The association between estradiol levels, hormonal contraceptive use, an responsiveness to one-session-treatment for spider phobia in women
The association between estradiol levels, hormonal contraceptive use, an responsiveness to one-session-treatment for spider phobia in women
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DOI：
10.1016/j.psyneuen.2018.02.019
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发表时间：
2018-04-01
影响因子：
3.7
通讯作者：
Ost, Lars-Goran
中科院分区：
文献类型：
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作者：
Graham, Bronwyn M.;Li, Sophie H.;Ost, Lars-Goran
临床前研究表明，由于月经波动或激素避孕药的使用，内源性激素雌二醇水平较低的女性的条件性恐惧消退会受到损害。由于恐惧消退是针对焦虑和创伤性疾病的暴露疗法的实验室模型，因此我们评估了这样的假设：当暴露疗法在低雌二醇期间进行时，治疗效果可能会降低。 90 名患有蜘蛛恐惧症的女性（60 名骑自行车的女性和 30 名使用激素避孕药的女性）接受了一次针对蜘蛛恐惧症的暴露治疗，随后评估了血清雌二醇水平。根据雌二醇水平的中位数将自行车参与者分为两组；雌二醇较低和较高。在治疗前、治疗后以及 12 周的随访评估中测量了行为回避和自我报告的对蜘蛛的恐惧。与两组没有差异的骑行女性相比，使用激素避孕药的女性在整个治疗过程中表现出明显较慢的改善速度，在治疗后和随访中表现出更大的行为回避，以及更少的自我启动的治疗后暴露任务。自我报告的恐惧没有明显的群体差异。相关分析显示，在整个样本中，较低的雌二醇水平与整个治疗过程中改善速度较慢以及治疗后自我报告的恐惧和行为回避程度较高有关，但与后续治疗无关。这些结果提供了第一个证据，证明内源性雌二醇、激素避孕药的使用和蜘蛛恐惧症女性的暴露疗法结果之间存在关联。激素水平可能部分解释了女性对焦虑和创伤障碍心理治疗反应的变异性。
Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treatment, greater behavioral avoidance at post-treatment and follow-up, and fewer self initiated post-treatment exposure tasks, relative to both groups of cycling women, who did not differ. No group differences in self-reported fear were evident. Correlational analyses revealed that across the whole sample, lower estradiol levels were associated with slower rates of improvement across treatment, and greater self reported fear and behavioral avoidance at post-treatment, but not follow-up. These results provide the first evidence of an association between endogenous estradiol, hormonal contraceptive use, and exposure therapy outcomes in spider phobic women. Hormonal profile may partly account for variability in responsiveness to psychological treatments for anxiety and trauma disorders in women.