In a recent study, we investigated the effects of cortisol administration on threat processing and approach and avoidance behavior in a non-clinical sample of high and low anxious students (van Peer et al., 2007). The results of that study showed relatively faster avoidance behavior as well as enhanced positive amplitudes (P150 and P300) on midline electrodes during avoidance of angry faces after cortisol administration, indicating increased processing of threat stimuli during threat avoidance. Importantly, these effects were found only in high and not low anxious participants, suggesting a context-specific effect of cortisol on threat processing in participants highly sensitive to threat signals. These findings may be very relevant for patients characterized by strong avoidance tendencies and sensitivity to social threat, in particular patients with social anxiety disorder (SAD). Therefore, with the present study we aimed to replicate and extend these findings in a clinical group of patients with generalized SAD.The stress hormone cortisol (corticosterone in animals) plays an important role in the regulation of social motivational behavior (e.g., Kalin et al., 1998a;Roelofs et al., 2005Roelofs et al., , 2007Roelofs et al., , 2009bSapolsky et al., 2000;Van Honk et al., 1998, 2000van Peer et al., 2007). In addition, dysregulation of cortisol levels is implicated in the development and maintenance of various mood and anxiety disorders (e.g., Roelofs et al., 2009b;De Kloet et al., 2005;Holsboer and Ising, 2008). However, studies investigating the effects of cortisol on cognitiveemotional processes have focused heavily on declarative memory (see Lupien et al., 2007 for a comprehensive review) and studies examining cortisol effects on threat processing and avoidance behavior in humans are scarce. Nevertheless, the results of some recent studies in healthy human subjects show that cortisol can affect threat processing and avoidance behavior, especially in high anxious individuals. Putman et al. (2007a) found acute cortisol administration in healthy participants to result in an increased performance bias for angry (compared to neutral) faces on a computerized object-relocation task, which was suggested to reflect a cortisol-induced increase in preferential processing of angry faces. In line with these results, in a study using a reaction time task to measure approach and avoidance responses to happy and angry faces, we found increased ERP amplitudes and relatively faster avoidance responses in reaction to angry faces after acute cortisol administration in high anxious healthy participants (van Peer et al., 2007). These results are in line with animal studies showing that high levels of cortisol are associated with increased fearful temperament and threat avoidance (Kalin et al., 1998a(Kalin et al., ,b, 2000Sapolsky, 1990) We investigated the effects of cortisol administration on approach and avoidance tendencies in 20 patients with social anxiety disorder (SAD). Event-related brain potentials (ERPs) were measured duri...