Endogenous testosterone levels are predictive of symptom reduction with exposure therapy in social anxiety disorder

PSYCHONEUROENDOCRINOLOGY

卷:115

Article

Hutschemaekers, M. H. M.^1,2  de Kleine, R. A.³  Davis, M. L.^4,5  Kampman, M.^1,2  Smits, J. A. J.^4,5  Roelofs, K.^2,6 

[1] Inst Integrated Mental Hlth Care Pro Persona, Overwaal Ctr Expertise Anxiety Disorders, OCD & PTSD, Tarweweg 2, NL-6534 AM Nijmegen, Netherlands

[2] Radboud Univ Nijmegen, Behav Sci Inst, Montessorilaan 3, NL-6525 HR Nijmegen, Netherlands

[3] Leiden Univ, Inst Psychol, Wassenaarsweg 52, NL-2333 AK Leiden, Netherlands

[4] Univ Texas Austin, Dept Psychol, Austin, TX 78712 USA

[5] Univ Texas Austin, Inst Mental Hlth Res, Austin, TX 78712 USA

[6] Radboud Univ Nijmegen, Ctr Neuroimaging, Ponders Inst Brain Cognit & Behav, Nijmegen, Netherlands

关键词: Endogenous testosterone;    HPG-axis;    Challenge hypothesis;    Social anxiety disorder;    Exposure therapy;    Avoidance behavior;   

DOI  :  10.1016/j.psyneuen.2020.104612

来源: Elsevier

【 摘 要 】

The Hypothalamus-Pituitary-Gonadal (HPG)-axis, and testosterone in particular, play an important role in social motivational behavior. Socially avoidant behavior, characteristic of social anxiety disorder (SAD), has been linked to low endogenous testosterone levels, and can be alleviated by testosterone administration in SAD. Although these beneficial effects of testosterone may translate to exposure therapy, it remains unknown whether testosterone increases prior to exposure improve therapy outcomes. In this proof-of-principle study, we tested whether pre-exposure (reactive and baseline) endogenous testosterone levels were predictive of exposure outcome in SAD. Seventy-three participants (52 females) with a principal SAD diagnosis performed four speech exposures: three during one standardized exposure therapy session and one at post-assessment one week later. Subjective fear levels were assessed before and after each speech exposure and social anxiety symptoms were assessed at pre- and post-treatment. Pre-treatment testosterone levels were assessed before (baseline) and in response to a pre-exposure instruction session (reactive). Pre-treatment testosterone levels were not related to fear levels during exposure therapy, but predicted pre- to post-treatment reductions in social anxiety symptom severity. Specifically, low baseline and high reactive pre-treatment testosterone levels were associated with larger reductions in social anxiety symptom severity. These findings support the role of HPG-axis in social fear reduction. Specifically, our finding that high reactive testosterone as well as low baseline testosterone predicted exposure outcome in SAD, suggests that good reactivity of the HPG-axis is a promising marker for the symptom-reducing effects of exposure therapy.

【 授权许可】

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