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Feeling Fearful? See Your Therapist Before Lunch

Let a naturally occurring hormone help in the healing process.

By Tom Jacobs


(Photo: Moss/Flickr)

Panic, anxiety, and phobias are among the many reasons people seek out psychotherapy. If you’re getting professional help for such a fear-based issue, newly published research has a tip for you: Schedule your appointment for the morning.

In a small study, treatment for panic disorder was more successful when it took place earlier in the day. A research team led by psychologist Alicia Meuret of Southern Methodist University links this positive outcome to the fact that levels of a helpful hormone — cortisol — tend to be higher during those hours.

“Taking advantage of cortisol’s natural rhythm may have some advantages,” the researchers write in the journal Psychoneuroendocrinology.

Cortisol, commonly known as the “stress hormone,” has been called “public enemy number one,” due to its harmful overproduction in response to emotional stress. But as Meuret and her colleagues noted in a 2014 study, it can aid in the “fear extinction process.”

Specifically, they report cortisol “reduces the retrieval of aversive memories, and thereby partially interrupts the vicious cycle of spontaneously retrieving, re-experiencing, and re-consolidating” fearful associations. What’s more, they found it also enhances “the storage of corrective experiences.”

If your assignment is to spend some time in a scary place, it’s best to do so before lunch.

Since cortisol levels are higher in the morning, they suspected psychotherapy sessions scheduled at that time of day would yield better results. To find out, they received 24 people who met the DSM-IV criteria for panic disorder with agoraphobia.

All took part in three sessions (one per week for three weeks), which were evenly distributed throughout the day. During each session, they spent an average of 40 minutes in a situation that had caused them emotional discomfort in the past, including tall building, overpasses, subways, and supermarkets.

The results: “Sessions conducted earlier in the day predicted superior reductions in threat appraisal and avoidance behavior, and greater improvements in perceived control over anxiety-provoking situations,” the researchers write.

Higher a.m. cortisol levels didn’t entirely explain this positive finding. Among other factors, the body’s circadian rhythm may also play a role. But the hormone clearly “accounts for some of the therapeutic effects associated with time-of-day,” they conclude.

Meuret and her colleagues note that it’s impractical for all such sessions to be held before lunch. But they add that, in this form of “exposure therapy,” much of the work “often takes place in ‘homework’ sessions conducted by the patients themselves.”

So if your assignment is to spend some time in a scary place — and thereby gradually tame your fears — it’s best to do so before lunch.