Soravia Leila M, Heinrichs Markus, Aerni Amanda, Maroni Caroline, Schelling Gustav, Ehlert Ulrike, Roozendaal Benno, de Quervain Dominique J-F
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Zürich, Zürichbergstrasse 43, CH-8044 Zürich, Switzerland.
Proc Natl Acad Sci U S A. 2006 Apr 4;103(14):5585-90. doi: 10.1073/pnas.0509184103. Epub 2006 Mar 27.
Phobias are characterized by excessive fear, cued by the presence or anticipation of a fearful situation. Whereas it is well established that glucocorticoids are released in fearful situations, it is not known whether these hormones, in turn, modulate perceived fear. As extensive evidence indicates that elevated glucocorticoid levels impair the retrieval of emotionally arousing information, they might also inhibit retrieval of fear memory associated with phobia and, thereby, reduce phobic fear. Here, we investigated whether acutely administrated glucocorticoids reduced phobic fear in two double-blind, placebo-controlled studies in 40 subjects with social phobia and 20 subjects with spider phobia. In the social phobia study, cortisone (25 mg) administered orally 1 h before a socio-evaluative stressor significantly reduced self-reported fear during the anticipation, exposure, and recovery phase of the stressor. Moreover, the stress-induced release of cortisol in placebo-treated subjects correlated negatively with fear ratings, suggesting that endogenously released cortisol in the context of a phobic situation buffers fear symptoms. In the spider phobia study, repeated oral administration of cortisol (10 mg), but not placebo, 1 h before exposure to a spider photograph induced a progressive reduction of stimulus-induced fear. This effect was maintained when subjects were exposed to the stimulus again 2 days after the last cortisol administration, suggesting that cortisol may also have facilitated the extinction of phobic fear. Cortisol treatment did not reduce general, phobia-unrelated anxiety. In conclusion, the present findings in two distinct types of phobias indicate that glucocorticoid administration reduces phobic fear.
恐惧症的特征是过度恐惧，由可怕情境的出现或预期引发。虽然已知糖皮质激素在可怕情境中会释放，但尚不清楚这些激素反过来是否会调节感知到的恐惧。大量证据表明，糖皮质激素水平升高会损害对情绪唤起信息的提取，它们可能还会抑制与恐惧症相关的恐惧记忆的提取，从而减轻恐惧。在此，我们在两项双盲、安慰剂对照研究中，对40名社交恐惧症患者和20名蜘蛛恐惧症患者进行了调查，以探究急性给予糖皮质激素是否能减轻恐惧。在社交恐惧症研究中，在社会评价应激源出现前1小时口服可的松（25毫克），显著降低了应激源预期、暴露和恢复阶段自我报告的恐惧。此外，安慰剂治疗组受试者应激诱导的皮质醇释放与恐惧评分呈负相关，表明在恐惧情境中内源性释放的皮质醇可缓冲恐惧症状。在蜘蛛恐惧症研究中，在接触蜘蛛照片前1小时重复口服皮质醇（10毫克）而非安慰剂，可使刺激诱导的恐惧逐渐减轻。在最后一次给予皮质醇2天后再次让受试者接触刺激时，这种效果依然存在，这表明皮质醇可能也促进了恐惧的消退。皮质醇治疗并未减轻与恐惧症无关的一般性焦虑。总之，在两种不同类型恐惧症中的当前研究结果表明，给予糖皮质激素可减轻恐惧。
