Patient and therapist in-session cortisol as predictor of post-session patient reported affect

Eyal Levi, Susanne Fischer, Hadar Fisher, Roee Admon, Sigal Zilcha-Mano

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


The importance of the role of affect in psychotherapy for major depressive disorder (MDD) is well established, but the common use of self-reported measures may limit our understanding of its underlying mechanisms. A promising predictor of patient affect is the stress hormone cortisol. To date, no studies have studied in-session changes in cortisol in psychotherapy for MDD. We investigated whether an increase in patient cortisol over the course of a session correlated with higher negative and lower positive affect. Given previous findings on healthy individuals on the contagious nature of stress, an additional aim was to examine whether these relationships are moderated by therapist cortisol. To this end, 40 dyads (including 6 therapists) provided saliva samples before and after four pre-specified sessions (616 samples). After each session, the patients provided retrospective reports of in-session affect. We found no association between patient cortisol and affect. However, increases in patient cortisol predicted negative affect when the therapists exhibited decreases in cortisol, and increases in patient cortisol predicted positive affect when the therapists showed increases. Our study provides initial evidence for the importance of the social context in the cortisol–affect relationship in MDD.

Original languageEnglish
Article number1483
JournalBrain Sciences
Issue number11
StatePublished - 10 Nov 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


Funding: This work was supported by the Israel Science Foundation (ISF, Grant No.: 186/15 to Sigal Zilcha-Mano).

FundersFunder number
Israel Science Foundation186/15


    • Affect
    • Cortisol
    • Psychotherapy
    • Social support
    • Stress
    • Therapist


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