Glucocorticoids enhance in vivo exposure-based therapy of spider phobia.
Author(s): Soravia LM(1), Heinrichs M, Winzeler L, Fisler M, Schmitt W, Horn H, Dierks T,
Strik W, Hofmann SG, de Quervain DJ.
Affiliation(s): Author information:
(1)University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
Publication date & source: 2014, Depress Anxiety. , 31(5):429-35
BACKGROUND: Preclinical and clinical studies indicate that the administration of
glucocorticoids may promote fear extinction processes. In particular, it has been
shown that glucocorticoids enhance virtual reality based exposure therapy of fear
of heights. Here, we investigate whether glucocorticoids enhance the outcome of
in vivo exposure-based group therapy of spider phobia.
METHODS: In a double blind, block-randomized, placebo-controlled, between-subject
study design, 22 patients with specific phobia of spiders were treated with two
sessions of in vivo exposure-based group therapy. Cortisol (20 mg) or placebo was
orally administered 1 hr before each therapy session. Patients returned for a
follow-up assessment one month after therapy.
RESULTS: Exposure-based group therapy led to a significant decrease in phobic
symptoms as assessed with the Fear of Spiders Questionnaire (FSQ) from
pretreatment to immediate posttreatment and to follow-up. The administration of
cortisol to exposure therapy resulted in increased salivary cortisol
concentrations and a significantly greater reduction in fear of spiders (FSQ) as
compared to placebo at follow-up, but not immediately posttreatment. Furthermore,
cortisol-treated patients reported significantly less anxiety during standardized
exposure to living spiders at follow-up than placebo-treated subjects. Notably,
groups did not differ in phobia-unrelated state-anxiety before and after the
exposure sessions and at follow-up.
CONCLUSIONS: These findings indicate that adding cortisol to in vivo
exposure-based group therapy of spider phobia enhances treatment outcome.
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