Cortisol plays an important role in the stress response. Maintaining an adequate balance of cortisol is essential for health (Healthdirect 2022).

What is Cortisol?

Cortisol is a hormone produced by the two adrenal glands, which are located on top of each kidney. The pituitary gland in the brain regulates cortisol production (Healthdirect 2022).

How is Cortisol Used by the Body?

Cortisol is described as ‘essential for life’ due to its ability to:

• Maintain consistent blood pressure
• Maintain immune function
• Decrease inflammation
• Manage stress
• Collaborate with the hormone insulin to maintain blood sugar levels
• ‘Convert protein into glucose to boost flagging blood sugar levels’
• Improve glucose metabolism
• React to dangers via the ‘fight or flight’ response.

(Better Health Channel 2017; Healthdirect 2022)

What is Cortisol’s Role in the Stress Response?

The natural stress response is as follows:

• A threat is perceived when a trigger/risk of danger presents (e.g. dog barking)
• The hypothalamus alarms the body
• Nerve and hormone signals lead to the adrenal glands’ production of hormones, which include adrenaline and cortisol
• Adrenaline increases pulse rate, blood pressure and energy supply
• Cortisol is the chief stress hormone and increases:
• Glucose in the bloodstream
• The brain’s use of glucose
• Tissue repair constituent accessibility
• Cortisol lowers non-essential bodily functions that could prevent the effectiveness of the fight or flight response (e.g. digestion, growth and reproduction)
• The stress response also affects brain areas responsible for mood, fear and motivation.

(Mayo Clinic 2023)

Whilst this stress response normally stops once the perceived threat has disappeared, some people experience a long-term fight-or-flight response. This means that these people will experience ongoing or repeat exposure to excessive cortisol and related stress hormones. Evidently, this means that other bodily functions are repeatedly or chronically affected (Mayo Clinic 2023). This may lead to the following issues:

• Anxiety
• Depression
• Digestive issues
• Headaches
• Heart disease
• Sleep issues
• Weight gain
• Memory and concentration issues.

(Mayo Clinic 2023)

For this reason, it is important to learn healthy ways to cope with stressors (Mayo Clinic 2023).

Cortisol has also been associated with post-traumatic stress disorder (PTSD). Additionally, patients who experience ongoing or chronic stress and affected cortisol levels are at risk of hypertension, heart disease and ulcers. Cortisol is a biomarker for stress and it can evidently foresee the development of certain mental and physical health conditions (Burns 2017).

Excessive cortisol can result in Cushing’s syndrome (also known as hypercortisolism) (Better Health Channel 2017). This condition may be caused by:

• Taking high doses of oral corticosteroid medications (e.g. to manage inflammatory diseases such as lupus)
• Tumours.

(Better Health Channel 2017)

Symptoms of Excessive Cortisol

• Weight gain, especially near the face and abdomen
• Thin, fragile skin
• Slow-healing skin
• Acne
• Facial hair in women
• Irregular menstrual periods.

(Healthdirect 2022)

How can you help a patient deal with excessive or repeated cortisol in the body?

Every person experiences and responds to stress uniquely. For example, genetic differences between individuals may mean that some people experience underactive or overactive stress responses. Certain life events may cause a person who has experienced trauma to have increased stress responses in comparison to a person who has not experienced trauma. Childhood abuse places people at particular risk of stress (Mayo Clinic 2023).

Clearly, it’s essential that health professionals help clients deal with cortisol and stress responses in a healthy manner (Mayo Clinic 2023). You may encourage strategies such as:

• Healthy diet
• Regular exercise
• Adequate sleep
• Relaxation (e.g. yoga)
• Deep breathing
• Meditation
• Hobbies (e.g. music)
• Positive social and family relationships
• Community engagement (e.g. volunteer work)
• Professional counselling.

(Mayo Clinic 2023)

One such form of treatment is cognitive behavioural therapy (CBT). Holdevici and Craciun (2015) researched a CBT intervention that included mindfulness and found that it successfully reduced the participants’ levels of stress (as per the Perceived Stress Scale) and cortisol (as per blood samples) pre- and post-intervention.

Rosnick et al. (2016) similarly highlight the need to support clients in managing stress and raised cortisol levels by utilising CBT. Stress and raised cortisol levels are particularly concerning in later life, as they place older adults at risk of cognitive and physiological deterioration. Rosnick et al. (2016) conclude in their study that ‘CBT augmentation for late-life anxiety disorders’ could improve wellbeing.

Symptoms of Inadequate Cortisol

Having not enough cortisol, on the other hand, may cause:

• Fatigue
• Nausea and vomiting
• Weight loss
• Muscle weakness
• Abdominal pain.

(Healthdirect 2022)

Inadequate cortisol can be treated using corticosteroids. However, corticosteroids are associated with a variety of side effects, including thinning skin, osteoporosis and mood changes.

Conclusion

Evidently, there is a range of ways in which health practitioners can support patients experiencing stress and/or elevated cortisol levels. Health education and health coaching are undeniably crucial in improving quality of life and wellbeing. Appropriate referrals to relevant health professionals (e.g. counsellors, qualified CBT therapists) is another important way to support clients, as is keeping up-to-date with current best practices and research findings.