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

社交恐惧症是最常见的焦虑症之一。有人提出，功能失调的策略，以应对社交恐惧焦虑减少再学习和习惯化的可能性。最有效的治疗方法是体内对抗。社交恐惧症患者面临焦虑激发的情况，使经验与他们的恐惧不一致，反过来表现出减少的生理反应。通过这种方式，对抗可以纠正社交恐惧症的认知并形成生理习惯。目前，还不清楚为什么手动对抗疗法并不适用于所有社交恐惧症患者。这可能与安全行为和习惯化能力的差异有关。植物神经系统和下丘脑-垂体-肾上腺皮质（HPA）轴可能起着重要作用。研究表明，如果像TSST这样的标准化任务组合被用于社交恐惧症患者的压力诱导，他们会表现出皮质醇高反应性。这支持了健康人和社交恐惧症患者之间习惯化差异的观点。根据目前的文献，尚不清楚这种压力反应的差异是否与习惯化和治疗成功的差异有关，以及在整个治疗过程中社交恐惧认知的变化是否与压力反应的变化有关。在此基础上，本文研究了以下问题：1.与健康受试者相比，社交恐惧症患者在TSST的社交应激诱导过程中是否表现出皮质醇反应的明显较慢的习惯化？2.治疗前的习惯化与治疗后的减毒是否有关系？3.社交恐怖症患者在治疗前对压力的皮质醇反应改变是否可以逆转，即在心理治疗后对TSST的皮质醇反应正常化？4.心理治疗后社交恐惧认知的变化量是否能显著预测治疗后皮质醇反应的变化？

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?