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，针对特定恐惧症(蜘蛛)的模拟暴露治疗后的夜间睡眠减少了心理生理和自我报告的反应。这项拟议的研究将把这些发现扩展到一种更具衰弱和临床重要性的焦虑症--社交焦虑症。我们将研究暴露后小睡是否可以用来加强在暴露练习中形成的治疗性消退记忆，用于这种疾病的行为治疗。共有32名确诊为DSM-IV社交焦虑障碍的患者将参加以暴露为基础的小组治疗。在两年的资助期内，将提供8个连续治疗小组，每个小组4名患者。在这项为期5周/5次的有效治疗的第三和第四次会议上，每个参与者都将就一个单独选择的引起显著社交焦虑的话题发表演讲。在这两次会议之后，所有4名参与者都将前往附近的马萨诸塞州综合医院睡眠实验室，在那里，2名参与者将获得2小时的睡眠机会，并进行多导睡眠监测(PSG)，另外2名参与者将接受类似的工具，但接受2小时的安静清醒监测(在第3次会议之前，参与者将被随机分配到睡眠或清醒手臂上)。在开始治疗之前和最后一次治疗后的几天内，所有参与者都将被单独评估社交焦虑症状。 使用标准化的自我报告工具。与此同时，他们将接受Trier社会压力测试(TSST)的修改，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周期间使用活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，那些在暴露期间允许2小时睡眠的人在修改后的TSST期间将显示出更大的基于问卷的临床改善以及较低的心理生理和肥皂水反应性。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睡眠和慢波睡眠的持续时间以及REM的连续性，将预测午睡患者的临床改善和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和日记测量的睡眠质量。积极的结果将为暴露疗法治疗一种临床显著的焦虑症提供第一个增加睡眠的原则证明。

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.