Augmentation of exposure therapy for high levels of social anxiety using post-exposure naps

描述（由申请人提供）：广泛重复的研究表明，睡眠可以增强记忆巩固。这些发现的潜在临床应用才刚刚开始探索。我们最近发现，当参与者再次暴露于相同的和新的蜘蛛刺激时，特定恐惧症（蜘蛛）模拟暴露疗法后的夜间睡眠减少了心理生理和自我报告的反应。这项拟议中的研究将把这些发现扩展到一种更令人衰弱和临床上重要的焦虑症--社交焦虑症。我们将研究暴露后小睡是否可以用来加强在这种疾病的行为治疗中使用的暴露练习过程中形成的治疗性消退记忆。总共有32名诊断为DSM-IV社交焦虑障碍的个体将被招募到这种障碍的基于焦虑的团体治疗中。在2年的资助期内，将提供8个连续的治疗组，每组4名患者。这个经过验证的5周/5次治疗的第三次和第四次会议将涉及每个参与者就单独选择的主题发表演讲，以引起显著的社交焦虑。所有4名参与者将前往附近的马萨诸塞州总医院睡眠实验室，其中2人将获得2小时的睡眠机会，并进行多导睡眠图（PSG）检查监测，另外2名将被类似地仪器化，但经历2小时监测的安静觉醒（在第3阶段之前，参与者将被随机分配到睡眠或觉醒组）。在开始治疗前和最后一次治疗后的几天内，所有参与者将单独评估社交焦虑症状 使用标准化的自我报告工具。同时，他们将接受特里尔社会压力测试（TSST），该测试经过修改以进行持续的心理生理监测，其中还包括重复的主观痛苦单位（SUDS）自我报告和唾液皮质醇采样。除实验室PSG外，还将在治疗前基线和治疗最后3周期间使用体动记录仪和睡眠日记对家庭睡眠进行动态监测。我们假设，与那些保持安静清醒的人相比，那些在暴露会话后允许2小时睡眠机会的人在改良的TSST期间将显示出更大的基于问卷的临床改善以及更小的心理生理和SUDS反应性。我们进一步假设，午睡期间的睡眠质量和结构特征，特别是总睡眠、REM睡眠和慢波睡眠以及REM连续性的持续时间，将预测午睡者的临床改善和TSST反应性降低。为了帮助确保观察到的睡眠效果归因于两个2小时的睡眠机会，我们将在治疗期间控制活动记录仪和日记测量的睡眠质量。积极的结果将提供第一个证明的原则，睡眠增加暴露疗法的临床显着的焦虑症。

DESCRIPTION (provided by applicant): Widely replicated studies demonstrate that sleep can enhance memory consolidation. Potential clinical applications of such findings have only begun to be explored. We have recently shown that nocturnal sleep following simulated exposure therapy for Specific Phobia (spiders) reduced both psychophysiological and self-reported reactivity when participants were re-exposed to the same and to novel spider stimuli. The proposed research will extend these findings to a more debilitating and clinically important anxiety disorder, Social Anxiety Disorder. We will examine whether post-exposure naps can be used to strengthen therapeutic extinction memories formed during exposure exercises used in the behavioral treatment of this disorder. A total of 32 individuals with diagnosed DSM-IV Social Anxiety Disorder will be enrolled in an exposure-based group treatment for this disorder. Eight successive therapy groups of 4 patients each will be offered during the 2-year funding period. The third and fourth sessions of this validated 5-week/5-session treatment will involve each participant delivering a speech on a topic individually chosen to elicit significant social anxiety Following both of these sessions, all 4 participants will go to the nearby Massachusetts General Hospital sleep laboratory where 2 will be given a 2-hour sleep opportunity with polysomnographic (PSG) monitoring and the other 2 will be similarly instrumented but undergo 2 hours of monitored quiet wakefulness (prior to session 3 participants will be randomized to the sleep or wakefulness arm). Before beginning treatment and within several days following the final treatment session, all participants will be individually assessed for social anxiety symptoms using standardized self-report instruments. At these same times, they will undergo a Trier Social Stress Test (TSST) modified for continuous psychophysiological monitoring that also includes repeated Subjective Units of Distress (SUDS) self report and sampling for salivary cortisol. In addition to laboratory PSG, ambulatory monitoring of home sleep with actigraphy and sleep diaries will take place at pre-treatment baseline and during the last 3 weeks of treatment. We hypothesize that those individuals allowed a 2-hour sleep opportunity following exposure sessions, compared to those who remained quietly awake, will show greater questionnaire- based clinical improvement as well as lesser psychophysiological and SUDS reactivity during the modified TSST. We further hypothesize that characteristics of sleep quality and architecture during naps, specifically durations of total sleep, REM sleep and slow-wave sleep as well as REM continuity, will predict clinical improvement and diminished TSST reactivity in those who napped. To help ensure that observed sleep effects are attributable to the two 2-hour sleep opportunities, we will control for actigraph and diary-measured sleep quality during treatment. Positive results will provide the first proof-of-principle for sleep augmentation of exposure therapy for a clinically significant anxiety disorder.