Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany.
Department of Cognitive Psychology, Ruhr-University Bochum, Bochum, Germany.
Psychoneuroendocrinology. 2019 Jan;99:174-182. doi: 10.1016/j.psyneuen.2018.09.015. Epub 2018 Sep 13.
Cortisol administration prior to treatment can promote the efficacy of exposure-based treatments in specific phobia: cortisol has been proposed to reduce fear retrieval at the beginning of exposure and to enhance the acquisition and consolidation of corrective information learned during exposure. Whether cortisol exerts a beneficial therapeutic effect when given after exposure, e.g., by targeting the consolidation of new corrective information, has not been addressed so far to date. Here, we examined whether post-exposure cortisol administration promotes fear reduction and reduces return of fear following contextual change in specific phobia. Furthermore, the effect of cortisol on return of fear following contextual change (i.e., contextual renewal) was assessed. Patients with spider phobia (N = 43) were treated with a single session of in-vivo exposure, followed by cortisol administration (20 mg hydrocortisone) in a double-blind, placebo-controlled study design. Return of fear was assessed with behavioral approach tests (BATs) in the familiar therapy context (versus a novel unfamiliar context) at one-month and seven-month follow-up assessment. Exposure was effective in reducing fear from pre-treatment to post-treatment (i.e., 24 h after exposure) on fear-related behavioral (approach behavior during the BAT), psychophysiological (heart rate during the BAT) and subjective (fear during the BAT, spider-fear related questionnaires) measures of therapeutic outcome, with no add-on benefit of cortisol administration. Cortisol had no effect on contextual renewal at one-month follow-up. However, in a subsample (N = 21) that returned to the seven-month follow-up, an adverse effect of cortisol on fear renewal was found, with cortisol-treated patients showing an increase in subjective fear at the final approach distance of the BAT from post-treatment to seven-month follow-up. These and previous findings underline the importance of considering the exact timing of cortisol application when used as an add-on treatment for extinction-based psychotherapy: post-exposure cortisol administration does not seem to be effective, but might promote fear renewal at the subjective level.
皮质醇被提议减少暴露开始时的恐惧检索，并增强在暴露过程中学习到的纠正信息的获得和巩固。皮质醇在暴露后给药（例如，通过靶向新的纠正信息的巩固）是否具有有益的治疗效果，迄今为止尚未得到解决。在这里，我们研究了暴露后皮质醇给药是否可以促进恐惧减轻，并减少特定恐惧症中上下文变化后的恐惧返回。此外，评估了皮质醇对上下文变化（即上下文更新）后恐惧返回的影响。在一项双盲、安慰剂对照的研究设计中，对蜘蛛恐惧症患者（N=43）进行单次体内暴露治疗，随后给予皮质醇（20mg 氢可的松）治疗。在一个月和七个月的随访评估中，通过行为接近测试（BAT）在熟悉的治疗环境（与新的不熟悉的环境相比）评估恐惧的返回。暴露在治疗上是有效的，从治疗前到治疗后（即暴露后 24 小时），在与治疗相关的行为（BAT 期间的接近行为）、心理生理（BAT 期间的心率）和主观（BAT 期间的恐惧、与蜘蛛恐惧相关的问卷）测量恐惧方面，皮质醇给药没有附加的益处。皮质醇对一个月的随访时的上下文更新没有影响。然而，在一个亚组（N=21）中，他们回到七个月的随访中，发现皮质醇对恐惧更新有不利影响，皮质醇治疗的患者在 BAT 的最终接近距离处，从治疗后到七个月的随访中，主观恐惧增加。这些和以前的发现强调了在作为基于消退的心理治疗的附加治疗使用皮质醇时，考虑皮质醇应用的确切时间的重要性：暴露后皮质醇给药似乎没有效果，但可能会在主观层面促进恐惧的重现。
