A Randomized Controlled Trial on the Efficacy of PositivePsychotherapy on Improving Executive Function and Plasma Cortisol Levels in Patients with Anxiety
International Journal of Applied Behavioral Sciences,
Vol. 8 No. 2 (2021),
18 July 2021
Interoduction: Anxiety among students can lead to decreased performance and may be associated with other psychological and biological consequences. Therefore, it deserves clinical attention. On the other hand, reinforcing positive resources such as feelings, behaviors, and positive cognitions can be used as an important intervention in managing and improving mood disorders. This study evaluated the efficacy of positive psychotherapyon improving executive function and modulating serum cortisol levels in patients with anxiety.Method: In a randomized controlled clinical trial, 30 students with anxiety symptoms were selected using purposive sampling method and were assigned to experimental and control groups through block randomization method after confirming entry criteria. The intervention was presented to the experimental group in a positive approach for ten weekly sessions and the control group was placed on the waiting list. Changes in the executive functions index were considered as primary outcomes and serum cortisol levels fluctuations were considered as secondary outcomes. Data were analyzed by multivariate analysis of covariance in SPSS 21 software. Result: Primary outcomesshowed that ten weeks of positive therapy had a significant effect on improvement of executive function (p<0.001). Secondary outcomes also showed that positive psychotherapy was effective in decreasing serum cortisol levels (p<0.001).Conclusion: Results showed that positive psychotherapy had a significant effect on the improvement of executive function and reducing serum cortisol levels. These findings demonstrate the effectiveness of psychotherapy on the prefrontal cortex (PFC)and its interaction with the hypothalamic–pituitary–adrenal (HPA) axis function.Declaration of Interest: None.Declaration of Interest: None
- Anxiety, Cortisol, Executive functions, Positive therapy, Psychotherapy
How to Cite
-Bashir MBA, Hussein Albaawy IMA, Cumber SN. Predictors and correlates of examination anxiety and depression among high school students taking the Sudanese national board examination in Khartoum state, Sudan: a cross-sectional study. Pan Afr Med J.2019;33.
-England BJ, Brigati JR, Schussler EE. Student anxiety in introductory biology classrooms: Perceptions about active learning and persistence in the major. Jana NR, editor. PLOS ONE. 2017 Aug 3;12(8):e0182506.
-Ghavidel Heydari M, Shirazi M, Sanagouyemoharer GR. The effect of positive psychoth erapy in test anxiety among Zahedan students with hemophilia. Research in Psychotherapy: Psychopathology, Process and Outcome. PAGE. 2018 Apr 12.
-Khanjani M. The Impact of Positive Psychotherapy on Decreasing the College Students' Stress, Anxiety, Depression and Increasing their Well-being. QCPS. 2017; 7(28), 97-110.
-Dwight L., Evans Edna B., Foa, Raquel E, et al.Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don??t Know: A Research Agenda for Improving the Mental Health of Our Youth. J Nerv Ment Dis. 2006 May;194(5):390.
-Seligman MEP, Rashid T, Parks AC. Positive psychotherapy. Am Psychol. 2006 Nov;61(8):774–88.
-Tabatabaee SM, Albooyeh G, Safari H, Rajabppor M. The effect of positive psychology intervention on psychological well-being of drugs inmates. IJABS.2016; 2(3):8-14.
-Pirnia B, Malekanmehr P, Haghighat S &Sadeghi, P. Psychotherapy and Addiction; Examining the Effectiveness of Well-being group therapy on Craving Index in Methamphetamine-dependent Men under Short-term residential treatment, a controlled randomized trial. RRJ. 2020; 9(4), 83-92.
-Song R, Sun N, Song X. The Efficacy of Psychological Capital Intervention (PCI) for Depression From the Perspective of Positive Psychology: A Pilot Study. Front Psychol.2019 Aug 7;10.
-Taylor CT, Lyubomirsky S, Stein MB. Upregulating the positive affect system in anxiety and depression: Outcomes of a positive activity intervention. Depress Anxiety. 2017 Jan 6;34(3):267–80.
-Boumparis N, Karyotaki E, Kleiboer A, Hofmann SG, Cuijpers P. Corrigendum to “The effect of psychotherapeutic interventions on positive and negative affect in depression: A systematic review and meta-analysis” [J. Affect. Disord. 202 (2016) 153–162]. J Affect Disord. 2017 Apr;213:223.
-Bakker DJ, Lyons ST, Conlon PD. An Exploration of the Relationship between Psychological Capital and Depression among First-Year Doctor of Veterinary Medicine Students. J Vet Med Educ.2017 Feb;44(1):50–62.
-Asbrand J, Heinrichs N, Nitschke K, Wolf OT, Schmidtendorf S, Tuschen-Caffier B. Repeated stress leads to enhanced cortisol stress response in child social anxietydisorder but this effect can be prevented with CBT. Psychoneuroendocrinology. 2019 Nov;109:104352.
-MacDonald D, Wetherell MA. Competition Stress Leads to a Blunting of the Cortisol Awakening Response in Elite Rowers. Front Psychol.2019 Jul 18;10.
-Lim I-S. Comparative analysis of the correlation between anxiety, salivary alpha amylase, cortisol levels, and athletes’ performance in archery competitions. J Nutr Biochem. 2018 Dec 31;22(4):69–74.
-Pirnia B, Givi F, Roshan R, Pirnia K & Soleimani AA. The cortisol level and its relationship with depression, stress and anxiety indices in chronic methamphetamine-dependent patients and normal individuals undergoing inguinal hernia surgery. MJIRI. 2016; 30, 395.
-Harris MA, Cox SR, Brett CE, Deary IJ, MacLullich AMJ. Cognitive ability across the life course and cortisol levels in older age. Neurobiol Aging.2017 Nov;59:64–71.
-Scheffer M, Becker J, de Azeredo LA, Grassi-Oliveira R, de Almeida RMM. Subjective and physiological stress measurement in a multiple sclerosis sample and the relation with executive functions performance. J Neural Transm.2019 Feb 6;126(5):613–22.
-Feeney JC, O’Halloran AM, Kenny RA. The Association between Hair Cortisol, Hair Cortisone, and Cognitive Function in a Population-Based Cohort of Older Adults: Results From The Irish Longitudinal Study on Ageing. J Gerontol.2018 Nov 9.
-Pirnia B, Pirnia K, Mohammadpour S, Malekanmehr P, Soleimani A, Mahmoodi Z, Zahiroddin A. The effectiveness of acupuncture on HPA functional in depressed patients under methadone maintenance treatment, a randomized double-blind sham-controlled trial. Asian J Psychiatr. 2018;36, 62–63.
-Mehrsafar AH, Strahler J, Gazerani P, Khabiri M, Sánchez JCJ, Moosakhani A, et al. The effects of mindfulness training on competition-induced anxiety and salivary stress markers in elite Wushu athletes: A pilot study. Physiol. Behav. 2019 Oct;210:112655.
-Rauch SAM, King AP, Liberzon I, K. Sripada R. Changes in Salivary Cortisol during Psychotherapy for Posttraumatic Stress Disorder. J Clin Psychiatry.2017 May 24;78(5):599–603.
-Fischer S, Cleare AJ. Cortisol as a predictor of psychological therapy response in anxiety disorders—Systematic review and meta-analysis. J Anxiety Disord.2017 Apr;47:60–8.
-Fischer S, Strawbridge R, Vives AH, Cleare AJ. Cortisol as a predictor of psychological therapy response in depressive disorders: Systematic review and meta-analysis. Br J Psychiatry.2017 Feb;210(2):105–9.
-Kayikcioglu O, Bilgin S, Seymenoglu G, Deveci A. State and Trait Anxiety Scores of Patients Receiving Intravitreal Injections. Biomed Hub.2017 Aug 5;2(2):1–5.
-Rouel M, Raman J, Hay P, Smith E. Validation of the Behaviour Rating Inventory of Executive Function –Adult Version (BRIEF-A) in the obese with and without binge eating disorder. Eat Behav. 2016 Dec;23:58–65.
-Pirnia B, Masoudi R, Pirnia K, Jalali M, Eslami M, Malekanmehr P, Pirnia F, Ajori L. Effect of Magnesium Sulfate Added to Tincture of Opium and Buprenorphine on Pain and Quality of Life in Women with Dysmenorrhea: A Prospective, Randomized, Double-blind, Placebo-controlled Trial. Addiction&Health. 2020; 12(4): 259-268.
-Pirnia B, Hamdieh M, Kazemi Ashtiani M, Malekanmehr P, Pirnia K, Zahiroddin A, Sadeghi P. The Effectiveness of Intranasal Oxytocin on Addiction Severity Index and Anhedonia Symptoms in an Alcoholic Case with Oropharyngeal Cancer, a Protocol for a Single-case Experimental Design Pilot Study. IJPR. 2020; 19(3): 18-23.
-Pirnia B, Homayounfar N, Hosseini N, Ebrahimi F, Haj Sadeghi Z & Malekanmehr P. The Predictive Role of Body Image and Sexual Function in Quality of Life After Modified Radical Mastectomy Regarding the Mediating Role of Emotion; A Cross Sectional Study. IJCM. 2020; 13(11).
-Alizadeh Zarei M, Salman Mohammadtaqi N, Hassani Mehraban A, Akbar Fahimi M. Study of face validity and reliability of the Persian-version of Behavior Rating Inventory of Executive Function (BRIEF) in ADHD children. MEJDS. 2016; 6 :299-303.
-Kaipper MB, Chachamovich E, Hidalgo MPL, da Silva Torres IL, Caumo W. Evaluation of the structure of Brazilian State-Trait Anxiety Inventory using a Rasch psychometric approach. J Psychosom Res.2010 Mar;68(3):223–33.
-Panahi Shahri, Mahmoud. Preliminary review of validity, reliability and normativeization of the Spielberger State-trait anxiety inventory. Master Thesis. 1993. Tarbiat Modares University.
-Tang Y-Y, Tang R, Posner MI. Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug Alcohol Depend. 2016 Jun;163:S13–S18.
-Taren AA, Gianaros PJ, Greco CM, Lindsay EK, Fairgrieve A, Brown KW, et al. Mindfulness Meditation Training and Executive Control Network Resting State Functional Connectivity. Psycho Med. 2017;79(6):674–83.
-Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MGM. 8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice –A systematic review. BrainCogn.2016 Oct;108:32–41.
-Lai JCL, Evans PD, Ng SH, ChongAML, Siu OT, Chan CLW, et al. Optimism, positive affectivity, and salivary cortisol. Br J Health Psychol 2005 Nov; 10(4):467–84.
-Pirnia B, Pirnia K, Aghajanpoor M, Mardan F, Zahiroddin A. Relationship between function of hypothalamic-pituitary-adrenal axis and executive functions in chronic methamphetamine users: A cross-sectional study. Asian J Psychiatr.2018 Jun;35:113–4.
-Pirnia B, Khosravani V, Maleki F, Kalbasi R, Pirnia K, Malekanmehr P, et al. The role of childhood maltreatment in cortisol in the hypothalamic–pituitary–adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts. J Affect Disord. 2020 Feb; 263:274–81.
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