Psychotherapy sessions are best in the morning when levels of helpful hormone are high

SMU Research

Originally Posted: October 3, 2016

New study found patients with anxiety, phobias and fears showed greater improvement from therapy that was scheduled in the morning, when levels of cortisol — a naturally occurring hormone — test higher.

Participants in the study were 24 people diagnosed with panic disorder and agoraphobia, which is a fear of public places where a person feels panicked, trapped or helpless. Participants underwent a standard psychotherapeutic treatment of “exposure therapy," with those in morning sessions achieving greater improvement. (Credit: iStock)

Participants in the study were 24 people diagnosed with panic disorder and agoraphobia, which is a fear of public places where a person feels panicked, trapped or helpless. Participants underwent a standard psychotherapeutic treatment of “exposure therapy,” with those in morning sessions achieving greater improvement. (Credit: iStock)

Patients make more progress toward overcoming anxiety, fears and phobias when their therapy sessions are scheduled in the morning, new research suggests.

The study found that morning sessions helped psychotherapy patients overcome their panic and anxiety and phobic avoidance better, in part, because levels of cortisol — a naturally occurring hormone — are at their highest then, said clinical psychologist Alicia E. Meuret, Southern Methodist University, Dallas.

“The hormone cortisol is thought to facilitate fear extinction in certain therapeutic situations,” said Meuret, lead author on the research. “Drugs to enhance fear extinction are being investigated, but they can be difficult to administer and have yielded mixed results. The findings of our study promote taking advantage of two simple and naturally occurring agents – our own cortisol and time of day.”

The findings were reported in the article “Timing matters: Endogenous cortisol mediates benefits from early-day psychotherapy” in the journal Psychoneuroendocrinology.

Co-authors from the SMU Department of Psychology are David RosenfieldLavanya Bhaskara and Thomas Ritz. Co-authors from the Department of Psychiatry at the University of Michigan are Richard Auchus, Israel Liberzon, and James L. Abelson.

The study taps into research that anxiety and phobias are best treated by learning corrective information. Patients with anxiety and phobic disorders will overestimate the threat that a sensation or situation can cause. But by direct exposure, a patient learns that the likelihood of an expected catastrophe is very low.

“For example, a patient may think that standing in an elevator could cause him or her to lose control or faint, suffocate, or may create physical symptoms that would be intolerable,” Meuret said. “By having them stand in an elevator for a prolonged time, the patient learns that their feared outcome does not occur, despite high levels of anxiety. We call this corrective learning.”

However, since not all patients benefit equally from exposure therapy, researchers seek to identify ways to enhance corrective learning. To date, no simple way to augment fear extinction has been established.

The hormone cortisol is thought to help the extinction of fear. It appears to suppress the fear memory established by earlier distressing encounters while at the same time helping a patient better absorb and remember the new corrective information.

“In a prior study, we have shown that higher levels of cortisol during and in anticipation of exposure facilitate corrective learning,” said Meuret, an associate professor in the SMU Psychology Department and director of the SMU Anxiety and Depression Research Center in the Clinical Psychology Division of the department. “We also know that cortisol is higher early in the day. But we did not know whether cortisol would act as a mediator between time of day and therapeutic gains. This is what our study investigated.”

Exposure therapy in general resulted in significant improvements
Participants in the study were 24 people diagnosed with panic disorder and agoraphobia, which is a fear of public places where a person feels panicked, trapped or helpless.

For the study, participants underwent a standard psychotherapeutic treatment of “exposure therapy,” in which patients are exposed to situations that can typically induce their panic or fear with the goal that repeated exposure can help diminish a disabling fear response over time.

Patients received weekly sessions over three weeks, each lasting, on average, 40 minutes. Exposure situations included tall buildings, highways and overpasses, enclosed places such as elevators, supermarkets, movie theaters, and public transportation such as subways and intercity trains and boats. In addition, levels of cortisol were measured at various times during each exposure session by swabbing inside the mouth for saliva.

In the session following exposure, the researchers measured patients’ appraisals of the threats, their avoidance behavior, how much control they perceived themselves as having, and the severity of their panic symptoms.

Assessing the results from those measurements, the researchers found the exposure therapy in general resulted in significant improvements in all measures over all time periods.

Biggest gains after sessions that started earlier in the day
However, patients made the biggest gains in overcoming their fears after the sessions that started earlier in the day. At the next session, patients reported less severe symptoms for threat misappraisal, avoidance behaviors and panic symptom severity. They also perceived greater control over their panic symptoms.

“Notably, higher cortisol was related to greater reductions in threat appraisal, perceived control and panic symptom severity at the next session,” Meuret said, “and that was the case over-and-above the effects of time-of-day, with large effect sizes.”

That finding suggests that cortisol accounts for some of the therapeutic effects associated with time-of-day, she said.

Because cortisol levels are generally higher in the morning, the authors speculate that higher cortisol levels may aid extinction learning, and contribute to enhanced early-day benefits of exposure sessions through such a mechanism.

However, Meuret cautioned that the precise mechanism by which cortisol enhances the effectiveness of morning exposure sessions remains unclear and can’t be directly addressed from the data in this study. The sample size of the study was small and findings need to be confirmed independently in larger studies, she said.

Meuret and her team suspect additional mechanisms are at play to explain the time-of-day effect. Other factors could include memory and learning and the body’s natural circadian rhythm, quantity and quality of sleep, attention control, and interactions between those factors and others. — Margaret Allen, SMU

Fondren library closed Saturday, September 17th

Fondren Library will be closed this Saturday, September 17th for Game Day. Regular hours will resume Sunday September 18th at Noon. READ MORE 

SMU climbs to 56 in U.S. News & World Report rankings

SMU News

Originally Posted: September 13, 2016

DALLAS (SMU) – SMU rose to its highest ranking among the nation’s universities in the 2017 edition of U.S. News & World Report’s Best Colleges, released online today.

Among 220 institutions classified as national universities, SMU ranks 56, up from 61 a year ago.

The new ranking again places SMU in the first tier of institutions in the guide’s “best national universities” category. In Texas, only Rice University ranks higher. SMU and the University of Texas-Austin were tied.  Among private national universities, SMU ranks 39.

SMU’s increase was one of the five largest among the top 100 universities. Since 2008, SMU’s 11-point increase is one of the four largest among schools in the top 60.

For the rankings, U.S. News considers measures of academic quality, such as peer assessment scores and ratings by high school counselors, faculty resources, student selectivity, graduation rate performance, financial resources and alumni giving. SMU ranks 24 among all national universities in alumni giving at 25 percent.

In other ranking categories, SMU ranks 32 as one of the best national universities for veterans.

“It is gratifying for SMU to be recognized for its positive movement among the best national universities,” said SMU President R. Gerald Turner. “The ranking is an example of the momentum of the Second Century Campaign and the University’s Centennial Celebration.

“We appreciate external recognition of our progress and believe it’s valid, but we also know that rankings do not portray the whole picture of an institution and its strengths. We encourage parents and students to visit the institutions they are considering for a firsthand look at the academic offerings, the campus environment and the surrounding community to best gauge a university.”

The rankings of 1,374 institutions, including national universities, liberal arts colleges, regional colleges and regional universities, are available now online and on newsstands Sept. 23. Find the “Best Colleges 2017” guidebook in stores Oct. 4. READ MORE


Oh, the places Dedman College students will go… (after graduation)!

Dedman College graduate employer list

Welcome to the Class of 2020

SMU News

Originally Posted: August 22, 2016

Following you will find Class of 2020 PhotoMaking the Class of 2020 PhotoOpening Convocation scenesOpening Convocation speechCamp Corral scenes“Discover Dallas” scenes“Discover Dallas” StorifyCorral Kick-OffMove-In video and scenes, and AARO.

SMU Class of 2020 Photo

SMU Class of 2020

Calendar Highlights: Back to school in brief, Fall 2016

Dallas Hall at SMU

Welcome to the 2016-17 academic year! Here are a few Fall 2016 dates to remember:

  • Opening Convocation and Common Reading discussion: Sunday, Aug. 21
  • First day of classes: Monday, Aug. 22
  • General Faculty Meeting: Wednesday, Aug. 24
  • Labor Day: Monday, Sept. 5 (University offices closed)
  • First Faculty Senate Meeting of 2016-17: Wednesday, Sept. 7
  • Family Weekend: Friday-Saturday, Sept. 23-24
  • Fall Break: Monday-Tuesday, Oct. 10-11
  • Homecoming Weekend: Friday-Saturday, Nov. 4-5
  • Thanksgiving: Thursday-Friday, Nov. 24-25 (University offices closed, no classes on Wednesday, Nov. 23)
  • Last day of classes: Monday, Dec. 5
  • Reading days: Tuesday-Wednesday, Dec. 6-7
  • Final exams: Thursday-Wednesday, Dec. 8-14 (no exams scheduled for Sunday)
  • December Commencement Convocation: Saturday, Dec. 17 (official close of term and date for conferral of degrees)
  • Christmas/Winter Break: Friday, Dec. 23, 2016-Monday, Jan. 2, 2017 (University offices closed)


SMU remains weapons-free under Texas ‘campus carry’ law

SMU News

Originally Posted: July 27, 2016

SMU prohibits the possession of any dangerous weapon (either openly or in a concealed manner), or facsimiles of dangerous weapons such as water guns or toy guns and knives, on all University property, athletic venues, passenger transportation vehicles and any groups or building on which University activities are conducted.

Student-owned sporting firearms or other weapons (including all BB and pellet guns) are the responsibility of the owner and must be stored at an appropriate location off campus.

SMU has been a weapons-free campus since at least 1994. See for the full policy.

Any violation of this policy is considered a serious offense. If you have questions about this policy, please contact the SMU Police Department at 214-768-3388. READ MORE

Psychology professor, former student reunite at Mount Everest base camp

SMU News

Originally Posted: July 13, 2016

Psychology Professor Susan Hornstein has taught more than 7,000 students over the course of her 14 years at SMU, so she’s used to running into former pupils around town.

What she isn’t used to is running into them at base camp on Mount Everest, but that’s exactly what happened May 21 when Hornstein was spotted by former student Aliza Greenberg during a Himalayan trek with two friends

“It was cold. I had my hat and my glasses on – I don’t know how she recognized me,” Hornstein says. “My two friends were talking with her father and when I walked up, Aliza turned to me and said ‘Hornstein?’ I was so amazed she recognized me.”

Standing in the middle of a small village of colored tents in the shadow of the world’s most famous mountain, the student and her former professor caught up.

“I asked how she was doing, what she’d done since graduation – she’d just earned a masters in holocaust studies and she said she was going to the Northeast for her Ph.D.,” Hornstein says. “I met her father, who she was traveling with, and then we took a picture together.”

It was the first time they’d crossed paths since Greenberg took Hornstein’s Introduction to Psychology class in 2011. Hornstein has developed a bit of a reputation for the class, as she frequently uses pictures from her travels to drive home particular points about each week’s lecture.

“Oh, this picture will absolutely make the presentation this fall,” Hornstein says. “It was a surreal experience and it goes to show how small the world really is.” READ MORE