hennig, J., Laschefski, U., and Opper, C. (1994). Biopsychological changes after bungee jumping: β-Endorphin immunoreactivity as a mediator of euphoria? Neuropsychobiology 29: 28-32.Google Scholar
  19. Ironson, G., Friedman, A., Klimas, N., Antoni, M., Fletcher, M. A., LaPerriere, A., Simoneau, J., and Schneiderman, N. (1994). Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men with Human Immunodeficiency Virus. Int. J. Behav. Med. 1: 90-105.Google Scholar
  20. Ironson, G., Field, T., Scafidi, F., Hashimoto, M., Kumar, M., Kumar, A., Price, A., Goncalves, A., Burman, I., Tetenman, C., Patarca, R., and Fletcher, M. A. (1996). Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. Int. J. Neurosci. 84: 205-217.Google Scholar
  21. Jin, P. (1989). Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi. J. Psychosom. Res. 33: 197-206.Google Scholar
  22. Kelly, J. A., Murphy, D. A., Bahr, G. R., Kalichman, S., Morgan, M., Stevenson, L., Koob, J., Brasfield, T., and Bernstein, B. (1993). Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. Am. J. Psychiatry 150: 1679-1686.Google Scholar
  23. Kirschbaum, C., and Hellhammer, D. H. (1989). Salivary cortisol in psychobiological research: An overview. Neuropsychobiology 22: 150-169.Google Scholar
  24. Kirschbaum, C., and Hellhammer, D. H. (1994). Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology 19: 313-333.Google Scholar
  25. Kirschbaum, C., Pruessner, J. C., Stone, A. A., and Federenko, I. (1995). Persistent high cortisol responses to repeated psychological stress in a subpopulation of healthy men. Psychosom. Med. 57: 468-474.Google Scholar
  26. Kumar, M., Kumar, A., Morgan, R., Szapocznik, J., and Eisdorfer, C. (1993). Abnormal pituitaryadrenocortical response in early HIV-1 infection. J. Acquir. Immune Defic. Syndr. 6: 61-65.Google Scholar
  27. Lutgendorf, S. K., Antoni, M. H., Ironson, G., Klimas, N., Kumar, M., Starr, K., McCabe, P., Cleven, K., Fletcher, M. A., and Schneiderman, N. (1997). Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-Type 2 antibody titers in symptomatic HIV seropositive gay men. J. Consult. Clin. Psychol. 65: 23-31.Google Scholar
  28. Luthe, W. (1969). Autogenic Therapy, Grune and Stratton, New York.Google Scholar
  29. Mason, J. (1986). A Guide to Stress Reduction, Celestial Arts, Berkeley, CA.Google Scholar
  30. McNair, D. M., Lorr, M., and Droppleman, L. F. (1971). EITS Manual for the Profile of Mood States, Educational and Industrial Testing Service, San Diego, CA.Google Scholar
  31. Mulder, C. L., Emmelkamp, P. M. G., Antoni, M. H., Mulder, J. W., Sandfort, T. G. M., and deVries, M. J. (1994). Cognitive-behavioral and experiential group psychotherapy for HIVinfected homosexual men: A comparative study. Psychosom. Med. 56: 423-431.Google Scholar
  32. Mulder, C. L., Antoni, M. H., Emmelkamp, P., Veugelers, P., Sandfort, T., van der Vijver, F., and de vries, M. (1995). Psychosocial intervention and the rate of decline of immunologic parameters in asymptomatic HIV-infected homosexual men. J. Psychother. Psychosom. 63: 185-192.Google Scholar
  33. Rondanelli, M., Solerte, S. B., Fioravanti, M., Scevola, D., Locatelli, M., and Ferrari, E. (1997). Circadian secretory pattern of growth hormone, insulin-like growth factor type I, cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, and prolactin during HIV infection. AIDS Res. Hum. Retroviruses 13: 1243-1249.Google Scholar
  34. Sarason, I. G., Johnson, J., and Soegal, J. M. (1978). Assessing the impact of life changes. J. Consult. Clin. Psychol. 46: 932-946.Google Scholar
  35. Smyth, J., Ockenfels, M. C., Porter, L., Kirschbaum, C., Hellhammer, D. H., and Stone, A. A. (1998). Stressors and mood measured on a momentary basis are associated with salivary cortisol secretion. Psychoneuroendocrinology 23: 353-370.Google Scholar
  36. Spitzer, R., Williams, J., Gibbon, M., and First, M. (1988). Structured Clinical Interview for DSMIII-R: Nonpatient Version for HIV Studies (SCID-NP-HIV 6/1/88), Biometrics Research Department, New York Psychiatric Institute, New York.Google Scholar
  37. Spitzer, R., Williams, J., Gibbon, M., and First, M. (1990). Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), Biometrics Research Department, New York Psychiatric Institute, New York.Google Scholar
  38. Van Eck, M. M., and Nicolson, N. A. (1994). Perceived stress and salivary cortisol in daily life. Ann. Behav. Med. 16: 221-227.Google Scholar
  39. Yalow, R., and Berson, S. (1971). Introduction and general considerations. In Odell, W. D., and Daughday, W. H. (eds.), Principles of Competitive Protein Binding Assays, Lippincott, Philadelphia, pp. 1-19.Google Scholar
  40. Zeier, H., Brauchli, P., and Joller-Jemelka, J. I. (1996). Effects of work demands on immunoglobulin A and cortisol in air traffic controllers. Biol. Psychol. 42: 413-423.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Dean G. Cruess
    • 1
  • Michael H. Antoni
    • 1
    • 2
  • Mahendra Kumar
    • 1
    • 2
  • Neil Schneiderman
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of PsychologyUniversity of MiamiUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of MiamiUSA
  3. 3.Department of MedicineUniversity of MiamiUSA
  4. 4.Department of Biomedical EngineeringUniversity of MiamiUSA

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