Effects of post-exposure naps on exposure therapy for social anxiety. (December 2018)

• Record Type: Journal Article
• Authors: Pace-Schott, Edward F.; Bottary, Ryan M.; Kim, Se-Yun; Rosencrans, Peter L.; Vijayakumar, Shilpa; Orr, Scott P.; Lasko, Natasha B.; Goetter, Elizabeth M.; Baker, Amanda W.; Bianchi, Matt T.; Gannon, Karen; Hoeppner, Susanne S.; Hofmann, Stefan G.; Simon, Naomi M.
• Is Part Of: Psychiatry research. Volume 270(2018)
• Page Start: 523
• Page End: 530
• Publication Date: 2018-12
• Subjects: Sleep -- Social anxiety disorder -- Exposure therapy -- Extinction -- Psychophysiology -- Cortisol; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2018.10.015
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Sleep following exposure sessions might strengthen therapeutic extinction memory. Participants with social anxiety disorder completed 5-session group exposure therapy. 17 napped and 15 remained awake following 2 intensive social exposure sessions. Naps did not improve pre-post therapy outcomes on the Liebowitz Social Anxiety Scale. Naps enhanced pre-post therapy reduction in physiological reactivity to social stressor. Abstract: Exposure therapy for social anxiety disorder (SAD) utilizes fear extinction, a memory process enhanced by sleep. We investigated whether naps following exposure sessions might improve symptoms and biomarkers in response to social stress in adults undergoing 5-week exposure-based group SAD therapy. Thirty-two participants aged 18–39 (18 females) with SAD were randomized. Before and after treatment, participants completed the Liebowitz Social Anxiety Scale (LSAS) and underwent a Trier Social Stress Test with psychophysiological monitoring (mpTSST) that included skin conductance (SCL), electromyographic (EMG) and electrocardiographic recording, and an auditory startle procedure while anticipating the social stressor. At sessions 3 and 4, exposure was followed by either a 120-min polysomnographically monitored sleep opportunity (Nap, N = 17) or wakefulness (Wake, N = 15). Primary hypotheses about SAD symptom change (LSAS) and EMG blink-startle response failed to differ with naps, despite significant symptom improvement (LSAS) with therapy. Some secondary biomarkers, however, provided preliminary support for enhanced extinction learning with naps, with trend-level Time (pre-, post-treatment) × Arm interactions and significant reduction from pre- to post treatment in the Nap arm alone for mpTSST SCL and salivary cortisol rise. Because of the small sample size and limited sleep duration, additional well-powered studies with more robust sleep interventions are indicated.