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Augmentation of exposure therapy with D-cycloserine for social anxiety disorder.
Arch Gen Psychiatry. 2006 Mar; 63(3):298-304.AG

Abstract

CONTEXT

Social anxiety disorder (SAD) is common and debilitating. Although exposure therapy is one of the most effective forms of psychotherapy for this disorder, many patients remain symptomatic. Fear reduction in exposure therapy is similar to extinction learning, and early clinical data with specific phobias suggest that the treatment effects of exposure therapy for SAD may be enhanced with d-cycloserine, an agonist at the glutamatergic N-methyl-d-aspartate receptor.

OBJECTIVE

To determine whether short-term treatment with 50 mg of d-cycloserine enhances the efficacy of exposure therapy for SAD.

DESIGN

Randomized, double-blind, placebo-controlled augmentation trial examining the combination of d-cycloserine or pill placebo with exposure therapy for SAD.

SETTING

Patients were self-referred from the general community to 1 of 3 research clinics.

PARTICIPANTS

Twenty-seven participants meeting DSM-IV criteria for SAD with significant public speaking anxiety.

INTERVENTIONS

Following a diagnostic interview and pretreatment assessment, participants received 5 therapy sessions delivered in either an individual or group therapy format. The first session provided an introduction to the treatment model and was followed by 4 sessions emphasizing exposure to increasingly challenging public speech situations with videotaped feedback of performances. One hour prior to each session, participants received single doses of d-cycloserine or placebo.

MAIN OUTCOME MEASURES

Symptoms were assessed by patient self-report and by clinicians blind to the randomization condition before treatment, after treatment, and 1 month after the last session.

RESULTS

Participants receiving d-cycloserine in addition to exposure therapy reported significantly less social anxiety compared with patients receiving exposure therapy plus placebo. Controlled effect sizes were in the medium to large range.

CONCLUSION

The pilot data provide preliminary support for the use of short-term dosing of d-cycloserine as an adjunctive intervention to exposure therapy for SAD.

Authors+Show Affiliations

Department of Psychology and Center for Anxiety and Related Disorders, Boston University, Boston, MA 02215, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16520435

Citation

Hofmann, Stefan G., et al. "Augmentation of Exposure Therapy With D-cycloserine for Social Anxiety Disorder." Archives of General Psychiatry, vol. 63, no. 3, 2006, pp. 298-304.
Hofmann SG, Meuret AE, Smits JA, et al. Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Arch Gen Psychiatry. 2006;63(3):298-304.
Hofmann, S. G., Meuret, A. E., Smits, J. A., Simon, N. M., Pollack, M. H., Eisenmenger, K., Shiekh, M., & Otto, M. W. (2006). Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Archives of General Psychiatry, 63(3), 298-304.
Hofmann SG, et al. Augmentation of Exposure Therapy With D-cycloserine for Social Anxiety Disorder. Arch Gen Psychiatry. 2006;63(3):298-304. PubMed PMID: 16520435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. AU - Hofmann,Stefan G, AU - Meuret,Alicia E, AU - Smits,Jasper A J, AU - Simon,Naomi M, AU - Pollack,Mark H, AU - Eisenmenger,Katherine, AU - Shiekh,Michael, AU - Otto,Michael W, PY - 2006/3/8/pubmed PY - 2006/3/30/medline PY - 2006/3/8/entrez SP - 298 EP - 304 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 63 IS - 3 N2 - CONTEXT: Social anxiety disorder (SAD) is common and debilitating. Although exposure therapy is one of the most effective forms of psychotherapy for this disorder, many patients remain symptomatic. Fear reduction in exposure therapy is similar to extinction learning, and early clinical data with specific phobias suggest that the treatment effects of exposure therapy for SAD may be enhanced with d-cycloserine, an agonist at the glutamatergic N-methyl-d-aspartate receptor. OBJECTIVE: To determine whether short-term treatment with 50 mg of d-cycloserine enhances the efficacy of exposure therapy for SAD. DESIGN: Randomized, double-blind, placebo-controlled augmentation trial examining the combination of d-cycloserine or pill placebo with exposure therapy for SAD. SETTING: Patients were self-referred from the general community to 1 of 3 research clinics. PARTICIPANTS: Twenty-seven participants meeting DSM-IV criteria for SAD with significant public speaking anxiety. INTERVENTIONS: Following a diagnostic interview and pretreatment assessment, participants received 5 therapy sessions delivered in either an individual or group therapy format. The first session provided an introduction to the treatment model and was followed by 4 sessions emphasizing exposure to increasingly challenging public speech situations with videotaped feedback of performances. One hour prior to each session, participants received single doses of d-cycloserine or placebo. MAIN OUTCOME MEASURES: Symptoms were assessed by patient self-report and by clinicians blind to the randomization condition before treatment, after treatment, and 1 month after the last session. RESULTS: Participants receiving d-cycloserine in addition to exposure therapy reported significantly less social anxiety compared with patients receiving exposure therapy plus placebo. Controlled effect sizes were in the medium to large range. CONCLUSION: The pilot data provide preliminary support for the use of short-term dosing of d-cycloserine as an adjunctive intervention to exposure therapy for SAD. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/16520435/Augmentation_of_exposure_therapy_with_D_cycloserine_for_social_anxiety_disorder_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.63.3.298 DB - PRIME DP - Unbound Medicine ER -