A randomized controlled trial of intranasal oxytocin as an adjunct to exposure therapy for social anxiety disorder

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Summary

In humans, oxytocin nasal administration reduces social-threat perception and improves processes involved in communication and the encoding of positive social cues. The aim of this study was to determine whether oxytocin given as an adjunct to exposure therapy improves treatment for social anxiety disorder (SAD) as indicated by a comprehensive set of symptom outcome measures. In a randomized, double-blind, placebo-controlled trial, we administered 24 IU of oxytocin or a placebo in combination with exposure therapy to twenty-five participants who met primary diagnosis for SAD. Participants administered with oxytocin showed improved positive evaluations of appearance and speech performance as exposure treatment sessions progressed. These effects did not generalize to improve overall treatment outcome from exposure therapy. Participants who received oxytocin or placebo reported similar levels of symptom reduction following treatment across symptom severity, dysfunctional cognition, and life-impairment measures. This study shows that the administration of oxytocin improves mental representations of self, following exposure therapy. These effects may be either short term or situation specific. Future research is now needed to determine whether oxytocin can enhance treatment outcomes for SAD when used with greater frequency, with a wider variety of social learning experiences, and in conjunction with interventions that more specifically target change in broader dysfunctional cognitions.

Section snippets

Participants

Participants were recruited from the community if they met DSM-IV diagnosis for SAD using the Anxiety Disorder Interview Schedule for Adults (ADIS-IV; Brown et al., 1994) and reported fear of public speaking on self-report measures. All participants were recruited through the University of New South Wales Psychology Clinic. Assessment and treatment sessions were conducted by registered or provisionally registered clinical psychologists and were supervised by a senior clinical psychologist

Participant beliefs about treatment

Participant ratings on expectation and credibility scales were moderate to high and not different between the two groups (largest t (23) = 1.05, p = 0.30). There was no difference between drug conditions with regard to guessing to which drug condition subjects believed they had been assigned at any time point [largest t(21) = 1.21, p = 0.26]. On average, 46.8% of OT-assigned participants and 51.8% of placebo-assigned participants believed they had received OT. On average, 4 OT and 3 placebo

Discussion

This is the first trial of OT as an adjunct to exposure therapy for SAD. Results partially confirmed hypotheses. OT reduced the exaggerated negative mental representations of self which are typically displayed by SAD patients following a speech exposure task. Participants who received OT showed greatest improvements in both their ratings of speech performance and their speech appearance in comparison to placebo treated patients. There was, however, no evidence that these benefits generalized to

Role of funding source

Funding for data collection was provided by a UNSW Goldstar Scheme and NHMRC Grant 35093. This funding scheme had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

Dr. Guastella, Dr Dadds, Dr. Mitchell Miss Howard and Mr Carson report no biomedical financial interests or potential conflicts of interest.

Disclosure

This treatment trial is registered on the Australian Clinical Trials Registry: A randomized controlled trial to evaluate the effect of oxytocin in combination with exposure therapy in the treatment of social anxiety disorder to improve the severity of social anxiety disorder symptoms; #12607000256471, URL: http://www.actr.org.au/).

Acknowledgements

We thank Dr. Daniel Hermens and Alex Berardino for helpful comments on this manuscript, we also thank Miss Siobhan Kelly, Angela Nickerson, Rochelle Cox, and Hionia Achelle for assistance with data collection. This research was supported by a UNSW Goldstar award and NHMRC Project Grant (#350963).

References (46)

  • K.J. Parker et al.

    Intranasal oxytocin administration attenuates the ACTH stress response in monkeys

    Psychoneuroendocrinology

    (2005)
  • R.M. Rapee et al.

    Mental representation of observable attributes in people with social phobia

    J. Behav. Ther. Exp. Psychiatry

    (2006)
  • R.M. Rapee et al.

    The effects of video feedback on the self-evaluation of performance in socially anxious subjects

    Behav. Res. Ther.

    (1996)
  • M. Abbott et al.

    Post-event rumination and negative self-appraisal in social phobia before and after treatment

    J. Abnorm. Psychol.

    (2004)
  • APA

    Diagnostic and Statistical Manual of Mental Disorders

    (2000)
  • T.L. Bale et al.

    CNS region-specific oxytocin receptor expression: importance in regulation of anxiety and sex behavior

    J. Neurosci.

    (2001)
  • K. Blair et al.

    Neural response to self and other referential praise and criticism in generalized social phobia

    Arch. Gen. Psychiatry

    (2008)
  • A. Blume et al.

    Oxytocin reduces anxiety via ERK1/2 activation: local effect within the rat hypothalamic paraventricular nucleus

    Eur. J. Neurosci.

    (2008)
  • T. Brown et al.

    Anxiety Disorders Interview Schedule Adult Version (ADIS-IV)

    (1994)
  • J. Cohen

    Statistical Power Analysis for the Behavioral Sciences

    (1988)
  • J.R.T. Davidson et al.

    Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia

    Arch. Gen. Psychiatry

    (2004)
  • Z.R. Donaldson et al.

    Oxytocin, vasopressin, and the neurogenetics of sociality

    Science

    (2008)
  • A.J. Guastella et al.

    Does oxytocin influence the early detection of angry and happy faces?

    Psychoneuroendocrinology

    (2008)

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