Category: Adult Anxiety - Social
Background: In a recent study, greater homework compliance the week preceding a CBT session for obsessive-compulsive disorder was not only related to lower OCD-related symptoms, but was also moderated by D-cycloserine (DCS) (Olatunji et al., 2015). Specifically, higher homework compliance was related to significantly lower symptom ratings for participants receiving DCS, but not for those receiving pill placebo. DCS may therefore augment the effect of CBT in homework-compliant patients. The aim of this study was to examine whether this moderating effect of DCS could be replicated in group CBT for adults with Social Anxiety Disorder (SAD).
Methods: One hundred sixty-nine participants with generalized SAD received 50 mg of DCS or placebo while participating in 12-session exposure-based group CBT. DCS/pill was administered prior to sessions 3-7. Improvements in social anxiety were assessed by independent raters at each session using the Liebowitz social anxiety scale (LSAS). Homework compliance was comprised of between-session assignments using techniques learned in the treatment sessions. Multilevel modeling was used to examine whether DCS would moderate the effect of between-session homework completion on LSAS measured at the next session.
Results: Controlling for LSAS at the previous session and irrespective of treatment condition (DCS or pill placebo), we found that greater homework compliance in the week prior to an exposure session was related to lower LSAS at that session (b=-1.10, t(587)=-4.36, pb=.22, t(715)=7.95, p.001). Finally, LSAS levels were unrelated to homework compliance in the following week (b=.00, t(122)=.31, p=.757), controlling for prior-week homework compliance.
Conclusion: Greater homework compliance in group CBT for SAD predicted greater reductions in social anxiety severity. However, no moderating effect of DCS on homework compliance was found. Conversely, symptom severity did not have an effect on homework compliance. These findings diverge from Olatunji et al., possibly due to DCS dose, with all sessions being enhanced in the Olatunji study compared to only 40% in this study. Theoretical and clinical implications will be discussed.
Andres Roque– Graduate Student, Southern Methodist University, Dallas, Texas
David Rosenfield– Southern Methodist University
Jasper Smits– Professor, University of Texas at Austin
Naomi Simon– Professor of Psychiatry; Director, Center for Anxiety and Traumatic Stress Disorders; Chief Medical Officer, Home Base Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Michael Otto– Professor, Boston University, Boston
Luana Marques– Massachusetts General Hospital/Harvard Medical School
Mark Pollack– Rush Medical School
Stefan Hofmann– Professor of Psychology, Boston University
Alicia Meuret– Professor, Southern Methodist University, Dallas, Texas
Professor of Psychiatry; Director, Center for Anxiety and Traumatic Stress Disorders; Chief Medical Officer, Home Base Program
Massachusetts General Hospital, Harvard Medical School
Michael W. Otto, PhD, is Professor in the Department of Psychological and Brain Sciences at Boston University. He has had a major career focus on developing and validating new psychosocial treatments for anxiety, mood, psychotic, and substance use disorders, with a particular focus on treatment refractory populations. This includes a translational research agenda investigating brain-behavior relationships in therapeutic learning. His focus on hard-to-treat conditions and principles underlying behavior-change failures led him to an additional focus on health behavior promotion, including investigations of addictive behaviors, medication adherence, sleep, and exercise. Across these health behaviors, he has been concerned with cognitive, attention, and affective factors that derail adaptive behaviors, and the factors that can rescue these processes. He also investigates exercise as an intervention for affective and addictive disorders, as well as for cognitive enhancement. He has over 400 publications spanning his research interests, and was identified as a “top producer” in the clinical empirical literature, and an ISI Highly Cited Researcher. He is a Past President of the Association of Behavioral and Cognitive Therapies, and is currently President of Division 12 of the American Psychological Association.