Cortisol reactivity in social anxiety disorder: A highly standardized and controlled study

Petrowski, Katja; Schmalbach, Ileana; Strunk, Anne; Hoyer, Jürgen; Kirschbaum, Clemens; Joraschky, Peter

doi:10.1016/j.psyneuen.2020.104913

Cited by 14 publications

(9 citation statements)

References 42 publications

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“…Indeed, although dysphoria and major depressive disorder may confound interpretation of cortisol suppression in PTSD, both are also frequent comorbidities in anxiety spectrum disorders. Similar to the findings in PTSD, evidence of hyporesponsiveness of saliva-derived cortisol in social anxiety disorder has been found 46 . However, results are mixed with elevations in saliva amylase and cortisol reported in generalized anxiety disorder 47 .…”

Section: Pathophysiologysupporting

confidence: 65%

“…Similar to the findings in PTSD, evidence of hyporesponsiveness of saliva-derived cortisol in social anxiety disorder has been found. 46 However, results are mixed with elevations in saliva amylase and cortisol reported in generalized anxiety disorder. 47 As in PTSD, interpretation of cortisol findings is complicated by diurnal factors in cortisol levels and potentially heterogeneity and state-related factors.…”

Section: Key Pointsmentioning

confidence: 99%

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Posttraumatic Stress Disorder and Anxiety-Related Conditions

Jaffee¹,

Jorge²

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW This article provides a synopsis of current assessment and treatment considerations for posttraumatic stress disorder (PTSD) and related anxiety disorder characteristics. Epidemiologic and neurobiological data are reviewed as well as common associated symptoms, including sleep disruption, and treatment approaches to these conditions. RECENT FINDINGS PTSD is no longer considered an anxiety-related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition classification and instead is associated with trauma/stressor-related disorders. PTSD symptoms are clustered into four domains including intrusive experiences, avoidance, mood, and arousal symptoms. Despite this reclassification, similarities exist in consideration of diagnosis, treatment, and comorbidities with anxiety disorders. PTSD and anxiety-related disorders are heterogeneous, which is reflected by the neural circuits involved in the genesis of symptoms that may vary across symptom domains. Treatment is likely to benefit from consideration of this heterogeneity. Research in animal models of fear and anxiety, as well as in humans, suggests that patients with PTSD and generalized anxiety disorder have difficulty accurately determining safety from danger and struggle to suppress fear in the presence of safety cues. Empirically supported psychotherapies commonly involved exposure (fear extinction learning) and are recommended for PTSD. Cognitive-behavioral therapy has been shown to be effective in other anxiety-related disorders. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used in the treatment of PTSD and anxiety disorders in which pharmacologic intervention is supported. Treating sleep disruption including sleep apnea (continuous positive airway pressure [CPAP]), nightmares, and insomnia (preferably via psychotherapy) may improve symptoms of PTSD, as well as improve mood in anxiety disorders. SUMMARY PTSD has a lifetime prevalence that is close to 10% and shares neurobiological features with anxiety disorders. Anxiety disorders are the most common class of mental conditions and are highly comorbid with other disorders; treatment considerations typically include cognitive-behavioral therapy and pharmacologic intervention. Developing technologies show some promise as treatment alternatives in the future.

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Section: Pathophysiologysupporting

confidence: 65%

Section: Key Pointsmentioning

confidence: 99%

Posttraumatic Stress Disorder and Anxiety-Related Conditions

Jaffee¹,

Jorge²

2021

CONTINUUM: Lifelong Learning in Neurology

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“…Since neuroimaging studies have repeatedly documented stronger amygdala responses for SAD via fMRI ( 49 ) patients’ physiological stress systems may have been adapted from being hyper-responsive and they may sooner or later become hyporesponsive as has been documented in conjunction with other disorders ( 50 ). There is initial evidence documenting hyporeactivity of parts of the HPA axis in SAD patients following acute stress induction ( 51 ). On the other hand, it is also possible that patients with SAD may form subgroups that reveal different psychobiological reactivity patterns.…”

Section: Discussionmentioning

confidence: 99%

Empathy Modulates the Effects of Acute Stress on Anxious Appearance and Social Behavior in Social Anxiety Disorder

et al. 2022

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Patients suffering from social anxiety disorder (SAD) fear social interaction and evaluation, which severely undermines their everyday life. There is evidence of increased prosocial behavior after acute social stress exposure in healthy individuals, which may be interpreted as stress-regulating “tend-and-befriend” behavior. In a randomized controlled trial, we measured empathic abilities in a first diagnostic session. In the following experimental session, we investigated how patients with SAD (n = 60) and healthy control participants (HC) (n = 52) respond to an acute social stressor (Trier Social Stress Test for groups) or a non-stressful control condition, and whether empathic abilities and acute social stress interact to modulate anxious appearance and social behavior in a social conversation test. Salivary cortisol, heart rate, and subjective stress response were repeatedly measured. The anxious appearance and social behavior of participants were rated by the conversation partner. SAD patients demonstrated stronger subjective stress responses while the biological responses did not differ from HC. Moreover, patients performed worse overall in the conversation task, which stress additionally undermined. Finally, we found that both emotional and cognitive empathy buffered the negative effects of acute stress on social behavior in SAD, but not in HC. Our data highlight the importance of empathic abilities for SAD during stressful situations and call for multimodal clinical diagnostics. This may help to differentiate clinical subtypes and offer better-tailored treatment for patients.General Scientific Summary: This study shows that high levels of cognitive and emotional empathy can buffer the negative effects of acute stress on social behavior in social anxiety disorder (SAD). Empathic abilities may be included as an additional diagnostic resource marker for SAD.

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“…Outcome measures were US-expectancy ratings, SCR responses, evaluative ratings, and avoidance responses to the CSs and GSs. Exploratorily, all outcome measures were correlated with cortisol reactivity in both the stress and no-stress control group, as it has been shown that altered cortisol reactivity plays an important role in fear inhibition to safety signals (Zuj, Palmer, Malhi, Bryant, & Felmingham, 2017) and is related to several stress-and anxiety-related disorders (Petrowski et al, 2021;Wichmann, Kirschbaum, Böhme, & Petrowski, 2017;Zuj et al, 2017). We predicted more generalization in the stress group relative to the no-stress control group, as indicated by increased US expectancy and SCR responses during the fear generalization test and more avoidance to GS stimuli in the stress group relative to the no-stress control group, with a higher percentage of avoidance responses to GSs that were more similar to the CS+.…”

Section: Introductionmentioning

confidence: 99%

Overgeneralization of fear, but not avoidance, following acute stress

Lemmens¹,

Beckers²,

Dibbets³

et al. 2021

Preprint

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Research has demonstrated the spreading of fear from threat-related stimuli to perceptually similar, but innocuous, stimuli. Less is known, however, about the generalization of avoidance behavior. Given that stress is known to affect learning and memory, we were interested in the effect of acute stress on (over)generalization of fear and avoidance responses. On the first day, one geometrical shape was paired with a mild electrical stimulus (CS+), whereas another shape was not (CS-). One day later, after participants had been exposed to the Maastricht Acute Stress Test or a control task, generalization of avoidance responses and fear (shock expectancy and skin conductance responses) was tested to a range of perceptual generalization stimuli. Generalization gradients were observed across different outcome measures. Stress enhanced generalization of shock expectancy to the stimulus most similar to the CS+. Our findings confirm that stress can affect the generalization of fear, but further studies are warranted.

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Cortisol reactivity in social anxiety disorder: A highly standardized and controlled study

Cited by 14 publications

References 42 publications

Posttraumatic Stress Disorder and Anxiety-Related Conditions

Posttraumatic Stress Disorder and Anxiety-Related Conditions

Empathy Modulates the Effects of Acute Stress on Anxious Appearance and Social Behavior in Social Anxiety Disorder

Overgeneralization of fear, but not avoidance, following acute stress

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