The psychology of HPA axis activation: Examining subjective emotional distress and control in a phobic fear exposure model

Stefanie E. Mayer, Michael Snodgrass, Israel Liberzon, Hedieh Briggs, George C. Curtis, James L. Abelson

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


The HPA axis plays a key role in mediating the effects of “stress” on health, but clarifying mechanisms requires an understanding of psycho-biological linkages. There has long been an implicit assumption that subjective emotional distress (e.g., fear) should activate the HPA axis. Although this assumption was challenged 25 years ago (Curtis, 1976), laboratory studies in humans are limited. In this study we sought to replicate Curtis’ findings and extend it by investigating if presence or absence of stressor control shapes HPA axis reactivity in a phobic fear exposure model. We recruited 19–45-year-old specific phobia participants (n = 32 spider/snake phobia; n = 14 claustrophobia) and gradually exposed them to their feared object or situation while measuring hormonal (ACTH and cortisol) and subjective (emotional distress, perceived control) responses. Utilizing a dyadic yoked design, we compared HPA reactivity when the pace of exposure was controlled by participants to identical exposure given to matched participants in the absence of control. Results showed that phobic fear exposure generated intense emotional distress without a corresponding increase in HPA axis activity. Although our actual manipulation of control failed to impact HPA responses, perceived control during exposure was associated with lower cortisol, an effect that was moderated by actual availability of stressor control. Our findings replicate Curtis‘ findings and challenge the still common but unsupported assumption that HPA axis activity reflects subjective distress. These results also highlight the importance of both perceived and actual aspects of stressor control in understanding what is truly “stressful” to the HPA axis system.

Original languageEnglish (US)
Pages (from-to)189-198
Number of pages10
StatePublished - Aug 2017


  • ACTH
  • Control
  • Cortisol
  • Exposure
  • Fear
  • Phobia
  • Stress context

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Endocrine and Autonomic Systems
  • Psychiatry and Mental health
  • Biological Psychiatry


Dive into the research topics of 'The psychology of HPA axis activation: Examining subjective emotional distress and control in a phobic fear exposure model'. Together they form a unique fingerprint.

Cite this