Glucocorticoid Treatment for Social Phobia

Background

Anxiety disorders have major public health significance and social phobia ranks as the third most common mental health disorder after depression and alcoholism. Even though cognitive-behavioral therapy (CBT) is the most effective non-pharmacological approach to the treatment of social phobia, more than one third of the patients do not respond to treatment, or achieve only partial remission of symptoms. Pharmacotherapy (e.g., SSRIs, benzodiazepines) has been shown to be effective in the acute treatment of social phobia, however, with high rates of relapse when medication is discontinued. In addition, the combination of CBT and medication does not seem to be more beneficial than CBT alone. Consequently, the development of innovative psychobiological approaches combining effective psychotherapy methods with synergizing substance administration is a primary challenge in interdisciplinary research on treatment of social phobia.

In a recent study the investigators found evidence that a pharmacological elevation of glucocorticoid levels reduces fear in patients with social phobia and spider phobia exposed to a phobic stimulus. Furthermore, the investigators have shown that repeated administration of glucocorticoids before exposure to a phobic stimulus leads to an extinction of phobic fear. Also the low-dose administration of cortisone over a month in patients with post-traumatic stress disorder reduces cardinal of symptoms the disorder. Based on these findings, glucocorticoid treatment, in combination with exposure therapy, may help to reduce fear and promote extinction of phobic fear.

In an interdisciplinary research project involving psychology, behavioral pharmacology psychiatry, genetics and neuroimaging the investigators propose to investigate the therapeutic efficacy of combining an exposure-based cognitive-behavioral group therapy (CBGT) with hydrocortisone treatment. The investigators hypothesize that hydrocortisone exerts both acute beneficial effects by reducing fear during exposure, and long-term beneficial effects by facilitating the extinction of phobic fear. Furthermore, the investigators hypothesize differential treatment responses depending on genetic variations in glucocorticoid-related genes (substudy 1). These hypotheses will be tested in a clinical study with 100 patients with mainly speech anxiety who fulfill DSM-IV criteria for a diagnosis of social phobia and 60 patients with spider phobia.

This is the first study aimed at determining the therapeutic efficacy of combining hydrocortisone administration and a short-term exposure-based cognitive-behavioral group therapy for the treatment of social phobic patients with specific speech anxiety and patients with spider phobia. Considering the large number of patients suffering from social phobia, the suggested interdisciplinary project will have important clinical implications for the development of a more effective therapy.