Fear, whether it occurs in humans suffering from an anxiety disorder or in experimental models with rodents, is reduced by exposing the frightened organism to the fearful stimulus in the absence of any negative consequences (i.e., extinction, or exposure therapy). However, fear often renews when the feared stimulus is encountered in a context different from the exposure context. In rats, we found that interfering with the animal's ability to process contexts during extinction by administering an anticholinergic drug prevented fear renewal. This proposal will determine if the beneficial effect of this drug translates to exposure therapy in socially anxious humans. To this end, 100 individuals with Social Phobia who fear public speaking will undergo repeated sessions of exposure to public speaking, within a virtual reality context. Participants will be randomized to either drug placebo, .2mg/.01 mL Scopolamine, .3mg/.01 mL Scopolamine or .4mg/.01 mL Scopolamine, administered via nasal drops, prior to each session of exposure therapy. One month after completion of exposure therapy, context renewal will be tested by comparing physiological and subjective responses to public speaking in the same virtual context as used during exposure therapy versus a context different than the one used during exposure therapy. The goal is to identify the dose of Scopolamine associated with the greatest reduction in context renewal. In addition, a secondary analysis will attempt to identify those individuals who benefit most from Scopolamine-augmentation of exposure therapy.

Public Health Relevance

Anxiety disorders can be devastating to the individuals, and their families, who suffer from them. Exposure therapy, the most successful psychosocial treatment for anxiety disorders, is only partially effective because fear may return if the previously feared stimulus is encountered in a different context. This proposal will use a pharmacological agent to reduce this contextualization and improve long term outcomes from exposure therapy.

National Institute of Health (NIH)
Planning Grant (R34)
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Interventions Committee for Adult Disorders (ITVA)
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Kozak, Michael J
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University of California Los Angeles
Schools of Arts and Sciences
Los Angeles
United States
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Craske, Michelle G; Treanor, Michael; Conway, Christopher C et al. (2014) Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 58:10-23