Augmentation of exposure therapy with D-cycloserine for social anxiety disorder
Augmentation of exposure therapy with D-cycloserine for social anxiety disorder
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DOI：
10.1001/archpsyc.63.3.298
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发表时间：
2006-03-01
影响因子：
--
通讯作者：
Otto, MW
中科院分区：
文献类型：
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作者：
Hofmann, SG;Meuret, AE;Otto, MW
背景：社交焦虑障碍（SAD）常见且具有致残性。尽管暴露疗法是治疗该障碍最有效的心理治疗形式之一，但许多患者仍有症状。暴露疗法中的恐惧减轻类似于消退学习，针对特定恐惧症的早期临床数据表明，使用D - 环丝氨酸（一种谷氨酸能N - 甲基 - D - 天冬氨酸受体激动剂）可能会增强暴露疗法对社交焦虑障碍的治疗效果。
目的：确定50毫克D - 环丝氨酸的短期治疗是否能提高暴露疗法对社交焦虑障碍的疗效。
设计：随机、双盲、安慰剂对照的强化试验，研究D - 环丝氨酸或安慰剂药丸与暴露疗法联合治疗社交焦虑障碍的效果。
地点：患者从普通社区自行转诊至3个研究诊所中的1个。
参与者：27名符合《精神障碍诊断与统计手册》第四版（DSM - IV）社交焦虑障碍标准且有明显公开演讲焦虑的参与者。
干预措施：在诊断性访谈和治疗前评估之后，参与者接受了5次以个体或团体治疗形式进行的治疗。第一次治疗介绍了治疗模式，随后的4次治疗强调暴露于越来越具有挑战性的公开演讲情境，并对表现进行录像反馈。每次治疗前1小时，参与者接受单剂量的D - 环丝氨酸或安慰剂。
主要观察指标：在治疗前、治疗后以及最后一次治疗后1个月，由患者自我报告以及对随机分组情况不知情的临床医生对症状进行评估。
结果：与接受暴露疗法加安慰剂的患者相比，除暴露疗法外还接受D - 环丝氨酸治疗的参与者报告的社交焦虑明显减轻。控制效应量处于中到大的范围。
结论：初步数据为使用D - 环丝氨酸短期给药作为社交焦虑障碍暴露疗法的辅助干预措施提供了初步支持。
Context: Social anxiety disorder ( SAD) is common and debilitating. Although exposure therapy is one of the most effective forms of psychotherapy for this disorder, many patients remain symptomatic. Fear reduction in exposure therapy is similar to extinction learning, and early clinical data with specific phobias suggest that the treatment effects of exposure therapy for SAD may be enhanced with D-cycloserine, an agonist at the glutamatergic N-methyl-D-aspartate receptor.Objective: To determine whether short-term treatment with 50 mg of D-cycloserine enhances the efficacy of exposure therapy for SAD.Design: Randomized, double-blind, placebo-controlled augmentation trial examining the combination of D-cycloserine or pill placebo with exposure therapy for SAD.Setting: Patients were self-referred from the general community to 1 of 3 research clinics.Participants: Twenty-seven participants meeting DSM-IV criteria for SAD with significant public speaking anxiety.Interventions: Following a diagnostic interview and pretreatment assessment, participants received 5 therapy sessions delivered in either an individual or group therapy format. The first session provided an introduction to the treatment model and was followed by 4 sessions emphasizing exposure to increasingly challenging public speech situations with videotaped feedback of performances. One hour prior to each session, participants received single doses of D-cycloserine or placebo.Main Outcome Measures: Symptoms were assessed by patient self-report and by clinicians blind to the randomization condition before treatment, after treatment, and 1 month after the last session.Results: Participants receiving D-cycloserine in addition to exposure therapy reported significantly less social anxiety compared with patients receiving exposure therapy plus placebo. Controlled effect sizes were in the medium to large range.Conclusion: The pilot data provide preliminary support for the use of short-term dosing of D-cycloserine as an adjunctive intervention to exposure therapy for SAD.