Comparison of habituation processes between healthy persons and patients with social phobia before and after confrontation therapy

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Social phobia is one of the most common anxiety disorders. It is proposed that dysfunctional strategies for coping with social phobic anxiety reduce the possibility of relearning and habituation. The most effective therapy is confrontation in vivo. Social phobic patients are confronted with anxiety-provoking situations to make experiences incongruent with their fears and in turn show a reduced physiological reaction. In this way, confrontation leads to a correction of social-phobic cognitions and to physiological habituation.For now, it is unclear why manualized confrontation therapy does not work for all social phobic patients. It is proposed that reasons may be security behavior and differences in the ability of habituation. It seems that the autonomic nervous system and the Hypothalamic-pituitary-adrenocortical (HPA) axis play an important role. Studies show that if a standardized combination of tasks like the TSST is used for stress induction in social phobic patients, they show a cortisol-hyperreactivity. This supports the idea of differences in habituation between healthy and social phobic persons. Based on the current literature it is unclear if this differences in stress-responsivity are related with differences in habituation and therapy success and if a change of social-phobic cognitions throughout therapy is related with changes in stress-responsivity. Based on this, following questions are examined:1. Do social phobic patients, compared to healthy participants, show a significant slower habituation of cortisol-reaction throughout social stress-induction with the TSST?2. Is there a relation of habituation before therapy and symptom-reduction after therapy?3. Is a changed cortisol-reaction to stress of social phobic patients before therapy reversible in a way that the cortisol-reaction to the TSST is normalized after psychotherapy?4. Does the amount of change of social-phobic cognitions because of psychotherapy significantly predict the change in cortisol-reaction after therapy?