Doctoral candidate Liza Hinchey and advisor Francesca Pernice receive $10,000 grant from the Wayne State University Social Sciences Research Support Program

head shot of Liza Hunchey
Liza Hinchey

Liza Hinchey, a doctoral candidate in counseling psychology, and her advisor Francesca Pernice, associate professor of educational psychology and coordinator of the counseling psychology program in the Wayne State University College of Education, were recently awarded $10,000 from the Wayne State University Social Sciences Research Support program. The grant will support their research study, “Cortisol Response to Psychosocial Stress Following Trauma Exposure: The Role of Subjective Perceptions of Trauma.” 

Recent evidence indicates cortisol levels are lower in people with post-traumatic stress syndrome (PTSD) and that administering cortisol in pill or intravenous form may be a beneficial short-term treatment for this population. Despite these successes, limitations in previous studies have prevented the expansion of these therapies to larger populations. In cortisol studies, trauma is often measured using checklists of potentially traumatic events; however, subjective perceptions of trauma are more reliably associated with trauma-related symptoms. This limited definition of trauma leads to inconclusive results regarding whether those who have experienced trauma and resulting symptoms — but do not meet the criteria for a PTSD diagnosis — also exhibit lower cortisol levels than non-traumatized individuals. If so, a broader population may also benefit from cortisol treatments.  

head shot of Pernice
Francesca Pernice, Ph.D.

Hinchey and Pernice are evaluating whether perceiving experiences as subjectively traumatic is associated with lower cortisol levels, regardless of diagnostic status.  

“This project is also part of our ongoing aim to expand how trauma is defined in research —particularly biological research,” said Hinchey. “Our goals include improving the accuracy of trauma measurement in medical and psychological research and empowering participants by capturing the nuance of their experiences.” 

Sixty to 80% of the general population will experience a potentially traumatic event, but only about 8% will develop PTSD. Limiting cortisol treatments to those with PTSD may prevent most of the population from accessing a beneficial treatment. There is evidence of a link between exposure to interpersonal trauma — regardless of PTSD status — and low cortisol, but results are inconclusive and must be clarified before widely investigating these treatments.  

Another complication is that treatments for trauma-related disorders such as PTSD and anxiety remain largely focused on exposure-based psychotherapies and long-term psychopharmacological interventions. Treatments are effective if completed, but dropout rates from exposure therapy treatments are as high as 80%. Because many patients are uninterested in ongoing pharmacological treatments, more options remain necessary. Understanding the role of trauma in relation to biological symptoms, such as cortisol reactivity, may allow researchers to target specific factors associated with mental health outcomes, expand use of cortisol treatments and improve clinical treatment across multiple trauma-related disorders.  

“This study addresses key problems in the fields of psychology, psychiatry and trauma research, including the need to identify biomarkers of trauma in the early stages of trauma-related disorders and the need to understand the underlying mechanisms through which trauma impacts our physiology so more effective treatments can be developed,” said Hinchey. “We also plan to shift current trauma research paradigms by including subjective definitions of trauma rather than only measuring the presence or absence of traumatic events — an approach taken by many trauma screenings and prior studies. We hope a more complete definition of trauma that includes objective and subjective measures will clarify inconsistent findings in cortisol reactivity research.”  

Inconsistent results have been a barrier to progress and prevented use of a blunted cortisol response as a biomarker of risk for trauma-related disorders, including PTSD and anxiety. Clarifying mechanisms through which trauma may impact cortisol response may allow researchers to assess risk for HPA axis dysfunction earlier based on perception of traumatic events and reveal biomarkers of trauma-related pathology that can be used in clinical and research settings to further understanding of these disorders.  

The project’s long-term goals also include improving health equity and access to quality health care. Decisions regarding experiences that “count as trauma” have historically been made by those in positions of power and privilege. The psychology field has only recently recognized the potentially traumatic impact of racial and/or culturally based discrimination.  

“Because of historically limited classifications of trauma, people who define trauma differently than majority groups may have lower chances of accessing appropriate diagnoses and treatments,” said Pernice. “Expanding clinical and academic definitions of trauma by incorporating subjective perceptions of events promotes a methodology that empowers individuals, makes space for definitions of trauma from all social and community contexts, and improves equity of care.”  

Hinchey and Pernice say if they are correct, the project may also provide justification for clinical trials investigating the efficacy of cortisol as a pharmaceutical component of integrative treatments for trauma-related symptoms across diagnoses.  

“Many people experience distressing trauma-related symptoms while not meeting the required number of criteria to be officially diagnosed with PTSD,” said Pernice. “Their distress is still real and deserving of empirically supported treatment.”  

Greater insight into potential cortisol dysregulation in this population may support the use of supplementary cortisol as a treatment option for a much wider group, thus improving access to effective mental health care. Because of the high dropout rates in many traditional treatments for trauma and PTSD (e.g., exposure therapy), improvements to these treatments may also result in higher therapy completion rates, subsequently improving quality of care and promoting successful treatment outcomes. Cortisol (e.g., hydrocortisone) is also an inexpensive treatment option, making it an ideal addition to existing therapies, particularly for those with limited access to quality health care.  

The first wave of data collection for the project began in February 2022 and ran through June. With this new funding, data collection continued beginning in September. Researchers anticipate finishing the project by September 2023.   

Investigators noted that collaboration plays an important role in completion of their study. 

“Dr. Alana Conti in the Wayne State School of Medicine has generously partnered with us and will be offering her wet lab space to analyze salivary cortisol samples collected from our participants,” said Hinchey. “This will allow graduate and undergraduate research team members to gain valuable hands-on experience working with biological samples.”  

“We are grateful for our team of research assistants Vivian Truong, Adelina Gjoni, Yousif Tatar, Sadia Farha, Kate Woo, Erik Sofroni, Joseph Genna, Rosa De La O, Asal Haddad and Malek Shalabi,” said Pernice. “This project and funding would not be possible without their hard work, curiosity and dedication.”  

Funding for this program is provided by Wayne State University’s Office of the Vice President for Research through the inaugural Social Science Research Support Program. This annual program supports research, creative and scholarly projects that engage the social sciences in carrying out the university's research mission. 

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