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Effects of post-exposure naps on exposure therapy for social anxiety

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

Psychiatry Research, December 2018, Vol.270, pp.523-530 [Peer Reviewed Journal]

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  • Title:
    Effects of post-exposure naps on exposure therapy for social anxiety
  • Author/Creator: 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
  • Language: English
  • Subjects: Sleep ; Social Anxiety Disorder ; Exposure Therapy ; Extinction ; Psychophysiology ; Cortisol ; Medicine
  • Is Part Of: Psychiatry Research, December 2018, Vol.270, pp.523-530
  • Description: 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, = 17) or wakefulness (Wake,  = 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.
  • Identifier: ISSN: 0165-1781 ; E-ISSN: 1872-7123 ; DOI: 10.1016/j.psychres.2018.10.015