social phobia; anxiety disorder; cognitive-behavioral therapy; hydrocortisone; pharmacology; cortisol; hypothalamic-pituitary-adrenal axis; psychotherapy; anxiety
Soravia Leila M, Orosz Ariane, Schwab Simon, Nakataki Masahito, Wiest Roland, Federspiel Andrea (2016), CBT reduces CBF: cognitive-behavioral therapy reduces cerebral blood flow in fear-relevant brain regions in spider phobia., in Brain and behavior
, 6(9), 00510-00510.
Soravia Leila M, Witmer Joëlle S, Schwab Simon, Nakataki Masahito, Dierks Thomas, Wiest Roland, Henke Katharina, Federspiel Andrea, Jann Kay (2016), Prestimulus default mode activity influences depth of processing and recognition in an emotional memory task., in Human brain mapping
, 37(3), 924-32.
Soravia Leila M, Heinrichs Markus, Winzeler Livia, Fisler Melanie, Schmitt Wolfgang, Horn Helge, Dierks Thomas, Strik Werner, Hofmann Stefan G, de Quervain Dominique J-F (2014), Glucocorticoids enhance in vivo exposure-based therapy of spider phobia., in Depression and anxiety
, 31(5), 429-35.
Fisler Melanie, Federspiel Andrea, Horn Helge, Dierks Thomas, Schmitt Wolfgang, Wiest Roland, de Quervain Dominique, Soravia Leila Maria (2014), Pinpointing regional surface distortions of the amygdala in patients with spider phobia.., 1(1)., in Journal of Psychiatry and Brain Functions
, 1(1), 1-7.
Fisler Melanie S, Federspiel Andrea, Horn Helge, Dierks Thomas, Schmitt Wolfgang, Wiest Roland, de Quervain Dominique J-F, Soravia Leila M (2013), Spider phobia is associated with decreased left amygdala volume: a cross-sectional study., in BMC psychiatry
, 13, 70-70.
Soravia Leila Maria, de Quervain Dominique J.-F. (2012), Cortisol, in Stefan Hofmann (ed.), Wiley-Blackwell, Wiley Series in Clinical Psychology, USA, 109-122.
Nakataki Masahito, Soravia Leila M, Schwab Simon, Horn Helge, Dierks Thomas, Strik Werner, Wiest Roland, Heinrichs Markus, de Quervain Dominique J-F, Federspiel Andrea, Morishima Yosuke, Glucocorticoid Administration Improves Aberrant Fear-Processing Networks in Spider Phobia., in Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
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 we 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, we have shown that repeated administration of glucocorticoids before exposure to a phobic stimulus leads to an extinction of phobic fear. 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, and genetics we propose to investigate the therapeutic efficacy of combining an exposure-based cognitive-behavioral group therapy (CBGT) with hydrocortisone treatment. We 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. These hypotheses will be tested in a clinical study with 100 patients who fulfill DSM-IV criteria for a diagnosis of social phobia. Patients will be randomly assigned to oral administration of either hydrocortisone (20 mg) or placebo 50 min before 5 weekly CBGT sessions. Psychopathological symptoms and stress reactivity will be assessed by psychometric and endocrine parameters before, during and after CBGT therapy.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 patients with social 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.