Social anxiety disorder (SAD) is among the most common psychiatric conditions and is associated with significant distress and dysfunction in affected individuals. Although treatment with cognitive-behavior therapy (CBT) results in some of the best outcomes in the empirical literature for SAD, many patients do not respond to this intervention and most do not achieve remission. Thus, given the prevalence and attendant morbidity of SAD, and its persistence despite treatment, there is a critical need for the development of novel interventions to improve outcome. In CBT, core therapeutic procedures include repeated and prolonged exposure practices to feared social situations, allowing fears to extinguish as patients acquire a sense of safety in the presence of these stimuli. Exposure therapy is based on animal models of extinction of conditioned fears, and recent animal research has mapped some of the core pathways and neurotransmitters involved in fear extinction. D-cycloserine (DCS), an agonist at the glutamatergic NDMA receptor site appears to augment learning in animals and in some human trials facilitating the process of extinction of conditioned fear. Thus, converging evidence from animal models of fear extinction, and from initial studies in humans, including work from our pilot study, indicates that DCS can facilitate CBT of SAD. We are proposing a 4-year study to systematically assess the efficacy of DCS augmentation of CBT for the treatment of SAD. The study comprises a randomized, controlled trial to compare the relative short-term and long-term benefits of 12 CBT sessions that include 5 DCS-augmented (50 mg) sessions with the same CBT protocol that includes 5 placebo-augmented sessions. In addition, we will explore potential mediators and moderators of treatment change. We will randomize a total of 192 patients with the identical protocol followed at each of the sites. We make use of a collaborating team of investigators across 3 treatment sites to help ensure the timely recruitment of adequate numbers of patients, including an ethnically diverse population. This study represents a crucial stage in translating bench research to the clinic, and testing a novel approach for combining pharmacologic and cognitive-behavioral strategies for treating patients. This study addresses an important public health issue by assessing an intervention that may lead to a more efficient and effective application of empirically based psychosocial interventions for the treatment of SAD.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH075889-04
Application #
7897762
Study Section
Interventions Committee for Adult Mood and Anxiety Disorders (ITMA)
Program Officer
Kozak, Michael J
Project Start
2007-09-19
Project End
2012-07-31
Budget Start
2010-08-01
Budget End
2012-07-31
Support Year
4
Fiscal Year
2010
Total Cost
$395,347
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Meuret, Alicia E; Chmielewski, Michael; Steele, Ashton M et al. (2016) The desire to belong: Social identification as a predictor of treatment outcome in social anxiety disorder. Behav Res Ther 81:21-34
Manning, Joshua; Reynolds, Gretchen; Saygin, Zeynep M et al. (2015) Altered resting-state functional connectivity of the frontal-striatal reward system in social anxiety disorder. PLoS One 10:e0125286
Tart, Candyce D; Handelsman, Pamela R; Deboer, Lindsey B et al. (2013) Augmentation of exposure therapy with post-session administration of D-cycloserine. J Psychiatr Res 47:168-74
Smits, Jasper A J; Hofmann, Stefan G; Rosenfield, David et al. (2013) D-cycloserine augmentation of cognitive behavioral group therapy of social anxiety disorder: prognostic and prescriptive variables. J Consult Clin Psychol 81:1100-12
Smits, Jasper A J; Rosenfield, David; Otto, Michael W et al. (2013) D-cycloserine enhancement of fear extinction is specific to successful exposure sessions: evidence from the treatment of height phobia. Biol Psychiatry 73:1054-8
Zalta, Alyson K; Dowd, Sheila; Rosenfield, David et al. (2013) Sleep quality predicts treatment outcome in CBT for social anxiety disorder. Depress Anxiety 30:1114-20
Hofmann, Stefan G; Smits, Jasper A J; Rosenfield, David et al. (2013) D-Cycloserine as an augmentation strategy with cognitive-behavioral therapy for social anxiety disorder. Am J Psychiatry 170:751-8
Smits, Jasper A J; Rosenfield, David; Otto, Michael W et al. (2013) D-cycloserine enhancement of exposure therapy for social anxiety disorder depends on the success of exposure sessions. J Psychiatr Res 47:1455-61
Doehrmann, Oliver; Ghosh, Satrajit S; Polli, Frida E et al. (2013) Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry 70:87-97
Smits, Jasper A J; Tart, Candyce D; Rosenfield, David et al. (2011) The interplay between physical activity and anxiety sensitivity in fearful responding to carbon dioxide challenge. Psychosom Med 73:498-503

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