Review Effects of appraisal and coping on the neuroendocrine response to extreme stress Miranda Olff a, * , Willie Langeland a,b , Berthold P.R. Gersons a a Department of Psychiatry, Center for Psychological Trauma, Academic Medical Center/De Meren, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands b Department of Psychiatry, Vrije University Amsterdam, Amsterdam, The Netherlands Received 11 August 2004; revised 6 December 2004; accepted 20 December 2004 Abstract Although many people are exposed to extreme stress, only some of them develop psychobiological disturbances that can lead to posttraumatic stress disorder (PTSD) or other posttrauma psychopathology. This paper examines the effects of different types of appraisal and coping to find clues to how individuals differ in their neuroendocrine responses to extreme stress. It proposes a conceptual model for components of the adult response to stressors. Threat appraisal and defensive coping may play crucial roles in determining the neuroendocrine response to trauma with potential mental health consequences, particularly PTSD. q 2005 Elsevier Ltd. All rights reserved. Keywords: Stress; Trauma; Posttraumatic stress disorder; Cognitive appraisal; Coping; Cortisol Contents 1. Introduction ........................................................................... 458 2. The neuroendocrine stress response .......................................................... 458 3. Stress-coping .......................................................................... 459 4. Cognitive appraisal and neuroendocrine responses ............................................... 459 5. Coping and neuroendocrine responses ........................................................ 460 6. A conceptual model ..................................................................... 462 7. Future research directions ................................................................. 464 8. Concluding remarks ..................................................................... 464 References ............................................................................ 405 0149-7634/$ - see front matter q 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.neubiorev.2004.12.006 Neuroscience and Biobehavioral Reviews 29 (2005) 457–467 www.elsevier.com/locate/neubiorev * Corresponding author. Tel.: C31 20 566 2356; fax: C31 20 691 9019. E-mail address: m.olff@amc.uva.nl (M. Olff).