Sleep Quality Predicts Treatment Outcome in CBT for Social Anxiety Disorder

Abstract

Background Sleep quality may be an important, yet relatively neglected, predictor of treatment outcome in cognitive-behavioral therapy (CBT) for anxiety disorders. Specifically, poor sleep quality may impair memory consolidation of in-session extinction learning. We therefore examined sleep quality as a predictor of treatment outcome in CBT for social anxiety disorder and the impact of d-cycloserine (DCS) on this relationship. Methods One hundred sixty-nine participants with a primary diagnosis of DSM-IV generalized social anxiety disorder were recruited across three sites. Participants were enrolled in 12 weeks of group CBT. Participants randomly received 50 mg of DCS (n = 87) or pill placebo (n = 82) 1 hr prior to sessions 3–7. Participants completed a baseline measure of self-reported sleep quality and daily diaries recording subjective feelings of being rested upon wakening. Outcome measures including social anxiety symptoms and global severity scores were assessed at each session. Results Poorer baseline sleep quality was associated with slower improvement and higher posttreatment social anxiety symptom and severity scores. Moreover, patients who felt more “rested” after sleeping the night following a treatment session had lower levels of symptoms and global severity at the next session, controlling for their symptoms and severity scores the previous session. Neither of these effects were moderated by DCS condition. Conclusions Our findings suggest that poor sleep quality diminishes the effects of CBT for social anxiety disorder and this relation is not attenuated by DCS administration. Therapeutic attention to sleep quality prior to initiation of CBT and during the acute treatment phase may be clinically indicated.

Comparison of the Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR): Reducing Anxiety Symptoms

“…Not only previous studies have supported the application of mindfulness-based stress reduction in patients with this disorder (12)(13)(14)(15)(16)(17)(18)(19) but also therapists have supported CBT in patients improvement (20)(21)(22). Furthermore, some studies have investigated MBSR versus CBT (23)(24)(25)(26).…”

Effects of sleep on memory for conditioned fear and fear extinction.

“…These findings have been replicated in a recent study that used virtual-reality exposure therapy for DSM-IV diagnosed Spider Phobia (Kleim et al, 2013). Yet more recently, a large study of cognitive behavioral therapy in Social Anxiety Disorder has shown that better self-reported baseline sleep was associated with better post-treatment outcome on measures of anxiety (Zalta et al, 2013). Therefore, the memory enhancing function of sleep might be exploited to strengthen therapeutic extinction learned in exposure-based therapy by using strategically timed sleep bouts (Kleim et al, 2013; Pace-Schott, Verga, et al, 2012a).…”

Looking Beyond Fear and Extinction Learning: Considering Novel Treatment Targets for Anxiety

“…One study demonstrated that afternoon naps as short as 1.5 hours immediately following successful exposure therapy for spider phobia resulted in significantly lower reported levels of distress and catastrophic cognitions at one-week follow-up [47]. Additionally, more restful sleep following CBT sessions for social anxiety disorder was associated with larger symptom reductions at subsequent sessions [48]. Mirroring findings in basic extinction learning paradigms [46], reducing the time interval between exposure therapy and sleep also enhances treatment outcomes.…”