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Normalisation of salivary cortisol levels and self-report stress by a brief lunchtime visit to an art gallery by London City workers

  • January 2006
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Angela Clow at University of Westminster
Angela Clow
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Abstract

Summary • We studied the impact of a brief lunchtime visit to an art gallery on City workers' levels of the stress hormone cortisol as well as self-report levels of stress and arousal. • Average levels of cortisol and self-report stress were significantly reduced by the visit, levels of arousal were unchanged. • On arrival at the gallery levels of cortisol were elevated relative to expected values. Following the gallery visit the cortisol concentrations had normalised to those expected for the time of day.
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© Journal of holistic healthcare
●
Volume 3 Issue 2 May 2006
29
Normalisation of salivary cortisol
levels and self-report stress by a
brief lunchtime visit to an art
gallery by London City workers
Angela Clow PhD
with
Cathrine Fredhoi MSc
Department of Psychology, University of
Westminster
As a psychophysiologist I investigate the way emotion (typically negative mood states
or stress) affects bodily functions and, in the long run, health. Recently people have
questioned whether the health benefits associated with a positive outlook and good
social support are merely a buffer for these negative effects or whether they have
direct and independent pathways to health. My research has involved development of
methodologically sound ways to explore these sorts of questions by measurement of
free cortisol concentrations in saliva.
Introduction
Measurement of the steroid stress
hormone cortisol is increasingly
employed as an objective biomarker
of stress.
1
Cortisol has a diverse set
of actions ranging from effects on
blood pressure, stored reserves of
energy and the balance of the
immune system. It regulates these
systems in normal (non-stressful)
day-to-day living as well in response
to a stressor: stress causes additional
bursts of cortisol secretion. Healthy
cortisol secretion shows a marked
circadian cycle with highest levels in
the morning falling to lower levels in
the evening and during the early
phases of sleep. This changing
circadian pattern is vital for informing
other body systems when it is night
and day so that they can operate to
maximum efficiency. Stressful living
conditions can disturb this healthy
pattern resulting in inappropriately
high cortisol concentrations for the
time of day. Disturbed cortisol
circadian profiles have been linked
to ageing,
2
clinical depression
3
and
a range of stress-related physical
disease (eg Sephton et al
4
).
Summary
• We studied the impact of a brief lunchtime visit to an art
gallery on City workers’ levels of the stress hormone cortisol
as well as self-report levels of stress and arousal.
• Average levels of cortisol and self-report stress were
significantly reduced by the visit, levels of arousal were
unchanged.
• On arrival at the gallery levels of cortisol were elevated
relative to expected values. Following the gallery visit the
cortisol concentrations had normalised to those expected for
the time of day.
• The observed drop in cortisol was rapid and substantial;
under normal circumstances it would take about 5 hours of
normal diurnal decline for cortisol levels to fall to this extent.
• We conclude that the gallery visit caused rapid normalisation
(recovery) from the consequences of high stress.
RESEARCH
© Journal of holistic healthcare
●
Volume 3 Issue 2 May 2006
30
It takes about 15 minutes for a stressor to illicit
increased cortisol secretion, the time course of which
can be accurately tracked by measuring the hormone in
sequential saliva samples.
5
There has been extensive
research into such stress-induced cortisol responding.
6
There has been less research exploring the impact of
positive experiences within a naturalistic setting on
cortisol levels although it has been shown that the size
of the cortisol response to a standard stressor can be
attenuated by cognitive behavioural therapy.
7, 8
Very little research has been carried out into effects
of naturalistic, non-therapeutic interventions such as are
presented in this article. The current study set out to
explore self-reported stress and arousal as well as salivary
cortisol levels of a group of London City workers during
a lunch hour, before and after a visit to The Guildhall
Art Gallery.
Procedures
Email invitations were sent out to office workers in
the vicinity of the Guildhall Art Gallery in the City of
London. The invitation included free gallery entrance,
participation is a study on stress as well as a free sandwich
lunch at the end of the study. On a typical working day
small groups of volunteers arrived at the gallery at
pre-arranged 15 minute intervals during their lunch
break (between 12.30 1.30pm). On arrival at the gallery
each group was directed to a quiet meeting room and
welcomed by our researcher. Having given informed
consent participants were asked to complete a short
questionnaire (the Cox Mackay Stress Arousal
Checklist).
9
This questionnaire assessed their state of
stress and arousal upon arrival at the gallery. At the
same time they were asked to supply a saliva sample
using the convenient Salivette saliva sampling device.
This process was repeated 35–40 minutes later, after
they had completed a visit to the gallery exhibition area.
Participants were free to explore the gallery in any way
they pleased; the only requirement was that they did not
leave the building and that they return to the meeting
room 35 minutes later. In this way we could study the
psychological and physiological impact of the short
gallery visit. Saliva samples were used to determine
levels of cortisol. Samples were thawed and cortisol
concentrations were determined by Enzyme Linked
Immuno-Sorbent Assay developed by Salimetrics LLC
(USA). (For details of assay procedures see
10
).
Participants
28 participants agreed to take part in the study, 14 males
and 14 females. Mean age was 33.6 years (range 22–58).
However three participants failed to provide complete
data sets and the following results are presented for 25
of the original 28 participants.
Results
There was a fall in self-reported stress after the gallery
visit compared with immediately before the visit. This
difference was statistically significant using paired t-tests
(mean ± SEM scores pre and post: 5.28 ± 0.94 and
2.89 ± 0.57 respectively, t=3.643, df=24, p<0.001).
There was no difference in level of arousal pre vs. post
the gallery visit (mean ± SEM scores pre and post:
8.60 ± 0.68 and 9.40 ± 0.72 respectively) (See Figure 1).
There was a corresponding drop in the average levels of
cortisol after the 35 minute gallery visit (mean ± SEM
cortisol concentrations pre and post: 5.82 ± 0.76 nmol/l
and 3.94 ± 0.25 nmol/l respectively, t=2.913, df=24,
p<0.008), see Figure 2.
Figure 3 shows that when the participants entered
the gallery their cortisol levels were higher than would
have been expected or predicted from our previous
Normalisation of salivary cortisol levels and self-report stress by a brief lunchtime visit to an art gallery by London City workers
RESEARCH
FIGURE 1 Levels of self-report stress and arousal before and after
the visit to the gallery (mean scores ± SEM, N=25)
FIGURE 2 Cortisol concentrations (nmol/l) before and after the
visit to the gallery (mean concentrations ± SEM, N=25)
Score
15
10
5
0
Pre Post
*
Before and after the 35 minute visit
Stress
Arousal
p<0.001
*
Cortisol concentration (nmol/l)
7.5
5.0
2.5
0.0
Before visit After visit
*
p<0.001
*
© Journal of holistic healthcare
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Volume 3 Issue 2 May 2006
31
research on participants of similar age and without
excessive stress in their lives. We can conclude that, on
average, at arrival the participants showed evidence of
relatively high levels of stress. However within the space
of 35 minutes average levels had dropped to below the
normal range. This fall in cortisol concentration (1.87
nmol) is greater than the average fall in concentration
from 10am to 3pm ie in five hours (1.68 nmol/l). In other
words, the visit induced a fall in cortisol concentration
equivalent to that which takes about five hours under
normal circumstances (the normal, healthy pattern of
cortisol secretion is for a gradual decline in
concentrations over the day.
11
There was a tendency for the male participants to
have higher levels of cortisol on arrival at the gallery,
although this did not reach statistical significance (mean
± SEM concentrations: 7.44 ± 1.31nmol/l and 4.54 ±
0.78 nmol/l for males and females respectively, t=2.001,
df=23, p= 0.057). However males did have significantly
higher cortisol levels after the end of the gallery visit
(mean ± SEM concentrations: 4.58 ± 0.38 nmol/l and
3.54 ± 0.29 nmo/l respectively, t=2.224, df=22,
p< 0.04), see Figure 4.
Although the males tended to show higher cortisol
levels on arrival at the gallery and were higher at the
end of the visit the results reveal that they were more
responsive than the female participants. When analysed
separately only the male participants showed a decrease
in their salivary cortisol levels (t=2.625, df=10, p<0.03)
whereas the females did not (t=1.492, df=13, p=0.159).
This gender difference in the objective measure of stress
was not reflected in gender differences in self-report
measures of stress.
Post hoc examination of the data revealed that there
were 16 participants who responded to the gallery visit
with a fall in cortisol (‘responders’) and nine who did
not show a reduction (‘non-responders’). Further
analyses showed that the ‘responders’ were those
participants who arrived at the gallery with high levels
of cortisol whereas the non responders arrived with
significantly lower levels of cortisol (mean ± SEM
concentrations: 7.53 ± 0.94 nmol/l and 2.77 ± 0.34 nmol/l
respectively, t=3.697 df=23 p<0.005) (see
Figure 5).
At the end of the gallery visit there was no difference
between the average cortisol concentrations of the two
groups (mean ± SEM concentrations: 4.03 ± 0.33 nmol/l
and 3.80 ± 0.41 nmol/l respectively).
Discussion
This study has demonstrated that a brief lunchtime visit
to an art gallery had substantial influences on both the
subjective experience of stress as well as levels of the
stress hormone cortisol. On arrival at the gallery average
levels of cortisol were higher than normative values but
these dropped rapidly to below the norm for the time of
day. Indeed analyses revealed that cortisol levels only
dropped in those participants who entered the study
with relatively high levels: the gallery visit induced
normalisation to desired cortisol levels for the time of
day. Recent research points to the importance of
Normalisation of salivary cortisol levels and self-report stress by a brief lunchtime visit to an art gallery by London City workers
RESEARCH
FIGURE 3 Cortisol concentrations (nmol/l) before and after the visit
to the gallery shown within the context of normative ‘unstressed’
cortisol concentrations determined from previous research
FIGURE 4 Cortisol concentrations (nmol/l) before and after the visit to the gallery for males and females separately (mean concentrations ± SEM)
Cortisol concentration (nmol/l)
10.0
5.0
2.5
0.0
7.5
Before After
*
Cortisol concentration (nmol/l)
6
5
4
3
Hour of day
10 11 12 13 14 15
Normative values
Study participants
Males
Cortisol concentration (nmol/l)
10.0
5.0
2.5
0.0
7.5
Before After
Females
© Journal of holistic healthcare
●
Volume 3 Issue 2 May 2006
32
maintaining a healthy circadian pattern of cortisol
secretion and this study demonstrates that even brief
respites within a hectic working lifestyle can buffer the
effects of stress. Furthermore it was interesting to
observe marked gender differences in this study.
Although they did not report more stress the males had
higher cortisol levels than the females, but in line with
the normalisation phenomenon, it was the males that
responded more markedly whereas the less
physiologically stressed females did not show a significant
fall in cortisol. It is well known that males are more
responsive to stressful events
12
and it is interesting to
observe in this study that this responsiveness also works
in the direction of reducing cortisol concentrations.
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Full-text available
  • Apr 2000
The enzyme 11-beta-hydroxysteroid dehydrogenase (11-beta-HSD) regulates glucocorticoid activity by converting cortisol into cortisone and vice versa. Frequent signs of major depression are elevated concentrations of circulating cortisol and ACTH. However, no information is available about the activity of 11-beta-HSD in this disorder. Therefore, we compared diurnal plasma concentrations of cortisol and cortisone and their ratios, reflecting 11-beta-HSD activity, in 25 severely depressed patients (Hamilton Depression Scale, 29 +/- 6; 14 men, 11 women, age 22-77 yr; mean, 47 +/- 16) and 30 control persons (20 men, 10 women age 23-85 yr; mean, 51 +/- 19). Cortisol and cortisone were measured at 0900 h, 1100 h, 1300 h, 2000 h, 2200 h, 0100 h, 0300 h, and 0700 h with specific RIAs after extraction. Both cortisol and cortisone concentrations were significantly increased in patients compared with controls (cortisol, 251.7 +/- 113.1 vs. 160 +/- 96.6 nmol/L; cortisone, 32.8 +/- 10.9 vs. 21.9 +/- 10.9 nmol/L). The calculated ratios of cortisol to cortisone were similar in controls and patients. Similar to cortisol, the circadian variation of cortisone was flattened in patients with the ratio of maximal cortisone to minimal cortisone being 1.9-fold higher in controls than in patients. There was no gender-specific difference in cortisone values neither in patients nor in controls. We conclude that in major depression increased cortisol is not due, at least partly, to an altered 11-beta-HSD activity or to a decrease in cortisone.
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Cortisol as a biomarker of stress
Article
  • Jan 2004
I am a founder member of the Psychophysiology and Stress Research Group (PSRG) at the University of Westminster.The PSRG has an international reputation in the study of salivary cortisol and the secretory immune system in relation to mood and susceptibility to infection.As both a health psychologist and researcher I have a strong belief in the mind-body link and through my research I seek to find the mechanisms that underpin this phenomenon. Recently I participated as an on-screen expert in the BBC TV series The Stress Test. Summary This review focuses on the use of salivary cortisol concentrations as a convenient and non-invasive biomarker of stress. Acute stress causes an increase in cortisol concentration and beneficial
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With aging in humans the activity of the hypothalamus-pituitary-adrenal system increases and its diurnal amplitude flattens
Article
There is compelling evidence for feedback disturbances in the hypothalamus-pituitary-adrenal system associated with human aging as assessed by challenge tests. However, reports about age-related changes in human basal activity are ambiguous and to date little is known about changes in the pulsatile features of the HPA system. To investigate these changes we studied twenty-two healthy male and eleven healthy female subjects ranging from 23 to 85 and 24 to 81 years respectively. 24-hour blood sampling with 30 minute sampling intervals was performed. From 18.00 to 24.00 hours blood was sampled every 10 minutes for analysis of pulsatile features of HPA activity. Statistical analysis revealed that age in particular had major effects upon basal HPA-system activity: there was a significant age-associated increase in minimal (p < 0.0001) and mean (p < 0.0002) cortisol plasma concentrations, but no alteration in pulsatile features. We found no age-cortisol correlation during daytime, but were able to demonstrate a strong impact of age upon cortisol plasma levels from 20.00 to 1.30 hours. The diurnal amplitude of cortisol (p < 0.0005) and ACTH (p < 0.0006), relative to the 24-hour mean of the hormones, showed an age-associated decline. Additionally, the evening cortisol quiescent period (p < 0.0001) was shortened in the elderly, suggesting increasingly impaired circadian function in aging. Our results suggest an increased basal activity and a flattened diurnal amplitude of the HPA system in the elderly.
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An inventory for the measure of selfreported stress and arousal
Article
Describes the development of a mood adjective checklist to measure self-reported stress and arousal. The scale was adapted for British use from one originally constructed by R. E. Thayer (see record 1967-08169-001). When the new scale was administered to 145 British undergraduates, 2 bipolar factors (rather than the 4 monopolar factors found by Thayer) were revealed and labeled Stress and Arousal. Item loadings on these factors are presented. A 2nd study with 72 Ss produced similar factors. Additional support for a 2-factor solution is described. (9 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The measurement of self-reported stress and arousal
Article
  • Jun 1985
This paper provides further discussion on the measurement of mood using self-report inventories. It comments on questions raised by Cruickshank (1984) about the structure and use of the stress-arousal checklist developed by Mackay and Cox (Mackay et al., 1978).
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Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Article
  • Jul 2000
: Abnormal circadian rhythms have been observed in patients with cancer, but the prognostic value of such alterations has not been confirmed. We examined the association between diurnal variation of salivary cortisol in patients with metastatic breast cancer and subsequent survival. We explored relationships between cortisol rhythms, circulating natural killer (NK) cell counts and activity, prognostic indicators, medical treatment, and psychosocial variables. Salivary cortisol levels of 104 patients with metastatic breast cancer were assessed at study entry at 0800, 1200, 1700, and 2100 hours on each of 3 consecutive days, and the slope of diurnal cortisol variation was calculated using a regression of log-transformed cortisol concentrations on sample collection time. NK cell numbers were measured by flow cytometry, and NK cell activity was measured by the chromium release assay. The survival analysis was conducted by the Cox proportional hazards regression model with two-sided statistical testing. Cortisol slope predicted subsequent survival up to 7 years later. Earlier mortality occurred among patients with relatively "flat" rhythms, indicating a lack of normal diurnal variation (Cox proportional hazards, P =. 0036). Patients with chest metastases, as opposed to those with visceral or bone metastases, had more rhythmic cortisol profiles. Flattened profiles were linked with low counts and suppressed activity of NK cells. After adjustment for each of these and other factors, the cortisol slope remained a statistically significant, independent predictor of survival time. NK cell count emerged as a secondary predictor of survival. Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. Suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.
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Edwards S, Clow A, Evans P, Hucklebridge F. Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity. Life Sci 68: 2093-2103
Article
Adrenocortical activity can be assessed by measurement of free cortisol in saliva. Cortisol status has important health implications in both physical and psychological terms. Assessment of cortisol status is complicated by the marked diurnal cortisol cycle. This cycle is characterised by an increase in secretory activity following awakening to achieve the morning acrophase. Thereafter it falls with a declining trend over the remainder of the day. For between subject studies the timing of sampling in relation to this cycle is an important consideration. We report a comprehensive study of the diurnal free cortisol cycle designed to analyse its components and to investigate their reliability and inter-relatedness. We instructed 42 healthy volunteers to collect saliva samples at home on two consecutive days. On each day the first sample was collected immediately upon awakening, followed by a further three samples at 15-minute intervals which collectively comprised the "awakening samples". A further four sample's were collected through the day at 3-hour intervals, all synchronized to awakening time. The cortisol response to awakening was calculated in two ways. Overall cortisol production in the first 45 minutes after awakening was calculated as area under the cortisol curve with reference to zero (AUC). The dynamic of the cortisol response to awakening was calculated as area under the cortisol response curve (AURC) with reference to the first awakening sample. In addition the underlying cortisol secretory activity was assessed based upon the diurnal three-hourly samples. All three parameters of adrenocortical activity showed reasonable stability across the two sampling days indicating all were reliable indexes of trait characteristic. AUC was representative of underlying diurnal activity but AURC was not. Measurement at any time point, 3, 6, 9 or 12 hours post-awakening was representative of the underlying 12-hour diurnal activity.
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The effect of dawn simulation on the cortisol response to awakening in healthy participants
Article
Bright light exposure after awakening has been shown to elevate cortisol levels in healthy participants. The present study examined the effect of dawn simulation (a treatment for seasonal affective disorder) on the cortisol response to awakening and mood. Twelve healthy participants were supplied with a dawn simulator (The Natural Alarm Clock, Outside In, Cambridge Ltd), a bedside light that increases in intensity prior to awakening to approximately 250 lux over 30 mins when an audible alarm sounds. A counterbalanced study was performed on 4 consecutive normal weekdays, two of which were control days (no dawn simulation) and two experimental (dawn simulation). Saliva samples were taken immediately on awakening then at 15, 30 and 45 minutes post awakening on all 4 study-days. Total cortisol production during the first 45 mins after awakening was found to be significantly higher in the experimental condition than in the control condition. Participants also reported greater arousal in the experimental condition and there was a trend for an association between increased arousal and increased cortisol secretory activity under dawn simulation. This study provides supportive evidence for the role of light and the suprachiasmatic nucleus in the awakening cortisol response.
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