Department of Psychology, University of Washington, Seattle, WA, USA.
Department of Psychology, University of Washington, Seattle, WA, USA; Department of Psychology, Boston College, Chestnut Hill, MA, USA.
Psychiatry Res. 2018 Dec;270:523-530. doi: 10.1016/j.psychres.2018.10.015. Epub 2018 Oct 9.
Exposure therapy for social anxiety disorder (SAD) utilizes fear extinction, a memory process enhanced by sleep. We investigated whether naps following exposure sessions might improve symptoms and biomarkers in response to social stress in adults undergoing 5-week exposure-based group SAD therapy. Thirty-two participants aged 18-39 (18 females) with SAD were randomized. Before and after treatment, participants completed the Liebowitz Social Anxiety Scale (LSAS) and underwent a Trier Social Stress Test with psychophysiological monitoring (mpTSST) that included skin conductance (SCL), electromyographic (EMG) and electrocardiographic recording, and an auditory startle procedure while anticipating the social stressor. At sessions 3 and 4, exposure was followed by either a 120-min polysomnographically monitored sleep opportunity (Nap, N = 17) or wakefulness (Wake, N = 15). Primary hypotheses about SAD symptom change (LSAS) and EMG blink-startle response failed to differ with naps, despite significant symptom improvement (LSAS) with therapy. Some secondary biomarkers, however, provided preliminary support for enhanced extinction learning with naps, with trend-level Time (pre-, post-treatment) × Arm interactions and significant reduction from pre- to post treatment in the Nap arm alone for mpTSST SCL and salivary cortisol rise. Because of the small sample size and limited sleep duration, additional well-powered studies with more robust sleep interventions are indicated.
暴露疗法治疗社交焦虑症（SAD）利用恐惧消除，这是一种通过睡眠增强的记忆过程。我们研究了在接受基于暴露的 SAD 团体治疗的成年人中，在暴露治疗后小睡是否可以改善社交压力下的症状和生物标志物。32 名年龄在 18-39 岁（18 名女性）的 SAD 患者被随机分组。治疗前后，参与者完成了 Liebowitz 社交焦虑量表（LSAS），并进行了特里尔社会应激测试，同时进行了心理生理监测（mpTSST），包括皮肤电导（SCL）、肌电图（EMG）和心电图记录，以及听觉惊吓程序，以预测社交应激源。在第 3 和第 4 次治疗中，暴露后要么进行 120 分钟多导睡眠监测睡眠机会（小睡，N=17），要么保持清醒（清醒，N=15）。尽管治疗后症状明显改善（LSAS），但关于 SAD 症状变化（LSAS）和 EMG 眨眼-惊吓反应的主要假设并没有因小睡而有所不同。然而，一些次要生物标志物初步支持小睡时增强的消退学习，存在趋势水平的时间（治疗前、后）×手臂交互作用，并且仅在小睡手臂中，mpTSST 的 SCL 和唾液皮质醇升高从治疗前到治疗后显著降低。由于样本量小和睡眠持续时间有限，需要进行更多具有更强睡眠干预的大型研究。
