Waking up calmer with hypnosis: Jena Safety Anchor reduces cortisol awakening response and morning heart rate in daily life

Waking up calmer with hypnosis: Jena Safety Anchor reduces cortisol awakening response and morning heart rate in daily life | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Waking up calmer with hypnosis: Jena Safety Anchor reduces cortisol awakening response and morning heart rate in daily life Barbara Schmidt, Michael Riede, Martin Walter, Veronika Engert This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8105165/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract With stress being causally linked to the most frequently occurring mental and physical health problems, effective coping with acute stress is essential for promoting overall well-being and building long-term stress resilience. However, most interventions aimed at improving stress regulation require extended periods of training and practice. In a previous study, we demonstrated that the Jena Safety Anchor —a brief, hypnosis-based intervention—effectively reduced subjective stress responses in a controlled laboratory setting using the Trier Social Stress Test (TSST). The present study examined whether this effect extends to everyday life. A total of 80 participants (n = 40 female) were randomly assigned to either a hypnosis group or a control group (n = 40 per group). Over the course of two weeks, all participants collected saliva samples at home to assess their cortisol awakening response (CAR), an indicator of anticipatory stress, reflecting the body's preparation for expected demands upon waking. Additionally, all participants continuously recorded their heart rate via smartwatches during the two data collection weeks. The hypnosis group received a single guided session of the Jena Safety Anchor at the end of the first week, while the control group came to the laboratory but received no intervention. CAR was measured via three saliva samples taken within one hour after waking on specified days. Morning heart rate was measured between 6 am and 9 am. Results revealed a significant reduction in CAR and morning heart rate in the hypnosis group during the second week, following the intervention. In contrast, no change in CAR and morning heart rate was observed in the control group. These findings show that a single session of the Jena Safety Anchor can effectively reduce physiological stress anticipation in the morning. This points to its potential as a rapid, low-effort intervention for enhancing stress coping and fostering resilience. It offers a promising approach to mental health promotion that is both time-efficient and easily integrated into everyday routines. Health sciences/Health care Biological sciences/Physiology Biological sciences/Psychology Social science/Psychology Hypnosis suggestion cortisol awakening response stress coping long-term effect Figures Figure 1 Figure 2 Introduction Chronic stress is a major risk factor for a range of physical and mental health conditions, including affective and cardiovascular disorders (Schmidt, Sterlemann, & Müller, 2008 ). Coping effectively with acute stress is a key component of mental well-being (Garfin, Thompson, & Holman, 2018 ). The ability to adapt, recover, or even grow stronger in the face of stress, adversity, or challenging circumstances is known as resilience (Luthar, Cicchetti, & Becker, 2000 ; Windle, Bennett, & Noyes, 2011 ; Engert et al., 2021 ; Köhne, Engert, & Rosendahl, 2023 ). Resilience is linked to lower stress levels, reduced negative affect, increased positive affect, and fewer physical symptoms (Smith et al., 2010 ). Given rising stress levels and the burden of stress-related illnesses in modern society (Johnson, 2022 ), there is a pressing need for interventions that enhance stress coping. Stress coping refers to the specific strategies or actions a person uses to manage acute stress. A recent study found that a short, one-week daily audio intervention combining mindfulness and hypnosis reduced subjective stress reactivity more than an active control condition where participants analyzed poems (Slonena & Elkins, 2021 ), highlighting the potential of low-effort approaches. Building on this evidence, we developed the Jena Safety Anchor—a post-hypnotic suggestion designed to promote feelings of safety—and tested its effectiveness in a previous study, showing promising reductions in subjective-emotional stress reactivity following an acute psychosocial stress paradigm (Schmidt, Rohleder & Engert, 2024 ). Hypnosis is a focused state of consciousness that enhances responsiveness to suggestion (Elkins et al., 2015 ). Typically induced and concluded by a therapist, hypnosis often includes suggestions aimed at altering perception or behavior. When given and tested during hypnosis, these are called hypnotic suggestions . Research shows that such suggestions produce specific neural and behavioral effects—for example, imagining a wooden board in front of the eyes reduces brain responses to visual stimuli (Schmidt et al., 2017 ; Franz et al., 2021 ), and imagining wearing earplugs lowers EEG brain responses to sound (Franz et al., 2020 ). To create a sense of safety, participants are guided to vividly imagine a personal safe place—like a sunny beach or a comforting childhood memory—engaging all senses, such as touch, smell, and sound. This imagined safety reduces brain responses to rewards (Schmidt et al., 2020 ; Schmidt & Holroyd, 2021 ) and helps in medical settings by lowering opioid use (Nowak et al., 2020 ) and improving acceptance of treatments such as non-invasive ventilation (Schmidt et al., 2021 ). However, when hypnosis and suggestion occur together, it’s hard to separate the effects of the hypnotic state from the suggestion itself. Post-hypnotic suggestions address this by allowing the effect of the suggestion to be reactivated outside hypnosis. We developed the Jena Safety Anchor , where participants, while hypnotized, wrote the letter "S" for “safety” on a piece of paper. Later, simply seeing or touching this paper reliably reactivated the feeling of safety—an effect that lasted for weeks (Böhmer & Schmidt, 2022 ). In a previous study, we demonstrated that a post-hypnotic suggestion of safety, delivered during a hypnosis session before an acute standardized laboratory stressor, significantly reduced subjective stress (Schmidt, Rohleder & Engert, 2024 ). Sixty participants received hypnosis with the Jena Safety Anchor. Half were instructed to actively use this anchor during the Trier Social Stress Test (TSST; Kirschbaum et al., 1993 ). Results showed that those who engaged the anchor experienced about 50% less subjective stress both immediately after the TSST and throughout a 90-minute recovery period. Notably, none of the participants, regardless of group allocation, exhibited what is conventionally defined as a physiologically significant cortisol response to the TSST (>/= 1.5 nmol/L above baseline levels; Miller et al., 2013 ). We attributed this to the hypnosis session taking place immediately prior to the stress testing, suggesting a possible carry-over effect of hypnosis-induced relaxation. To disentangle hypnosis from non-hypnosis effects, the current study randomly assigned participants to a hypnosis group (hypnosis plus Jena Safety Anchor) or a control group (no hypnosis, no anchor), with the hypnosis session scheduled on a day separate from stress testing. To evaluate the real-world applicability of the safety anchor, participants received smartwatches and at-home salivary sampling kits to track stress biomarkers in daily life. In this manuscript, we focus on the cortisol awakening response (CAR) and morning heart rate as indicators of physiological stress regulation. We test whether the Jena Safety Anchor influences stress anticipation in the morning, thereby clarifying its potential as an everyday stress management tool. The Cortisol Awakening Response (CAR) is a reliable physiological marker that reflects how the body prepares for the upcoming day. It involves a natural rise in cortisol levels within the first 30 to 45 minutes after waking, driven by the hypothalamic-pituitary-adrenal (HPA) axis. As cortisol plays a central role in managing energy, immune response, and stress regulation, CAR provides valuable insight into how the body anticipates and copes with daily demands (Stalder et al., 2025 ). Importantly, the Cortisol Awakening Response (CAR) is highly sensitive to psychological stress. In many studies, altered CAR (either elevated or blunted) has been linked to chronic stress, burnout, anxiety, and psychopathology — in other words, dysregulation in CAR often reflects an overtaxed or maladaptive HPA axis (Chida & Steptoe, 2009 ). In contrast, lower or more regulated CAR is sometimes considered an indicator of balanced HPA axis functioning and adaptive stress regulation. For instance, reductions in CAR have been observed following compassion-based mental training (Engert et al., 2023 ). Because it is easy to measure and closely tied to mental and physical health, CAR is widely used in stress research. Interventions that can lower or stabilize CAR—such as relaxation techniques, mindfulness, or hypnosis—are seen as promising tools for improving stress resilience (Engert, Höhne, & Singer, 2023). To index physiological arousal upon waking, morning HR should be measured immediately after awakening and before getting out of bed or moving, as posture and movement strongly influence HR (Azarbarzin, Ostrowski, Hanly, & Younes, 2014). This period typically reflects the body's transition from sleep to wakefulness, during which the autonomic nervous system becomes more active (Khoury, Sunderajan, & Kaplan, 1992 ). Elevated heart rate during this window, especially when recorded consistently using smartwatches in everyday settings, may indicate heightened sympathetic activity—commonly linked to stress, anxiety, or anticipation of daily demands (Kapogianni, Sideraki, & Anagnostopoulos, 2025 ). Conversely, a lower or stable heart rate may suggest a more relaxed or well-regulated state (Olshansky, Ricci, & Fedorowski, 2023 ). Smartwatches offer a practical and non-invasive way to capture heart rate data in real-life conditions, providing insights into how an individual's body responds to waking. Unlike lab-based measures, these devices allow for long-term tracking and assessment of trends, accounting for variations due to sleep quality, physical activity, or psychological stress (Kapogianni, Sideraki, & Anagnostopoulos, 2025 ). Morning heart rate can correlate with cortisol levels and subjective stress reports, reinforcing its role as a proxy for arousal (Pratap et al., 2020 ). Monitoring morning heart rate can be especially useful for understanding patterns related to mental health, recovery, and daily readiness (Altini & Plews, 2021 ; Speed, Blair, Hamer, & Stamatakis, 2023 ). It can help identify chronic stress or overtraining in athletes (Gleeson, 2002 ) and may serve as an early signal of dysregulation in individuals with anxiety or mood disorders (Siddi et al., 2023 ). The present manuscript focuses on the everyday effects of the Jena Safety Anchor using objective physiological measures in participants’ natural environments. Specifically, participants monitored their heart rate using smartwatches and collected saliva samples to assess the cortisol awakening response (CAR) for one week before and one week after the hypnosis intervention. A control group, which did not receive hypnosis, followed the same protocol. We expect that both CAR and morning heart rate would decrease in the hypnosis group following the intervention, reflecting reduced physiological stress. In contrast, we expect no significant changes in the control group. Materials and Methods Participants A power analysis was conducted using G*power to determine the adequate sample size for our study. We based this power analysis on our main hypothesis, which is the improvement of stress responses from the pre-intervention week to the post-intervention week in the hypnosis group. Meta-analyses on the effect of hypnotic suggestions on mental distress estimate a medium effect of d = .5 (Holler et al., 2021 ). With a power level of .9 and an alpha level of .05, 36 participants are required in the hypnosis group according to G*power (Faul et al., 2007 ). To account for potential participant drop-out, we included 40 participants in each group, resulting in a total of 80 participants. Participants were recruited via mailing lists, postings on social media and in lectures the Medical Faculty of Jena University. A computer-based randomization tool developed at the Jena University Hospital named Parandies was utilized to allocate participants to their respective groups. In each group, there were 20 female and 20 male participants. The mean age of participants was 28.2 years (SD = 9.1 years, range 18–58 years) with no significant difference between groups ( p = .95). Participants were predominantly white Europeans. As recommended for stress studies based on cortisol measurements (Allen et al., 2024), females had to have a natural menstrual cycle to be included. In consequence, participating females did not take any form of hormonal birth control, did not breastfeed and were not peri- or menopausal. General inclusion criteria were that participants are at least 18 years old, do not smoke more than 5 cigarettes per day, do not drink alcohol more than the low-risk dose (U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2020), do not consume other drugs such as cannabis, do not consume steroid-based medication, do not have acute psychological or neurological problems and do not suffer from cardiovascular disease (Funder et al., 2016 ). The local ethics committee at the Jena University Hospital approved the study (2022–2557_3-BO). Informed consent was obtained from all participants. This study was conducted in accordance with the principles of the Declaration of Helsinki. All methods were performed in accordance with the relevant guidelines and regulations. Participants received 90 euros for participation. The study was preregistered at DRKS, https://www.drks.de/search/de/trial/DRKS00031737/details on 21/04/2023. Procedure After participants were screened on the phone for study inclusion, they completed online questionnaires to measure their trait anxiety via the State Trait Anxiety Inventory, (STAI-T; Spielberger et al., 1970 ), chronic stress via the Perceived Stress Scale (PSS-10; Cohen, Kamarck, & Mermelstein, 1983 ) and the Trier Inventory for Chronic Stress (TICS; Schulz, Schlotz, & Becker, 2004 ), sleep quality via the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989 ), general health via the Patient Health Questionnaire (PHQ; Kroenke, Spitzer, & Williams, 2001 ), emotion regulation strategies via the Heidelberg Form for Emotion Regulation Strategies (H-FERST, Izadpanah, Barnow, Neubauer, & Holl, 2019 ), and depression via the Beck Depression Inventory (BDI; Beck et al., 1961 ). Then, an appointment was made to hand out the withings smartwatches and salivettes for home saliva collection. For the cortisol awakening response, according to current recommendations (Stalder et al.,2022), participants had to collect one saliva sample immediately after awakening as well as 30 minutes and 45 minutes later on two days in the first experimental week. Further saliva samples as well as participants’ subjective ratings of stress and wellbeing were collected throughout the remainder of the day; these data will be reported elsewhere. To control whether samples were taken on time, pictures with timestamps as recommended by Stalder et al. ( 2022 ) were collected. Participants stored the collected saliva samples in their home freezers. After the first week, participants returned to the laboratory to hand in their salivettes and receive the second home sampling batch. Participants from the experimental group also took part in the hypnosis session. Data collection happened as in week 1. Participants returned to the lab for one more visit to hand over the second batch of collected saliva samples and return all used equipment. In this final experimental session, we also performed a TSST with physiological and psychological measurements. This data, as well, will be reported elsewhere. Hypnosis session The participants in the hypnosis group received their hypnosis session between the two experimental weeks. Hypnosis was provided by trained medical students, supervised by the first author of the study. The participant and the hypnotist sat down in comfortable chairs and the hypnotist started the hypnosis session with a hypnosis introduction following the Stanford Hypnotic Susceptibility Scale (SHSS; Weitzenhoffer, & Hilgard, 1962 ). To test if participants followed the hypnotic suggestions, the hypnotist used the first item of the SHSS, suggesting that there is a heavy weight in the participant’s right hand. If, in response to this suggestion, the hand sinks downwards, the participant passed the test. Subsequently, the hypnotic suggestion of safety started. The hypnotist guided the participant to imagine that he or she is at a place where he or she feels comfortable and safe. Once this safe place was fully experienced, the participant was instructed to open their eyes and write the letter S for safety on a piece of paper. The hypnotist suggested that every time the participant sees this paper with the letter S on it, folds it and puts it in the pocket, he or she would re-experience the current feeling of safety. Then, the hypnotist ended the hypnotic state. The duration of the hypnosis intervention was about 30 minutes. Please see our Zenodo repository ( https://doi.org/10.5281/zenodo.10561059 ) for the complete wording of the hypnosis intervention. Participants then indicated how safe they feel on a scale from 1 (no change) to 5 (very safe). They also completed the Inventory Scale of Hypnotic Depth (ISHD; Riegel et al., 2018 ) containing 36 items to measure their trance depth. Participants rated each item on a scale from 1 to 4, resulting in a maximal score of 144 for trance depth. Statistical Analysis All statistical analyses were conducted using R (Version 4.4.1; R Core Team, 2025 ). Data were cleaned and prepared for analysis prior to statistical testing. Analysis of variance (ANOVA) was performed to examine group differences, followed by post hoc t -tests where appropriate to identify specific pairwise differences. Statistical significance was set at p .1), that is there were no groups differences in terms of state and trait anxiety (STAI-T; Spielberger et al., 1970 ), perceived stress (PSS-10; Cohen, Kamarck, & Mermelstein, 1983 ), chronic stress (TICS; Schulz, Schlotz, & Becker, 2004 ), sleep quality (PSQI; Buysse et al., 1989 ), general health (PHQ; Kroenke, Spitzer, & Williams, 2001 ), emotion regulation strategies (H-FERST, Izadpanah, Barnow, Neubauer, & Holl, 2019 ), and depression (BDI; Beck et al., 1961 ). Lower cortisol awakening response (CAR) with Jena Safety Anchor Participants collected their CAR saliva samples on two days in the week before and on two days in the week after the hypnosis intervention. We computed the CAR as a difference score between the saliva sample 45 minutes after waking up (S3) and the saliva sample immediately after waking up (S1). An ANOVA on the CAR with between factors group (hypnosis, control) and within factor time (before hypnosis, after hypnosis) revealed a significant main effect of group, F (1,372) = 5.03, p = .03, and a significant interaction of group and time, F (1,222) = 4.63, p = .03. All other effects did not reach significance ( p > .05). Post-hoc t -tests show that groups differed significantly before the hypnosis session in the first week, t (142) = 3.75, p < .001 with higher CAR in the hypnosis group (mean = 5.9 nmol/l) than in the control group (mean = 2.0 nmol/l). After the hypnosis session in the second week, the difference in CAR between groups was no longer significant ( p = .7). The effect size of CAR reduction in the hypnosis group, measured as the difference between the week before and the week after the hypnosis session, was Cohen’s d = .3 indicating a middle-sized effect. Lower morning heart rate with Jena Safety Anchor Participants’ heart rate was continuously recorded using a Withings smartwatch for one week before and one week after the hypnosis intervention. To focus on heart rate in the context of the cortisol awakening response, analyses were restricted to data collected in the morning between 6:00 and 9:00 a.m. Heart rate data were averaged into 10-minute bins. A mixed-design ANOVA with the between-subjects factor group (hypnosis vs. control) and the within-subjects factor time (before vs. after hypnosis) revealed no significant main effects or interaction ( p > .10). Given our a priori interest in potential baseline differences and group-specific changes over time (see preregistration at https://www.drks.de/search/de/trial/DRKS00031737/details ), follow-up t -tests were conducted to further explore the data. Before the hypnosis session, the hypnosis group showed a significantly higher morning heart rate ( M = 74 bpm) than the control group ( M = 71 bpm), t (898) = 3.41, p < .001. After the hypnosis session, this difference was no longer significant ( p = .60). The reduction in morning heart rate within the hypnosis group from pre- to post-session corresponded to a medium effect size (Cohen’s d = 0.6), suggesting a meaningful decrease despite the absence of significant omnibus effects. Hypnotic depth and immediate effect of Jena Safety Anchor in hypnosis session As an indicator of how deep their hypnotic trance was, participants filled in the ISHD (Riegel et al., 2018 ). The mean ISHD score was 95.22 (SD = 16.88), indicating a deep trance state according to Riegel et al. ( 2018 ). Participants rated how safe they felt on a scale from 1 (no change) to 5 (very safe) immediately after the hypnosis session. The mean safety rating after the hypnosis session was 4.5 (SD = 0.8) indicating a strong feeling of safety. The deeper participants’ hypnotic depth measured with the ISHD, the safer participants felt after the hypnosis session, r = .50, p = .001. Discussion In this study, we tested whether one hypnosis session is sufficient to affect different indicators of stress regulation in everyday life. During hypnosis, we installed the Jena Safety Anchor. Participants wrote the letter S for safety on a piece of paper, and the hypnotist suggested that every time they look at this paper, they will feel safe again. The control group did not receive a hypnosis session or a safety anchor. To measure everyday stress regulation, participants collected their saliva samples and heart rate during two days of one week before and during two days of one week after the hypnosis intervention. Our data show a significant effect of the hypnosis intervention on cortisol awakening response, indicating that participants in the hypnosis group exhibited a significant reduction in cortisol levels during the week following the intervention compared with the control group. For morning heart rate, the overall ANOVA did not show significant effects; however, exploratory analyses suggested a decrease in morning heart rate in the hypnosis group after the intervention, whereas the control group showed no comparable change. Furthermore, we observed significant baseline differences between groups in cortisol awakening response (CAR) and morning heart rate, with the hypnosis group showing higher values during the first week. Given that group allocation was performed using a computer-based randomization tool, these differences are likely attributable to chance. It is also possible that the reduction in stress responses in the hypnosis group was more easily achieved due to their initially elevated levels. Importantly, no significant baseline group differences were found for anxiety, stress, depression, or any of the other self-report measures collected prior to the intervention. The results of this study extends previous research that the Jena Safety Anchor produces robust and long-term subjective feelings of safety (Böhmer & Schmidt, 2022 ; Schmidt, 2022 ; Schmidt, Rohleder & Engert, 2024 ). In the present study, we showed that the Jena Safety Anchor is effective in everyday life. These findings indicate that our hypnotherapeutic technique may improve feelings of stress in anticipation of the upcoming day. If such anticipatory stress can be reduced long-term, a hypnotic safety anchor may help promote mental health and establish resilience. Reducing the cortisol awakening response (CAR) and morning heart rate may be linked to beneficial changes in participants' overall physical and psychological health. CAR is a natural rise in cortisol shortly after waking, reflecting hypothalamic-pituitary-adrenal (HPA) axis activity. While a typical CAR supports adaptation to daily demands, both abnormally high and abnormally low CAR have been associated with adverse health outcomes, including stress-related and affective disorders. This inconsistency highlights the importance of interpreting changes in CAR within the study context. In our case, the reduction in CAR is unlikely to indicate heightened stress; rather, it may reflect more efficient stress regulation and resilience, in line with previous interpretations (Engert, Höhne, & Singer, 2023; Stalder et al., 2025 ). Similarly, morning heart rate reflects the state of the autonomic nervous system, particularly the balance between sympathetic (fight or flight) and parasympathetic (rest and digest) activity (Azarbarzin, Ostrowski, Hanly, & Younes, 2014). A consistently elevated morning HR can be a sign of ongoing physiological arousal or poor recovery during sleep, often linked to stress or overtraining (Gleeson, 2002 ). Reducing morning HR may signal enhanced cardiovascular health, improved autonomic balance, and greater recovery capacity (Olshansky, Ricci, & Fedorowski, 2023 ). Together, decreases in CAR and morning HR suggest a more relaxed, well-regulated physiological state. Interventions that lead to such reductions—like relaxation techniques, hypnosis, or mindfulness—may support better stress management, emotional well-being, and thus lead to long-term positive health outcomes for participants. Limitations The study could not be conducted in a fully blind manner. It is not possible to disguise the hypnosis session, so participants knew if they received the hypnosis intervention or not. This awareness may have introduced demand characteristics, potentially influencing the found responses. Conclusion and clinical use Building on previous findings showing that the Jena Safety Anchor effectively reduces subjective stress in acute social stress situations, the current results demonstrate that its benefits extend to everyday life. Specifically, we found that use of the Jena Safety Anchor was associated with significant reductions in both the cortisol awakening response (CAR) and morning heart rate (HR). This suggests that the intervention not only helps in managing acute, high-pressure scenarios but may also promote a more balanced and resilient stress regulation, particularly less anticipatory stress at the beginning of the day, in daily routines. CAR reflects the activity of the hypothalamic-pituitary-adrenal (HPA) axis and is sensitive to chronic stress levels (Stalder et al., 2025 ). Elevated CAR has been linked to psychological strain, anxiety, and impaired well-being. Similarly, a heightened morning HR can be a sign of autonomic dysregulation and an indicator of increasing depression severity (Siddi et al., 2023 ). By decreasing both CAR and morning HR, the Jena Safety Anchor appears to support improved autonomic and neuroendocrine functioning. These findings suggest that practicing the Jena Safety Anchor may help individuals start their day from a more relaxed, regulated physiological state. This makes it a promising tool not only for coping with isolated stressful events, but also for enhancing stress resilience and overall well-being in everyday life. Declarations Author contributions Barbara Schmidt: Conceptualization, Methodology, Software, Formal analysis, Investigation, Resources, Data Curation, Writing - Original Draft, Visualization, Supervision, Project administration Michael Riede: Investigation, Data Curation, Writing – Review and Editing Martin Walter: Methodology, Resources, Writing – Review and Editing, Funding Acquisition Veronika Engert: Conceptualization, Methodology, Resources, Writing – Review and Editing, Supervision, Funding Acquisition Funding The Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN) and the Bundesministerium für Bildung und Forschung (BMBF) funded this research Competing Interest Statement The authors declare no competing interests. Data Availability Statement The datasets generated and analyzed during the current study are available in the Zenodo repository https://zenodo.org/records/17487301 Classification Major: Social Sciences; Minor: Psychological and Cognitive Sciences Acknowledgements We thank Anne Breitkreutz, Anika Schüller, Anna Dorißen, Lukas Richter, Nikolai Taxis, Ondine Anfelder and Sophie Heerwagen for their help with project organization and data collection. References Schmidt, M. V., Sterlemann, V. & Müller, M. B. Chronic stress and individual vulnerability. Ann. N. Y. Acad. Sci. 1148 , 174–183 (2008). Garfin, D. R., Thompson, R. R. & Holman, E. A. Acute stress and subsequent health outcomes: A systematic review. J. Psychosom. Res. 112 , 107–113 (2018). Luthar, S. S., Cicchetti, D. & Becker, B. The construct of resilience: A critical evaluation and guidelines for future work. Child Dev. 71 (3), 543–562. https://doi.org/10.1111/1467-8624.00164 (2000). Windle, G., Bennett, K. M. & Noyes, J. 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The usability of daytime and night-time heart rate dynamics as digital biomarkers of depression severity. Psychol. Med. https://doi.org/10.1017/S0033291723002047 (2023). Advance online publication. Holler, M., Koranyi, S., Strauss, B. & Rosendahl, J. Efficacy of hypnosis in adults undergoing surgical procedures: A meta-analytic update. Clin. Psychol. Rev. 85 , 102001. 10.1016/j.cpr.2021.102001 (2021). Faul, F., Erdfelder, E., Lang, A. G. & Buchner, A. G*power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods . 39 , 175–191 (2007). Allen, A. P., Kennedy, P. J., Cryan, J. F., Dinan, T. G. & Clarke, G. Biological and psychological markers of stress in humans: Focus on the Trier Social Stress Test. Neurosci. Biobehav Rev. 38 , 94–124 (2014). U.S. Department of Health and Human Services & U.S. Department of Agriculture. Dietary Guidelines for Americans, 2020–2025 9th edn (U.S. Government Publishing Office, 2020). https://www.dietaryguidelines.gov/ Funder, J. W. et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metabolism . 101 (5), 1889–1916. https://doi.org/10.1210/jc.2015-4061 (2016). Stalder, T. et al. Evaluation and update of the expert consensus guidelines for the assessment of the cortisol awakening response (CAR). Psychoneuroendocrinology 146 , 105946. https://doi.org/10.1016/j.psyneuen.2022.105946 (2022). Weitzenhoffer, A. M. & Hilgard, E. R. Stanford Hypnotic Susceptibility Scale, form C (Consulting Psychologists, 1962). Riegel, B., Isernhagen, J., Torlopp, C. & Ritterbusch, M. Messung der Trancetiefe mit der deutschen Version der Inventory Scale of Hypnotic Depth. Verhaltenstherapie 28 , 44–46 (2018). R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. (2025). https://www.R-project.org/ Spielberger, C. D., Gorsuch, R. L. & Lushene, R. E. Manual for the State-Trait Anxiety Inventory (Consulting Psychologists, 1970). Cohen, S., Kamarck, T. & Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 24 (4), 385–396. https://doi.org/10.2307/2136404 (1983). Schulz, P., Schlotz, W. & Becker, P. Trierer Inventar zum chronischen Stress (TICS): Manual [Trier Inventory for Chronic Stress: Manual] (Hogrefe, 2004). Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. & Kupfer, D. J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 28 (2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4 (1989). Kroenke, K., Spitzer, R. L. & Williams, J. B. W. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 16 (9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x (2001). Izadpanah, S., Barnow, S., Neubauer, A. B. & Holl, J. Development and validation of the Heidelberg Form for Emotion Regulation Strategies (HFERST): Factor structure, reliability, and validity. Assessment 26 (5), 880–906. https://doi.org/10.1177/1073191117720283 (2019). Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaugh, J. An inventory for measuring depression. Arch. Gen. Psychiatry . 4 (6), 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004 (1961). Riegel, B., Isernhagen, J., Torlopp, C. & Ritterbusch, M. Messung der Trancetiefe mit der deutschen Version der Inventory Scale of Hypnotic Depth. Verhaltenstherapie 28 , 44–46 (2018). Schmidt, B., Rohleder, N. & Engert, V. Post-hypnotic safety suggestion improves stress coping with long-lasting effects. Sci. Rep. 14 , 3548. https://doi.org/10.1038/s41598-024-54071-3 (2024). Schmidt, B. Feeling safe with hypnosis: Eliciting positive feelings during a special state of consciousness. Front. Psychol. 13 , 917139. 10.3389/fpsyg.2022.917139 (2022). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Mar, 2026 Reviews received at journal 02 Mar, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviewers agreed at journal 17 Jan, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviewers agreed at journal 15 Dec, 2025 Reviewers invited by journal 09 Dec, 2025 Editor assigned by journal 09 Dec, 2025 Editor invited by journal 19 Nov, 2025 Submission checks completed at journal 15 Nov, 2025 First submitted to journal 15 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:17:42","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111932,"visible":true,"origin":"","legend":"","description":"","filename":"d3dec8a75bc14c0281da3e79216f94da1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8105165/v1/6e757f0b526a2c8abd0a4b14.xml"},{"id":98245538,"identity":"656a2dd6-973d-4fc8-ba9b-745e65a16df5","added_by":"auto","created_at":"2025-12-15 16:18:03","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":125154,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8105165/v1/2ea3a828bd529c13efe019a0.html"},{"id":98245562,"identity":"c75d9791-97ab-47be-9a85-aab75ce14922","added_by":"auto","created_at":"2025-12-15 16:18:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46434,"visible":true,"origin":"","legend":"\u003cp\u003eParticipants in the hypnosis group showed a significantly reduced cortisol awakening response (CAR) after receiving the Jena Safety Anchor in the hypnosis session compared to participants in the control group.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8105165/v1/1098f5c6d6e271cd84f46626.png"},{"id":98245651,"identity":"ad11047e-b627-4c88-b013-c39a6822f7f1","added_by":"auto","created_at":"2025-12-15 16:18:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":75250,"visible":true,"origin":"","legend":"\u003cp\u003eParticipants in the hypnosis group showed a significantly reduced morning heart rate after receiving the Jena Safety Anchor in the hypnosis session compared to participants in the control group.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8105165/v1/9b55a0f3a19f74646a56cc53.png"},{"id":98434555,"identity":"33878a96-4391-492a-89ce-b919765af32e","added_by":"auto","created_at":"2025-12-17 16:52:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791407,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8105165/v1/c2523081-f101-4b93-9628-433feed67a4c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Waking up calmer with hypnosis: Jena Safety Anchor reduces cortisol awakening response and morning heart rate in daily life","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic stress is a major risk factor for a range of physical and mental health conditions, including affective and cardiovascular disorders (Schmidt, Sterlemann, \u0026amp; M\u0026uuml;ller, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Coping effectively with acute stress is a key component of mental well-being (Garfin, Thompson, \u0026amp; Holman, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The ability to adapt, recover, or even grow stronger in the face of stress, adversity, or challenging circumstances is known as resilience (Luthar, Cicchetti, \u0026amp; Becker, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Windle, Bennett, \u0026amp; Noyes, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Engert et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; K\u0026ouml;hne, Engert, \u0026amp; Rosendahl, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Resilience is linked to lower stress levels, reduced negative affect, increased positive affect, and fewer physical symptoms (Smith et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Given rising stress levels and the burden of stress-related illnesses in modern society (Johnson, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), there is a pressing need for interventions that enhance stress coping. Stress coping refers to the specific strategies or actions a person uses to manage acute stress. A recent study found that a short, one-week daily audio intervention combining mindfulness and hypnosis reduced subjective stress reactivity more than an active control condition where participants analyzed poems (Slonena \u0026amp; Elkins, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), highlighting the potential of low-effort approaches. Building on this evidence, we developed the Jena Safety Anchor\u0026mdash;a post-hypnotic suggestion designed to promote feelings of safety\u0026mdash;and tested its effectiveness in a previous study, showing promising reductions in subjective-emotional stress reactivity following an acute psychosocial stress paradigm (Schmidt, Rohleder \u0026amp; Engert, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHypnosis is a focused state of consciousness that enhances responsiveness to suggestion (Elkins et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Typically induced and concluded by a therapist, hypnosis often includes suggestions aimed at altering perception or behavior. When given and tested during hypnosis, these are called \u003cem\u003ehypnotic suggestions\u003c/em\u003e. Research shows that such suggestions produce specific neural and behavioral effects\u0026mdash;for example, imagining a wooden board in front of the eyes reduces brain responses to visual stimuli (Schmidt et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Franz et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and imagining wearing earplugs lowers EEG brain responses to sound (Franz et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo create a sense of safety, participants are guided to vividly imagine a personal safe place\u0026mdash;like a sunny beach or a comforting childhood memory\u0026mdash;engaging all senses, such as touch, smell, and sound. This imagined safety reduces brain responses to rewards (Schmidt et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Schmidt \u0026amp; Holroyd, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and helps in medical settings by lowering opioid use (Nowak et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and improving acceptance of treatments such as non-invasive ventilation (Schmidt et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, when hypnosis and suggestion occur together, it\u0026rsquo;s hard to separate the effects of the hypnotic state from the suggestion itself. Post-hypnotic suggestions address this by allowing the effect of the suggestion to be reactivated outside hypnosis. We developed the \u003cem\u003eJena Safety Anchor\u003c/em\u003e, where participants, while hypnotized, wrote the letter \"S\" for \u0026ldquo;safety\u0026rdquo; on a piece of paper. Later, simply seeing or touching this paper reliably reactivated the feeling of safety\u0026mdash;an effect that lasted for weeks (B\u0026ouml;hmer \u0026amp; Schmidt, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a previous study, we demonstrated that a post-hypnotic suggestion of safety, delivered during a hypnosis session before an acute standardized laboratory stressor, significantly reduced subjective stress (Schmidt, Rohleder \u0026amp; Engert, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Sixty participants received hypnosis with the Jena Safety Anchor. Half were instructed to actively use this anchor during the Trier Social Stress Test (TSST; Kirschbaum et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Results showed that those who engaged the anchor experienced about 50% less subjective stress both immediately after the TSST and throughout a 90-minute recovery period. Notably, none of the participants, regardless of group allocation, exhibited what is conventionally defined as a physiologically significant cortisol response to the TSST (\u0026gt;/= 1.5 nmol/L above baseline levels; Miller et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). We attributed this to the hypnosis session taking place immediately prior to the stress testing, suggesting a possible carry-over effect of hypnosis-induced relaxation.\u003c/p\u003e\u003cp\u003eTo disentangle hypnosis from non-hypnosis effects, the current study randomly assigned participants to a hypnosis group (hypnosis plus Jena Safety Anchor) or a control group (no hypnosis, no anchor), with the hypnosis session scheduled on a day separate from stress testing. To evaluate the real-world applicability of the safety anchor, participants received smartwatches and at-home salivary sampling kits to track stress biomarkers in daily life. In this manuscript, we focus on the cortisol awakening response (CAR) and morning heart rate as indicators of physiological stress regulation. We test whether the Jena Safety Anchor influences stress anticipation in the morning, thereby clarifying its potential as an everyday stress management tool.\u003c/p\u003e\u003cp\u003eThe Cortisol Awakening Response (CAR) is a reliable physiological marker that reflects how the body prepares for the upcoming day. It involves a natural rise in cortisol levels within the first 30 to 45 minutes after waking, driven by the hypothalamic-pituitary-adrenal (HPA) axis. As cortisol plays a central role in managing energy, immune response, and stress regulation, CAR provides valuable insight into how the body anticipates and copes with daily demands (Stalder et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eImportantly, the Cortisol Awakening Response (CAR) is highly sensitive to psychological stress. In many studies, altered CAR (either elevated or blunted) has been linked to chronic stress, burnout, anxiety, and psychopathology \u0026mdash; in other words, dysregulation in CAR often reflects an overtaxed or maladaptive HPA axis (Chida \u0026amp; Steptoe, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). In contrast, lower or more regulated CAR is sometimes considered an indicator of balanced HPA axis functioning and adaptive stress regulation. For instance, reductions in CAR have been observed following compassion-based mental training (Engert et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Because it is easy to measure and closely tied to mental and physical health, CAR is widely used in stress research. Interventions that can lower or stabilize CAR\u0026mdash;such as relaxation techniques, mindfulness, or hypnosis\u0026mdash;are seen as promising tools for improving stress resilience (Engert, H\u0026ouml;hne, \u0026amp; Singer, 2023).\u003c/p\u003e\u003cp\u003eTo index physiological arousal upon waking, morning HR should be measured immediately after awakening and before getting out of bed or moving, as posture and movement strongly influence HR (Azarbarzin, Ostrowski, Hanly, \u0026amp; Younes, 2014). This period typically reflects the body's transition from sleep to wakefulness, during which the autonomic nervous system becomes more active (Khoury, Sunderajan, \u0026amp; Kaplan, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e1992\u003c/span\u003e). Elevated heart rate during this window, especially when recorded consistently using smartwatches in everyday settings, may indicate heightened sympathetic activity\u0026mdash;commonly linked to stress, anxiety, or anticipation of daily demands (Kapogianni, Sideraki, \u0026amp; Anagnostopoulos, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Conversely, a lower or stable heart rate may suggest a more relaxed or well-regulated state (Olshansky, Ricci, \u0026amp; Fedorowski, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSmartwatches offer a practical and non-invasive way to capture heart rate data in real-life conditions, providing insights into how an individual's body responds to waking. Unlike lab-based measures, these devices allow for long-term tracking and assessment of trends, accounting for variations due to sleep quality, physical activity, or psychological stress (Kapogianni, Sideraki, \u0026amp; Anagnostopoulos, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Morning heart rate can correlate with cortisol levels and subjective stress reports, reinforcing its role as a proxy for arousal (Pratap et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMonitoring morning heart rate can be especially useful for understanding patterns related to mental health, recovery, and daily readiness (Altini \u0026amp; Plews, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Speed, Blair, Hamer, \u0026amp; Stamatakis, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It can help identify chronic stress or overtraining in athletes (Gleeson, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and may serve as an early signal of dysregulation in individuals with anxiety or mood disorders (Siddi et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe present manuscript focuses on the everyday effects of the Jena Safety Anchor using objective physiological measures in participants\u0026rsquo; natural environments. Specifically, participants monitored their heart rate using smartwatches and collected saliva samples to assess the cortisol awakening response (CAR) for one week before and one week after the hypnosis intervention. A control group, which did not receive hypnosis, followed the same protocol. We expect that both CAR and morning heart rate would decrease in the hypnosis group following the intervention, reflecting reduced physiological stress. In contrast, we expect no significant changes in the control group.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eA power analysis was conducted using G*power to determine the adequate sample size for our study. We based this power analysis on our main hypothesis, which is the improvement of stress responses from the pre-intervention week to the post-intervention week in the hypnosis group. Meta-analyses on the effect of hypnotic suggestions on mental distress estimate a medium effect of \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.5 (Holler et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). With a power level of .9 and an alpha level of .05, 36 participants are required in the hypnosis group according to G*power (Faul et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). To account for potential participant drop-out, we included 40 participants in each group, resulting in a total of 80 participants. Participants were recruited via mailing lists, postings on social media and in lectures the Medical Faculty of Jena University. A computer-based randomization tool developed at the Jena University Hospital named Parandies was utilized to allocate participants to their respective groups. In each group, there were 20 female and 20 male participants.\u003c/p\u003e\u003cp\u003eThe mean age of participants was 28.2 years (SD\u0026thinsp;=\u0026thinsp;9.1 years, range 18\u0026ndash;58 years) with no significant difference between groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.95). Participants were predominantly white Europeans. As recommended for stress studies based on cortisol measurements (Allen et al., 2024), females had to have a natural menstrual cycle to be included. In consequence, participating females did not take any form of hormonal birth control, did not breastfeed and were not peri- or menopausal. General inclusion criteria were that participants are at least 18 years old, do not smoke more than 5 cigarettes per day, do not drink alcohol more than the low-risk dose (U.S. Department of Health and Human Services \u0026amp; U.S. Department of Agriculture, 2020), do not consume other drugs such as cannabis, do not consume steroid-based medication, do not have acute psychological or neurological problems and do not suffer from cardiovascular disease (Funder et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The local ethics committee at the Jena University Hospital approved the study (2022\u0026ndash;2557_3-BO). Informed consent was obtained from all participants. This study was conducted in accordance with the principles of the Declaration of Helsinki. All methods were performed in accordance with the relevant guidelines and regulations. Participants received 90 euros for participation. The study was preregistered at DRKS, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.drks.de/search/de/trial/DRKS00031737/details\u003c/span\u003e\u003cspan address=\"https://www.drks.de/search/de/trial/DRKS00031737/details\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e on 21/04/2023.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eAfter participants were screened on the phone for study inclusion, they completed online questionnaires to measure their trait anxiety via the State Trait Anxiety Inventory, (STAI-T; Spielberger et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e1970\u003c/span\u003e), chronic stress via the Perceived Stress Scale (PSS-10; Cohen, Kamarck, \u0026amp; Mermelstein, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1983\u003c/span\u003e) and the Trier Inventory for Chronic Stress (TICS; Schulz, Schlotz, \u0026amp; Becker, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), sleep quality via the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e1989\u003c/span\u003e), general health via the Patient Health Questionnaire (PHQ; Kroenke, Spitzer, \u0026amp; Williams, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), emotion regulation strategies via the Heidelberg Form for Emotion Regulation Strategies (H-FERST, Izadpanah, Barnow, Neubauer, \u0026amp; Holl, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and depression via the Beck Depression Inventory (BDI; Beck et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1961\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThen, an appointment was made to hand out the withings smartwatches and salivettes for home saliva collection. For the cortisol awakening response, according to current recommendations (Stalder et al.,2022), participants had to collect one saliva sample immediately after awakening as well as 30 minutes and 45 minutes later on two days in the first experimental week. Further saliva samples as well as participants\u0026rsquo; subjective ratings of stress and wellbeing were collected throughout the remainder of the day; these data will be reported elsewhere. To control whether samples were taken on time, pictures with timestamps as recommended by Stalder et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) were collected. Participants stored the collected saliva samples in their home freezers.\u003c/p\u003e\u003cp\u003eAfter the first week, participants returned to the laboratory to hand in their salivettes and receive the second home sampling batch. Participants from the experimental group also took part in the hypnosis session. Data collection happened as in week 1. Participants returned to the lab for one more visit to hand over the second batch of collected saliva samples and return all used equipment. In this final experimental session, we also performed a TSST with physiological and psychological measurements. This data, as well, will be reported elsewhere.\u003c/p\u003e\u003cp\u003eHypnosis session\u003c/p\u003e\u003cp\u003eThe participants in the hypnosis group received their hypnosis session between the two experimental weeks. Hypnosis was provided by trained medical students, supervised by the first author of the study. The participant and the hypnotist sat down in comfortable chairs and the hypnotist started the hypnosis session with a hypnosis introduction following the Stanford Hypnotic Susceptibility Scale (SHSS; Weitzenhoffer, \u0026amp; Hilgard, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1962\u003c/span\u003e). To test if participants followed the hypnotic suggestions, the hypnotist used the first item of the SHSS, suggesting that there is a heavy weight in the participant\u0026rsquo;s right hand. If, in response to this suggestion, the hand sinks downwards, the participant passed the test. Subsequently, the hypnotic suggestion of safety started. The hypnotist guided the participant to imagine that he or she is at a place where he or she feels comfortable and safe. Once this safe place was fully experienced, the participant was instructed to open their eyes and write the letter S for safety on a piece of paper. The hypnotist suggested that every time the participant sees this paper with the letter S on it, folds it and puts it in the pocket, he or she would re-experience the current feeling of safety. Then, the hypnotist ended the hypnotic state. The duration of the hypnosis intervention was about 30 minutes. Please see our Zenodo repository (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5281/zenodo.10561059\u003c/span\u003e\u003cspan address=\"10.5281/zenodo.10561059\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) for the complete wording of the hypnosis intervention. Participants then indicated how safe they feel on a scale from 1 (no change) to 5 (very safe). They also completed the Inventory Scale of Hypnotic Depth (ISHD; Riegel et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) containing 36 items to measure their trance depth. Participants rated each item on a scale from 1 to 4, resulting in a maximal score of 144 for trance depth.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted using \u003cem\u003eR\u003c/em\u003e (Version 4.4.1; R Core Team, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Data were cleaned and prepared for analysis prior to statistical testing. Analysis of variance (ANOVA) was performed to examine group differences, followed by post hoc \u003cem\u003et\u003c/em\u003e-tests where appropriate to identify specific pairwise differences. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05 for all tests. Data are available via \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://zenodo.org/records/17487301\u003c/span\u003e\u003cspan address=\"https://zenodo.org/records/17487301\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eGroup differences\u003c/h2\u003e\u003cp\u003eThe two experimental groups did not differ in any of the pre-study scales (p\u0026thinsp;\u0026gt;\u0026thinsp;.1), that is there were no groups differences in terms of state and trait anxiety (STAI-T; Spielberger et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e1970\u003c/span\u003e), perceived stress (PSS-10; Cohen, Kamarck, \u0026amp; Mermelstein, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1983\u003c/span\u003e), chronic stress (TICS; Schulz, Schlotz, \u0026amp; Becker, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), sleep quality (PSQI; Buysse et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e1989\u003c/span\u003e), general health (PHQ; Kroenke, Spitzer, \u0026amp; Williams, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), emotion regulation strategies (H-FERST, Izadpanah, Barnow, Neubauer, \u0026amp; Holl, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and depression (BDI; Beck et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e1961\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLower cortisol awakening response (CAR) with Jena Safety Anchor\u003c/h2\u003e\u003cp\u003e Participants collected their CAR saliva samples on two days in the week before and on two days in the week after the hypnosis intervention. We computed the CAR as a difference score between the saliva sample 45 minutes after waking up (S3) and the saliva sample immediately after waking up (S1). An ANOVA on the CAR with between factors \u003cem\u003egroup\u003c/em\u003e (hypnosis, control) and within factor \u003cem\u003etime\u003c/em\u003e (before hypnosis, after hypnosis) revealed a significant main effect of group, \u003cem\u003eF\u003c/em\u003e(1,372)\u0026thinsp;=\u0026thinsp;5.03, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.03, and a significant interaction of group and time, \u003cem\u003eF\u003c/em\u003e(1,222)\u0026thinsp;=\u0026thinsp;4.63, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.03. All other effects did not reach significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). Post-hoc \u003cem\u003et\u003c/em\u003e-tests show that groups differed significantly before the hypnosis session in the first week, \u003cem\u003et\u003c/em\u003e(142)\u0026thinsp;=\u0026thinsp;3.75, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001 with higher CAR in the hypnosis group (mean\u0026thinsp;=\u0026thinsp;5.9 nmol/l) than in the control group (mean\u0026thinsp;=\u0026thinsp;2.0 nmol/l). After the hypnosis session in the second week, the difference in CAR between groups was no longer significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.7). The effect size of CAR reduction in the hypnosis group, measured as the difference between the week before and the week after the hypnosis session, was Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.3 indicating a middle-sized effect.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eLower morning heart rate with Jena Safety Anchor\u003c/h3\u003e\n\u003cp\u003eParticipants\u0026rsquo; heart rate was continuously recorded using a Withings smartwatch for one week before and one week after the hypnosis intervention. To focus on heart rate in the context of the cortisol awakening response, analyses were restricted to data collected in the morning between 6:00 and 9:00 a.m. Heart rate data were averaged into 10-minute bins. A mixed-design ANOVA with the between-subjects factor \u003cem\u003egroup\u003c/em\u003e (hypnosis vs. control) and the within-subjects factor \u003cem\u003etime\u003c/em\u003e (before vs. after hypnosis) revealed no significant main effects or interaction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.10).\u003c/p\u003e\u003cp\u003eGiven our a priori interest in potential baseline differences and group-specific changes over time (see preregistration at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.drks.de/search/de/trial/DRKS00031737/details\u003c/span\u003e\u003cspan address=\"https://www.drks.de/search/de/trial/DRKS00031737/details\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), follow-up \u003cem\u003et\u003c/em\u003e-tests were conducted to further explore the data. Before the hypnosis session, the hypnosis group showed a significantly higher morning heart rate (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;74 bpm) than the control group (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;71 bpm), \u003cem\u003et\u003c/em\u003e(898)\u0026thinsp;=\u0026thinsp;3.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001. After the hypnosis session, this difference was no longer significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.60). The reduction in morning heart rate within the hypnosis group from pre- to post-session corresponded to a medium effect size (Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.6), suggesting a meaningful decrease despite the absence of significant omnibus effects.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eHypnotic depth and immediate effect of Jena Safety Anchor in hypnosis session\u003c/h3\u003e\n\u003cp\u003eAs an indicator of how deep their hypnotic trance was, participants filled in the ISHD (Riegel et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The mean ISHD score was 95.22 (SD\u0026thinsp;=\u0026thinsp;16.88), indicating a deep trance state according to Riegel et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants rated how safe they felt on a scale from 1 (no change) to 5 (very safe) immediately after the hypnosis session. The mean safety rating after the hypnosis session was 4.5 (SD\u0026thinsp;=\u0026thinsp;0.8) indicating a strong feeling of safety. The deeper participants\u0026rsquo; hypnotic depth measured with the ISHD, the safer participants felt after the hypnosis session, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we tested whether one hypnosis session is sufficient to affect different indicators of stress regulation in everyday life. During hypnosis, we installed the Jena Safety Anchor. Participants wrote the letter S for safety on a piece of paper, and the hypnotist suggested that every time they look at this paper, they will feel safe again. The control group did not receive a hypnosis session or a safety anchor. To measure everyday stress regulation, participants collected their saliva samples and heart rate during two days of one week before and during two days of one week after the hypnosis intervention. Our data show a significant effect of the hypnosis intervention on cortisol awakening response, indicating that participants in the hypnosis group exhibited a significant reduction in cortisol levels during the week following the intervention compared with the control group. For morning heart rate, the overall ANOVA did not show significant effects; however, exploratory analyses suggested a decrease in morning heart rate in the hypnosis group after the intervention, whereas the control group showed no comparable change.\u003c/p\u003e\u003cp\u003eFurthermore, we observed significant baseline differences between groups in cortisol awakening response (CAR) and morning heart rate, with the hypnosis group showing higher values during the first week. Given that group allocation was performed using a computer-based randomization tool, these differences are likely attributable to chance. It is also possible that the reduction in stress responses in the hypnosis group was more easily achieved due to their initially elevated levels. Importantly, no significant baseline group differences were found for anxiety, stress, depression, or any of the other self-report measures collected prior to the intervention.\u003c/p\u003e\u003cp\u003eThe results of this study extends previous research that the Jena Safety Anchor produces robust and long-term subjective feelings of safety (B\u0026ouml;hmer \u0026amp; Schmidt, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Schmidt, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Schmidt, Rohleder \u0026amp; Engert, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In the present study, we showed that the Jena Safety Anchor is effective in everyday life. These findings indicate that our hypnotherapeutic technique may improve feelings of stress in anticipation of the upcoming day. If such anticipatory stress can be reduced long-term, a hypnotic safety anchor may help promote mental health and establish resilience.\u003c/p\u003e\u003cp\u003eReducing the cortisol awakening response (CAR) and morning heart rate may be linked to beneficial changes in participants' overall physical and psychological health. CAR is a natural rise in cortisol shortly after waking, reflecting hypothalamic-pituitary-adrenal (HPA) axis activity. While a typical CAR supports adaptation to daily demands, both abnormally high and abnormally low CAR have been associated with adverse health outcomes, including stress-related and affective disorders. This inconsistency highlights the importance of interpreting changes in CAR within the study context. In our case, the reduction in CAR is unlikely to indicate heightened stress; rather, it may reflect more efficient stress regulation and resilience, in line with previous interpretations (Engert, H\u0026ouml;hne, \u0026amp; Singer, 2023; Stalder et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilarly, morning heart rate reflects the state of the autonomic nervous system, particularly the balance between sympathetic (fight or flight) and parasympathetic (rest and digest) activity (Azarbarzin, Ostrowski, Hanly, \u0026amp; Younes, 2014). A consistently elevated morning HR can be a sign of ongoing physiological arousal or poor recovery during sleep, often linked to stress or overtraining (Gleeson, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Reducing morning HR may signal enhanced cardiovascular health, improved autonomic balance, and greater recovery capacity (Olshansky, Ricci, \u0026amp; Fedorowski, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTogether, decreases in CAR and morning HR suggest a more relaxed, well-regulated physiological state. Interventions that lead to such reductions\u0026mdash;like relaxation techniques, hypnosis, or mindfulness\u0026mdash;may support better stress management, emotional well-being, and thus lead to long-term positive health outcomes for participants.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe study could not be conducted in a fully blind manner. It is not possible to disguise the hypnosis session, so participants knew if they received the hypnosis intervention or not. This awareness may have introduced demand characteristics, potentially influencing the found responses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eConclusion and clinical use\u003c/h2\u003e\u003cp\u003eBuilding on previous findings showing that the Jena Safety Anchor effectively reduces subjective stress in acute social stress situations, the current results demonstrate that its benefits extend to everyday life. Specifically, we found that use of the Jena Safety Anchor was associated with significant reductions in both the cortisol awakening response (CAR) and morning heart rate (HR). This suggests that the intervention not only helps in managing acute, high-pressure scenarios but may also promote a more balanced and resilient stress regulation, particularly less anticipatory stress at the beginning of the day, in daily routines.\u003c/p\u003e\u003cp\u003eCAR reflects the activity of the hypothalamic-pituitary-adrenal (HPA) axis and is sensitive to chronic stress levels (Stalder et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Elevated CAR has been linked to psychological strain, anxiety, and impaired well-being. Similarly, a heightened morning HR can be a sign of autonomic dysregulation and an indicator of increasing depression severity (Siddi et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). By decreasing both CAR and morning HR, the Jena Safety Anchor appears to support improved autonomic and neuroendocrine functioning.\u003c/p\u003e\u003cp\u003eThese findings suggest that practicing the Jena Safety Anchor may help individuals start their day from a more relaxed, regulated physiological state. This makes it a promising tool not only for coping with isolated stressful events, but also for enhancing stress resilience and overall well-being in everyday life.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarbara Schmidt:\u003c/strong\u003e Conceptualization, Methodology, Software, Formal analysis, Investigation, Resources, Data Curation, Writing - Original Draft, Visualization, Supervision, Project administration \u003cstrong\u003eMichael Riede:\u003c/strong\u003e Investigation, Data Curation, Writing – Review and Editing \u003cstrong\u003eMartin Walter:\u003c/strong\u003e Methodology, Resources, Writing – Review and Editing, Funding Acquisition \u003cstrong\u003eVeronika Engert:\u003c/strong\u003e Conceptualization, Methodology, Resources, Writing – Review and Editing, Supervision, Funding Acquisition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (BGN) and the Bundesministerium für Bildung und Forschung (BMBF) funded this research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available in the Zenodo repository https://zenodo.org/records/17487301\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClassification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMajor: Social Sciences; Minor: Psychological and Cognitive Sciences\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Anne Breitkreutz, Anika Schüller, Anna Dorißen, Lukas Richter, Nikolai Taxis, Ondine Anfelder and Sophie Heerwagen for their help with project organization and data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchmidt, M. 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Psychol.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e, 917139. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2022.917139\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2022.917139\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypnosis, suggestion, cortisol awakening response, stress, coping, long-term effect","lastPublishedDoi":"10.21203/rs.3.rs-8105165/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8105165/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWith stress being causally linked to the most frequently occurring mental and physical health problems, effective coping with acute stress is essential for promoting overall well-being and building long-term stress resilience. However, most interventions aimed at improving stress regulation require extended periods of training and practice. In a previous study, we demonstrated that the \u003cem\u003eJena Safety Anchor\u003c/em\u003e\u0026mdash;a brief, hypnosis-based intervention\u0026mdash;effectively reduced subjective stress responses in a controlled laboratory setting using the Trier Social Stress Test (TSST). The present study examined whether this effect extends to everyday life.\u003c/p\u003e\u003cp\u003eA total of 80 participants (n\u0026thinsp;=\u0026thinsp;40 female) were randomly assigned to either a hypnosis group or a control group (n\u0026thinsp;=\u0026thinsp;40 per group). Over the course of two weeks, all participants collected saliva samples at home to assess their cortisol awakening response (CAR), an indicator of anticipatory stress, reflecting the body's preparation for expected demands upon waking. Additionally, all participants continuously recorded their heart rate via smartwatches during the two data collection weeks. The hypnosis group received a single guided session of the \u003cem\u003eJena Safety Anchor\u003c/em\u003e at the end of the first week, while the control group came to the laboratory but received no intervention. CAR was measured via three saliva samples taken within one hour after waking on specified days. Morning heart rate was measured between 6 am and 9 am.\u003c/p\u003e\u003cp\u003eResults revealed a significant reduction in CAR and morning heart rate in the hypnosis group during the second week, following the intervention. In contrast, no change in CAR and morning heart rate was observed in the control group.\u003c/p\u003e\u003cp\u003eThese findings show that a single session of the \u003cem\u003eJena Safety Anchor\u003c/em\u003e can effectively reduce physiological stress anticipation in the morning. This points to its potential as a rapid, low-effort intervention for enhancing stress coping and fostering resilience. It offers a promising approach to mental health promotion that is both time-efficient and easily integrated into everyday routines.\u003c/p\u003e","manuscriptTitle":"Waking up calmer with hypnosis: Jena Safety Anchor reduces cortisol awakening response and morning heart rate in daily life","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-15 16:09:01","doi":"10.21203/rs.3.rs-8105165/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-03T06:12:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T11:16:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212576219749746696328664427508406784919","date":"2026-02-17T08:10:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-14T17:26:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66569022692278964882605753615338512990","date":"2026-01-17T14:46:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192060960920304968522971390056160750565","date":"2026-01-05T16:36:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272351389670712764422704972218202035377","date":"2025-12-15T19:58:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-09T17:37:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T17:26:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-19T18:40:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-15T17:34:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-11-15T17:32:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ed8c3ec-a9d9-46f0-8ec9-13cae602f968","owner":[],"postedDate":"December 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59551724,"name":"Health sciences/Health care"},{"id":59551725,"name":"Biological sciences/Physiology"},{"id":59551726,"name":"Biological sciences/Psychology"},{"id":59551727,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-04T05:23:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-15 16:09:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8105165","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8105165","identity":"rs-8105165","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}