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。研究认为，社交恐惧焦虑的功能失调策略降低了再学习和习惯化的可能性。最有效的治疗方法是体内对抗。社交恐惧症患者面对引起焦虑的情况，使经历与他们的恐惧不一致，从而表现出减少的生理反应。通过这种方式，对抗导致了对社交恐惧症认知的纠正和生理习惯化。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。分析认为，原因可能是安全行为和习惯能力的差异。自主神经系统和下丘脑-垂体-肾上腺皮质（HPA）轴似乎起着重要的作用。研究表明，如果像TSST这样的标准化任务组合用于社交恐惧症患者的压力诱导，他们会表现出皮质醇过度反应。这支持了健康人与社交恐惧症患者在习惯化方面存在差异的观点。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，以及在治疗过程中社交恐惧认知的改变是否与压力反应的变化有关。在此基础上，考察了以下问题：1。与健康参与者相比，社交恐惧症患者在社交应激诱导过程中皮质醇反应的习惯化是否明显较慢？治疗前的习惯与治疗后的症状减轻是否有关系？社交恐惧症患者治疗前应激皮质醇反应的改变是否可以逆转，而治疗后应激应激皮质醇反应是否可以正常化？心理治疗导致的社交恐惧认知的改变量是否能显著预测治疗后皮质醇反应的改变？

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?