Optimizing expectations and distraction leads to lower cortisol levels after acute stress

Psychoneuroendocrinology. 2018 Feb;88:144-152. doi: 10.1016/j.psyneuen.2017.12.011. Epub 2017 Dec 21.


Background: A new approach of psychological interventions prior to stress aiming to optimize expectations may have beneficial effects on a person's health status by reducing physiological stress. The purpose of this experiment was to determine whether a brief psychological intervention designed to optimize personal control expectations prior to acute stress would affect perceived and biological stress responsiveness in comparison to two more established interventions (fostering gratitude or distraction) in a healthy sample.

Methods: 74 healthy participants were randomized to one of three psychological interventions prior to stress: (i) writing about ways to influence stress to optimize personal control expectations (EXPECTATION), (ii) writing a gratitude-letter (GRATITUDE) (iii) or a distraction writing task (DISTRACTION). After completing the intervention, the Maastricht acute stress test was administered to induce (psychosocial and physiological) stress. Assessments took place at baseline, post-intervention (15 min writing task) and after stress induction (additional salivary assessments: 15 and 30 min after stress). Main outcomes were expectations, emotions, perceived stress, salivary cortisol and alpha-amylase. Personality traits (eg, optimism) were assessed at baseline.

Results: EXPECTATION specifically increased personal control expectations (p = .016, d = .72) and GRATITUDE specifically increased gratitude (p = .026, d = .68). EXPECTATION and DISTRACTION led to lower cortisol concentrations after stress induction than GRATITUDE (time x group interaction: p < .001, d = .88). We detected no intervention effects on alpha-amylase or perceived stress. Optimism moderated intervention effects on cortisol (p = .023, d = .74).

Conclusions: Brief psychological interventions aiming to optimize expectations or distraction prior to stress reduce the cortisol response in healthy participants after an acute stressor.

Keywords: Distraction; Gratitude; Personal control expectation; Salivary alpha-amylase; Salivary cortisol; Stress.

Publication types

  • Clinical Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / therapy
  • Emotions
  • Female
  • Humans
  • Hydrocortisone
  • Male
  • Motivation / physiology
  • Psychological Techniques
  • Psychotherapy, Brief / methods*
  • Random Allocation
  • Stress, Psychological / prevention & control*
  • Stress, Psychological / psychology*


  • Hydrocortisone