Examining the Impact of a Resilience-Based Hope Intervention on Pain-Evoked Cortisol Response

Temporomandibular disorder (TMD) is an orofacial pain condition often resulting in functional impairment and pain-related disability. Given the relationship between stress and pain in TMD, it has been suggested that dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis (e.g., cortisol responsivity) could contribute to the onset and maintenance of the condition. Research has shown that therapies to control pain and stress can improve quality of life in patients with persistent pain, with recent evidence supporting resilience as a potential target of intervention. However, no studies have systematically examined whether a resilience intervention has efficacy in modulating neuroendocrine functioning in TMD. Therefore, the primary objective of this pilot study was to investigate the effects of a resilience-based hope intervention on pain-evoked cortisol levels in individuals with TMD. Twenty-nine participants were randomized to a 3-session intervention intended to increase hope or a control intervention targeting pain and stress education. Prior to and after the intervention, participants attended two experimental sessions whereby salivary cortisol was obtained after the induction of a painful, cold-water procedure. While there were no intervention group differences in pain-evoked cortisol response, greater situational and dispositional hope were associated with lower levels of cortisol. Overall, findings suggest that positive emotional resources may attenuate heightened neuroendocrine activity; however, further research is needed to determine the physiological benefits of resilience-oriented therapies.