Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, with the consequent hypercortisolism, is one of the most consistent findings in chronic stress and depression. The stress response will depend on characteristics of stressors, their subjective appraisal and the resulting coping strategies. The aim of this study was to evaluate the efficacy of cognitive therapy (CT) in the treatment of a chronic stress condition, such as generalized anxiety disorder (GAD), as it would be reflected through both psychological and biological parameters. For this purpose, a group of outpatients with GAD were treated with CT for up to a maximum of 24 sessions. In order to assess psychological and biological changes, anxiety-related symptoms were evaluated according to the Hamilton Anxiety Rating Scale (HAM-A), and the HPA function was determined through assessment of circulating cortisol levels.

Upon completion of the treatment, a significant decrease in HAM-A scores, along with significant changes in plasma cortisol levels, were observed in treated subjects. These observations contribute to demonstrate that CT may be effective to treat a chronic stress disorder, such as GAD, as it was observed at both psychological and biological levels, and moreover, this could represent an effective approach to treat hypercortisolism due to hyperactivity of the HPA axis. Therapeutic and preventive strategies will also be discussed.