d-Cycloserine as an Augmentation Strategy With Cognitive-Behavioral Therapy for Social Anxiety Disorder

Abstract

OBJECTIVE To test whether d-cycloserine, a partial agonist at the glutamatergic N-methyl-D-aspartate receptor, augments and accelerates a full course of comprehensive cognitive behavioral therapy (CBT) in medication-free adults with generalized social anxiety disorder. METHOD A randomized placebo-controlled efficacy-study conducted at Boston University, Massachusetts General Hospital, and Southern Methodist University between 9/2007 and 12/2011 of 169 medication-free adults with generalized social anxiety disorder; 144 completed treatment, and 131 completed the follow-up assessments. Patients were randomized to receive 50 mg of d-cycloserine or placebo 1 hour before each of 5 exposure sessions that were part of a 12-session cognitive behavioral group treatment. Response and remission status was determined at baseline, throughout treatment, post-treatment, and at 1, 3, and 6-month follow-up assessments rated by assessors who were blind to treatment condition. RESULTS D-cycloserine-augmented and placebo-augmented CBT were associated with similar completion rates (87% and 82%), response rates (79.3% and 73.3%), and remission rates (34.5% and 24.4%) at post-treatment that were largely maintained at follow-up. Although d-cycloserine was associated with a 24–33% faster rate of improvement in symptom severity and remission rates relative to placebo during the 12-week treatment phase, the groups did not differ in response and remission rates. CONCLUSIONS D-cycloserine did not augment a full course of comprehensive CBT for social anxiety disorder. TRIAL REGISTRATION http://www.ClinicalTrials.gov, ID# NCT00633984, http://www.clinicaltrials.gov/ct2/show/NCT00633984

The Role of the Medial Prefrontal Cortex in Regulating Social Familiarity-Induced Anxiolysis

“…Safety learning in humans and rodents can be enhanced by pairing the safety learning with D-cycloserine (Davis et al, 2006;Gupta et al, 2013;Hofmann et al, 2006b). D-cycloserine augmentation of cognitive behavioral therapy for social anxiety, in particular, was associated with a faster rate of improvement (Hofmann et al, 2013). Similarly, in the current study, pretreatment with D-cycloserine before pairings with the familiar conspecific reduced the number of SI training sessions required to reduce the anxiety-like response to the anxiogenic challenge.…”

Brain connectomics predict response to treatment in social anxiety disorder

“…31 However, this was accounted for in the current analysis and there was no main effect between the larger placebo and d-cycloserine groups. 32 Imaging Data acquisition. Data were acquired on a 3 T Siemens Trio Tim MRI scanner with a standard Siemens 32-channel phased array head coil.…”

Eficácia da terapia cognitiva processual no tratamento do transtorno de ansiedade social: avaliação de um ensaio clínico randomizado

“…A TCC tem sido considerada padrão-ouro no tratamento do TAS e diversos protocolos têm demonstrado efetividade no tratamento desta condição, além do expressivo número de ensaios clínicos randomizados com alto rigor metodológico já publicados (Barkowski et al, 2016;Hofmann et al, 2013;Hofmann & Otto, 2008;Hofmann & Smits, 2008;Ponniah & Hollon, 2008;Otte, 2011 (Heimberg, 2002).…”

“…Os resultados desta pesquisa confirmam ainda a literatura acerca da eficácia da TCC no tratamento do TAS, que indica que a intervenção cognitivo-comportamental é a mais eficaz no tramento desta condição, sendo considerada padrão-ouro (Acarturk et al, 2009;Barkowski et al, 2016;Hofmann et al, 2013;Mayo-Wilson et al, 2014;Ponniah & Hollon, 2006;Otte, 2011).…”