The effect of hydrocortisone on fear information processing as a predictor of clinical changes following brief cognitive-behavioral therapy in spider-fearfuls

• Applicant: Dr. Susann Schmiedgen
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: from 2014 to 2015
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 261555023

Meta-analytical data suggest that anxiety disorders are most effectively treated by exposure therapy. However, as it has been found that a subgroup of patients do not achieve clinically significant symptom improvement, more research is needed to identify key mechanisms for an effective treatment outcome and strategies to optimize the effects of exposure therapy. Recently, it has been shown that a single session of exposure-based cognitive-behavioral therapy (CBT) rapidly influences automatic threat processing (measured using cognitive bias reaction time tasks) which, in turn, is predictive of psychotherapeutic changes at 4-week follow up. The question remains whether additional treatment ingredients might (i) boost these early changes in emotional information processing and (ii) whether these predict a more pronounced symptom improvement. Here, a promising approach constitutes the administration of hydrocortisone - a glucocorticoid which is assumed to influence key neural processes which are related to a more pronounced symptom reduction after exposure therapy. Within the framework of an already funded project, 40 spider-fearful healthy adults who will be randomised to a group receiving a single dose of hydrocortisone versus placebo while performing a fear habituation task at drug peak level will be examined in a double-blind between-groups design. The current study aims to investigate (i) the effects of probing glucocorticoid function on performance in emotional cognitive tasks on the day after fear habituation and (ii) whether this treatment ingredient leads to stronger effects on changes in clinical symptoms after four weeks, compared to placebo. A further objective is to explore whether long-term integrated hair cortisol concentrations moderate effects of hydrocortisone administration on learning. The results of this study are believed to significantly extend the current understanding of basic mechanisms of learning related to probing glucocorticoid brain function and might further inform future research into improving the effects of CBT in the treatment of anxiety disorders.

• DFG Programme: Research Fellowships
• International Connection: United Kingdom
• Host: Dr. Andrea Reinecke