Why Does Psychotherapy Work and for Whom? Hormonal Answers

Susanne Fischer, Sigal Zilcha-Mano

Research output: Contribution to journalReview articlepeer-review


The questions of for whom and why psychotherapy is effective have been the focus of five decades of research. Most of this knowledge is based on self-report measures. Following the biopsychosocial model of mental disorders, this article explores the potential of hormones in answering these questions. The literature on cortisol, oxytocin, and oestradiol in psychotherapy was systematically searched, focusing on (a) baseline hormonal predictors of who may benefit from psychotherapy and (b) hormonal changes as indicators of therapeutic change. The search was limited to depression and anxiety disorders. In sum, the findings show that, of all three hormones, the role of cortisol is most established and that both cortisol and oxytocin are implicated in psychotherapy, although a causal role is still waiting to be demonstrated. Moreover, there is a differential role of hormones in the psychotherapy of depression versus anxiety. The directions of research mapped in this article may elucidate how psychotherapy can be selected to match patients’ endocrine states and how hormonal levels can be manipulated to improve outcomes.

Original languageEnglish
Article number1361
Issue number6
StatePublished - 9 Jun 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • alliance
  • cognitive behavioural therapy
  • cortisol
  • oestradiol
  • oxytocin
  • psychotherapy

ASJC Scopus subject areas

  • General Biochemistry, Genetics and Molecular Biology
  • Medicine (miscellaneous)


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