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，应对社交恐惧症的失灵策略会减少重新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着引发焦虑的情况，使他们的经历与他们的恐惧不一致，进而表现出减少的生理反应。通过这种方式，对抗导致了社交恐惧症认知的纠正和生理习惯。目前，尚不清楚为什么人工对抗疗法不适用于所有社交恐惧症患者。其原因可能是安全行为和适应能力的差异。似乎自主神经系统和下丘脑-垂体-肾上腺皮质(HPA)轴起着重要作用。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的习惯差异的观点。根据目前的文献，尚不清楚这种应激反应的差异是否与习惯性和治疗成功的差异有关，也不清楚整个治疗过程中社交恐惧症认知的变化是否与应激反应的变化有关。在此基础上，研究了以下问题：1.社交恐惧症患者在使用TSST进行社会压力诱导的整个过程中，是否表现出明显的较慢的皮质醇反应习惯化？2.治疗前的习惯化与治疗后症状的减轻有关系吗？3.社交恐惧症患者治疗前对应激的皮质醇反应变化是否可逆，从而使心理治疗后对TSST的皮质醇反应正常化？4.心理治疗引起的社交恐惧症认知的变化量是否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?