Two-pronged approach may curb social phobia

Research suggests that D-cycloserine may be a good adjunct to exposure-based therapy in individuals with social anxiety disorder, a debilitating condition marked by an excessive fear and avoidance of situations in which a person feels he or she will be judged by others, such as public speaking or even eating in front of others.

Exposure therapy, which is commonly used to combat social phobia, relies on extinction to treat the fears underlying the disorder.

Lead investigator Dr. Stefan G. Hofmann of Boston University told Reuters Health that in conducting the study “we argued that D-cycloserine ... which facilitates extinction learning in animals, should also enhance the effects of exposure therapy for social anxiety disorder in humans. Our findings seem to support this notion.”

In the study, 27 individuals suffering from social anxiety disorder with significant public speaking anxiety participated in five therapy sessions, which emphasized exposure to increasingly challenging public speech situations. One hour before each session, the participants were given a single dose of D-cycloserine or placebo.

Symptoms were assessed at baseline, just after the last session, and 1 month after the last session, by patient self-reports and reports of clinicians blinded to the treatment allocation.

Compared with the placebo group, patients in the D-cycloserine group had a significant improvement in symptoms, with a difference between the two groups in the medium-to-high range, Hofmann and colleagues report in the Archives of General Psychiatry.

“If these results can be replicated in a larger randomized controlled trial,” Hofmann noted, “it might be possible to significantly reduce the amount of therapy time and enhance the efficacy of psychological treatments in the future.”

D-cycloserine has been shown to reduce symptoms in schizophrenics and improve social and communication skills in autistic children.

SOURCE: Archives of General Psychiatry March 2006.

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