Can Stress Diminish the Effects of Cognitive Behavioral Therapy?

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Dr. Randi Fredricks, Ph.D. is a therapist, researcher and author with a Ph.D. in Psychology and a Doctorate in Naturopathy. Dr. Fredricks works ...Read More

Many of have seen firsthand that stress can impair our ability to control our emotions, but to this point, there has been little evidence to support this belief. A recent study entitled “Cognitive emotion regulation fails the stress test” suggested that even low levels of stress can interfere with certain techniques used in cognitive behavioral therapy (CBT) to moderate our emotions. If these research findings are correct, the implications may be far reaching since CBT is one of the most commonly used approaches to therapy.

Therapists often times use CBT techniques to help clients to alter their thoughts and change their emotional response. These techniques include methods such as focusing on the positive or non-threatening aspects of an event or stimulus that might normally produce fear. According to the researchers in this current study, some of these practices don’t always work in the real world when people are faced with the normal stressors of everyday life.


In conducting the research, the study’s authors created an experiment in which the study’s participants used cognitive behavioral techniques like those prescribed by therapists as a means to reduce their anxiety and worry.

The study occurred over a two-day period. For the first day of the research, the researchers induced fear in the participants using a well-known CBT technique called “fear conditioning.” To accomplish this, participants were instructed to view photos of spiders and snakes, two the most common things associated with phobias. In addition to viewing the pictures, half the participants would sporadically receive a shock to the wrist, while the remaining group did not get the shock. As might have been expected, the people who saw the pictures accompanied by the series of shocks developed significant fear responses, which were measured by both self-report and physiological arousal. Upon finishing the fear conditioning, the subjects were instructed on how to employ specific CBT strategies in order to reduce the fears that had been induced by the experiment.

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On the second day of the research, the participants were divided into two new groups in order to determine if the CBT techniques they learned the previous day would be useful under stress. To determine the participants stress levels, researchers measured each person’s salivary cortisol levels. The results indicated that the CBT training had no reduction in fear, suggesting that they were not able to successfully utilize the CBT techniques to their reduce fear.

Not surprisingly, the researchers concluded that even mild stress, such as that encountered in daily life, may impair the ability to use cognitive techniques known to control fear and anxiety. They did say, however, that with practice or after longer intervals of cognitive training, these strategies may become more habitual and less sensitive to the effects of stress.

In evaluating this study, some might jump to the conclusion that what an individual learns in therapy may not be as relevant in the real world as hoped for. A more accurate assessment might be that it takes more than one therapy session for an individual to sufficiently learn specific techniques for changing thoughts and behavior. It looks like a follow up study to confirm that supposition is in order.


Candace M. Raio, Temidayo A. Orederu, Laura Palazzolo, Ashley A. Shurick, and Elizabeth A. Phelps. Cognitive emotion regulation fails the stress test. Proceedings of the National Academy of Sciences, August 26, 2013 DOI: 10.1073/pnas.1305706110.

Keep Reading By Author Randi Fredricks, Ph.D.
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