Behavioral exposure therapy of anxiety disorders is believed to rely on fear extinction. Because preclinical studies have shown that glucocorticoids can promote extinction processes, we aimed at investigating whether the administration of these hormones might be useful in enhancing exposure therapy. In a randomized, doubleblind, placebo-controlled study, 40 patients with specific phobia for heights were treated with three sessions of exposure therapy using virtual reality exposure to heights. Cortisol (20 mg) or placebo was administered orally 1 h before each of the treatment sessions. Subjects returned for a posttreatment assessment 3-5 d after the last treatment session and for a follow-up assessment after 1 mo. Adding cortisol to exposure therapy resulted in a significantly greater reduction in fear of heights as measured with the acrophobia questionnaire (AQ) both at posttreatment and at follow-up, compared with placebo. Furthermore, subjects receiving cortisol showed a significantly greater reduction in acute anxiety during virtual exposure to a phobic situation at posttreatment and a significantly smaller exposure-induced increase in skin conductance level at follow-up. The present findings indicate that the administration of cortisol can enhance extinction-based psychotherapy.memory | retrieval | consolidation P hobic disorders can be characterized as disorders involving disturbed emotional learning and memory resulting in an enhanced fear response. A central mechanism in the pathogenesis of anxiety disorders is associative learning or conditioning that leads to formation of a fear memory (1-5). In phobic individuals, exposure to a phobic stimulus almost invariably provokes retrieval of stimulus-associated fear memory, which leads to the fear response (6-9). Exposure-based behavioral therapy of phobia is thought to rely on extinction of these fear responses (10-13). Extinction occurs when conditioned responding to a stimulus decreases when the reinforcer is omitted (12,14). Accordingly, fear reduction induced by exposure therapy is the result of decrements in the conditioned response over successive extinction trials. Extinction leads to the formation of an alternative set of nonfearful memory associations (extinction memory) that competes with, but does not erase original fear memory associations (14, 15). Considering the importance of extinction learning for exposure therapy, pharmacological interventions aimed at enhancing extinction processes are promising approaches to enhance exposure therapy, as it has been demonstrated with D-cycloserine (16-18).Glucocorticoids (cortisol in humans, corticosterone in rodents) are stress hormones released from the adrenal cortex and it has long been recognized that they readily enter the brain and affect learning and memory (19-24). Importantly, basic research studies in animals and humans have shown that the mnemonic effects of glucocorticoids can facilitate extinction processes (22,(25)(26)(27)(28)(29). Therefore, we aimed at investigating whether the administrati...

The enormous variation in remission rates indicates that SAD might have different course types (short, fluctuating, and chronic) and is not necessarily a chronic disorder. Prevention and treatment should be focused on enhancing positive and reducing negative factors.

BackgroundPeople with social anxiety disorder are afraid of being scrutinized by others and often feel that they are the excessive focus of other people's attention. This study investigated whether, when compared to low socially anxious individuals, high socially anxious individuals overestimate the proportion of people in a crowd who are observing them. It was hypothesized that any potential overestimation would be modulated by self-focused attention.MethodForty-eight high and 48 low socially anxious participants performed a “faces in a crowd” computer task during which they briefly saw matrices of faces, which varied in terms of the proportion of people who were looking at them. Participants estimated the proportion of people who were looking at them. The task was performed once with mirrors present (to induce an enhanced self-focused state) and once without mirrors present (neutral state).ResultsParticipants' subjective estimates and the objective proportion of faces looking towards them were strongly correlated in both the high and low socially anxious groups. However, high socially anxious participants estimated that more people were looking at them than low socially anxious participants. In the first phase of the experiment, but not in the later phases, this effect was magnified in the mirror condition.DiscussionThis study provides preliminary evidence of a social anxiety related perceptual difference that may be amplified by self-focused attention. Clinical implications are discussed.