Hydrocortisone as an adjunct to brief cognitive-behavioural therapy for specific fear: Endocrine and cognitive biomarkers as predictors of symptom improvement

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

Abstract

BACKGROUND: Glucocorticoid (GC) administration prior to exposure-based cognitive-behavioural therapy (CBT) has emerged as a promising approach to facilitate treatment outcome in anxiety disorders. Further components relevant for improved CBT efficacy include raised endogenous GCs and reductions in information-processing biases to threat.

AIMS: To investigate hydrocortisone as an adjunct to CBT for spider fear and the modulating role of threat bias change and endogenous short-term and long-term GCs for treatment response.

METHODS: Spider-fearful individuals were randomized to receiving either 20 mg of hydrocortisone ( n = 17) or placebo ( n = 16) one hour prior to single-session predominantly computerised exposure-based CBT. Spider fear was assessed using self-report and behavioural approach measures at baseline, 1-day and 1-month follow-up. Threat processing was assessed at baseline and 1-day follow-up. Cortisol and cortisone were analysed from hair and saliva samples at baseline.

RESULTS/OUTCOMES: Self-report, behavioural and threat processing indices improved following CBT. Hydrocortisone augmentation resulted in greater improvement of self-report spider fear and stronger increase in speed when approaching a spider, but not on threat bias. Neither threat bias nor endogenous GCs predicted symptom change, and no interactive effects with hydrocortisone emerged. Preliminary evidence indicated higher hair cortisone as predictor of a stronger threat bias reduction.

CONCLUSIONS/INTERPRETATION: Our data extend earlier findings by suggesting that GC administration boosts the success of exposure therapy for specific fear even with a low-level therapist involvement. Future studies corroborating our result of a predictive hair GC relationship with threat bias change in larger clinical samples are needed.

Details

Original languageEnglish
Pages (from-to)641-651
Number of pages11
JournalJournal of psychopharmacology
Volume35
Issue number6
Publication statusPublished - Jun 2021
Peer-reviewedYes

External IDs

WOS 000651159800001
Scopus 85105507600
PubMed 33908295
PubMedCentral PMC8278554
ORCID /0000-0002-1171-7133/work/142254999

Keywords

Keywords

  • Adolescent, Adult, Animals, Biomarkers/metabolism, Cognitive Behavioral Therapy/methods, Combined Modality Therapy, Double-Blind Method, Female, Follow-Up Studies, Glucocorticoids/administration & dosage, Humans, Hydrocortisone/administration & dosage, Implosive Therapy/methods, Male, Phobic Disorders/therapy, Spiders, Treatment Outcome, Young Adult