From the University of Nevada, Reno, NV.
J ECT. 2024 Mar 1;40(1):51-60. doi: 10.1097/YCT.0000000000000967. Epub 2023 Nov 24.
OBJECTIVES: Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety. METHODS: Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity. RESULTS: Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety. CONCLUSIONS: The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.
目的:暴露疗法是社交焦虑治疗的基石,但并非所有患者都对此有反应。在某些社交情境中(如群体间情境),症状可能特别难以治疗。通过刺激与安全学习相关的神经区域,如内侧前额叶皮层(mPFC),可以改善暴露疗法的效果。mPFC 在识别与自身相似的他人方面也起着重要作用。我们假设在暴露疗法期间针对 mPFC 进行治疗可以减轻群体间焦虑和社交焦虑。
方法:具有公开演讲亚型社交焦虑的参与者(N=31)在暴露疗法期间接受针对 mPFC 的主动(阳极)或假经颅直流电刺激(tDCS)。暴露疗法包括在虚拟现实中向观众发表演讲。为了针对群体间焦虑,将公开演讲暴露试验的一半与群体间观众进行,在本研究中,群体间观众定义为不同种族的观众。
结果:与假设相反,tDCS 并未促进症状减轻。甚至有一些证据表明,tDCS 暂时增加了群体内的偏好,尽管这些影响在 1 个月的随访中消失了。此外,将所有参与者综合来看,我们发现公开演讲焦虑和群体间焦虑随时间减少。
结论:数据提供了证据表明,针对社交焦虑的标准暴露疗法技术可以适应针对群体间焦虑的治疗。针对 mPFC 的经颅直流电刺激可能会增强安全信号,但仅在先前被条件化为安全信号的情境中有效,例如群体内情境。
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