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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

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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.
© 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 ofce 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 3540 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 2258).
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 signicant 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
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 ve hours (1.68 nmol/l). In other
words, the visit induced a fall in cortisol concentration
equivalent to that which takes about ve 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 signicance (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 signicantly
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 reected 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
signicantly 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 inuences 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 signicant
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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... 9 10 14 16 17 20 22 23 25 Another four used a within groups design, where measures were compared previewing to postviewing the artworks, with no comparator groups. 15 18 19 24 The final study used a cross-sectional design, measuring stress-reduction at one time point. 21 Of the nine between groups designs, six used a no artwork control group as a comparator, 9 10 17 20 22 23 and one used scrambled versions of the artworks. ...
... The researchers from two experimental studies told participants to attentively look at and explore each artwork, 14 18 whereas the researcher in another study asked visitors to explore the art gallery in any way they pleased. 15 The remaining two studies asked participants to discuss and describe each artwork to the group during art programmes. 20 24 One of these studies 24 had a trained art educator facilitating the discussions, whereas the other 20 had a lead researcher, with no specified training. ...
... 14 The cortisol and respiration results were less consistent. An art gallery visit decreased salivary cortisol levels 15 ; however, a 6-week art intervention for people living with dementia increased waking cortisol levels. 24 Lastly, after a stressor, salivary cortisol decreased faster in those viewing scrambled images, compared with those viewing landscapes. ...
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Objective To review the existing evidence on the effects of viewing visual artworks on stress outcomes and outline any gaps in the research. Design A scoping review was conducted based on the Joanna Briggs Institute methodology for scoping reviews and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two independent reviewers performed the screening and data extraction. Data sources Medline, Embase, APA PsycINFO, Cochrane CENTRAL, Scopus, Google Scholar, Google, ProQuest Theses and Dissertations Database, APA PsycExtra and Opengrey.eu were searched in May 2020. Eligibility criteria Studies were included if they investigated the effects of viewing at least one visual artwork on at least one stress outcome measure. Studies involving active engagement with art, review papers or qualitative studies were excluded. There were no limits in terms of year of publication, contexts or population types; however, only studies published in the English language were considered. Data extraction and synthesis Information extracted from manuscripts included: study methodologies, population and setting characteristics, details of the artwork interventions and key findings. Results 14 primary studies were identified, with heterogeneous study designs, methodologies and artwork interventions. Many studies lacked important methodological details and only four studies were randomised controlled trials. 13 of the 14 studies on self-reported stress reported reductions after viewing artworks, and all of the four studies that examined systolic blood pressure reported reductions. Fewer studies examined heart rate, heart rate variability, cortisol, respiration or other physiological outcomes. Conclusions There is promising evidence for effects of viewing artwork on reducing stress. Moderating factors may include setting, individual characteristics, artwork content and viewing instructions. More robust research, using more standardised methods and randomised controlled trial designs, is needed. Registration details A protocol for this review is registered with the Open Science Framework (osf.io/gq5d8).
... The stress alleviating effects of viewing visual art are mixed [37] and were mainly investigated in museum and gallery settings. Gallery visits caused faster recovery from high stress assessed by salivary cortisol level [38], and having an aesthetic experience in a religious cultural heritage site resulted in a decrease of 60% salivary cortisol level [39] compared to the normally associated level of cortisol decrease during the circadian cycle (as importantly, these two studies [38,39] had no other control groups). Furthermore, artworks-especially figurative ones in comparison with modern art-decreased systolic blood pressure as an indicator of stress relief [40]. ...
... The stress alleviating effects of viewing visual art are mixed [37] and were mainly investigated in museum and gallery settings. Gallery visits caused faster recovery from high stress assessed by salivary cortisol level [38], and having an aesthetic experience in a religious cultural heritage site resulted in a decrease of 60% salivary cortisol level [39] compared to the normally associated level of cortisol decrease during the circadian cycle (as importantly, these two studies [38,39] had no other control groups). Furthermore, artworks-especially figurative ones in comparison with modern art-decreased systolic blood pressure as an indicator of stress relief [40]. ...
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... Among the various effects, empirical evidence has shown that on-site art interactions have been particularly associated with decreased loneliness (Todd et al., 2017;Tymoszuk et al., 2019Tymoszuk et al., , 2020, improved mental health (symptoms of anxiety and depression; Clayton & Potter, 2017;Hansen et al., 2015;Roberts et al., 2011), and increased mood and subjective wellbeing (Bennington et al., 2016;Binnie, 2010;Davies et al., 2016;Hansen et al., 2015;Ho et al., 2015;Karnik et al., 2014;Roberts et al., 2011;Wang et al., 2020). For example, similar to the interventions that will be explored in this paper, Clow and Fredhoi (2006) asked individuals to take a 35-minute visit to an art gallery on their lunch break and found that even short exposures lead to significantly lower self-reported stress (~2.4 points on a pre-/post-visit 10-point scale) and cortisol concentrations (see Binnie, 2010;Ho et al., 2015 for similar examples using pre-post assessments). ...
... who reported a pre/post change (assessed via Brief Mood Introspection Scale) following an art exhibition visit in a hospital. As well asPaddon et al. (2014), who reported medium effect sizes in negative mood(Cohen's d = 0.38) and positive mood (d = 0.69), assessed via Positive and Negative Affect Schedule (PANAS), following a cultural museum object-handling session in a hospital (also seeClow and Fredhoi's (2006) report of reduction in self-reported stress after individuals spent a lunch break in-person in a museum of art).Even comparing to other domains, our results remain roughly equivalent. For example,Cracknell et al. (2016) reported a change in affective valence (assessed via 11-point bipolar Feeling Scale), following a roughly five-minute intervention in which participants observed an aquarium fish tank, ! ...
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... The benefits of art have also been measured through biological parameters of the central nervous system activity. For example, visits to art museums have reported to lower levels of salivary cortisol and self-reported measure of stress (Clow and Fredhoi, 2006) and to decrease systolic blood pressure (Mastandrea et al., 2019b). Taking into consideration the many benefits of art interventions, making them more accessible could be part of the wider strategy of managing mental health risk and treatment. ...
... Much of this research has analyzed the stress buffering effects of primary rewards using food, drink, or sex (Abad et al., 1996;Christiansen et al., 2011;Creswell et al., 2013). However, there is also emerging evidence that visual art interventions can enhance functional connectivity related to psychological resilience (Bolwerk et al., 2014), can lower levels of salivary cortisol and of self-reported measure of stress (Clow and Fredhoi, 2006) and even decrease systolic blood pressure (Mastandrea et al., 2019b). ...
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