Glucocorticoids enhance extinction-based psychotherapy
- aDivision of Cognitive Neuroscience, Department of Psychology, and
- bPsychiatric University Clinics, University of Basel, 4055 Basel, Switzerland;
- cDepartment of Clinical Psychology and Psychotherapy, University of Saarbrücken, 66123 Saarbrücken, Germany;
- dDepartment of Psychology, King's College London Institute of Psychiatry, Denmark Hill, London SE5 8AF, United Kingdom;
- eVirtual Reality Medical Institute, 1150 Woluwe-Saint-Pierre, Belgium;
- fVirtual Reality Medical Center, San Diego, CA 92121;
- gDepartment of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, 44301 Bochum, Germany; and
- hDepartment of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, 5020 Salzburg, Austria
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Edited* by James L. McGaugh, University of California, Irvine, CA, and approved December 20, 2010 (received for review December 6, 2010)

Abstract
Behavioral exposure therapy of anxiety disorders is believed to rely on fear extinction. Because preclinical studies have shown that glucocorticoids can promote extinction processes, we aimed at investigating whether the administration of these hormones might be useful in enhancing exposure therapy. In a randomized, double-blind, placebo-controlled study, 40 patients with specific phobia for heights were treated with three sessions of exposure therapy using virtual reality exposure to heights. Cortisol (20 mg) or placebo was administered orally 1 h before each of the treatment sessions. Subjects returned for a posttreatment assessment 3–5 d after the last treatment session and for a follow-up assessment after 1 mo. Adding cortisol to exposure therapy resulted in a significantly greater reduction in fear of heights as measured with the acrophobia questionnaire (AQ) both at posttreatment and at follow-up, compared with placebo. Furthermore, subjects receiving cortisol showed a significantly greater reduction in acute anxiety during virtual exposure to a phobic situation at posttreatment and a significantly smaller exposure-induced increase in skin conductance level at follow-up. The present findings indicate that the administration of cortisol can enhance extinction-based psychotherapy.
Footnotes
- ↵1To whom correspondence should be addressed. E-mail: dominique.dequervain{at}unibas.ch.
Author contributions: D.J.-F.d.Q., D.B., T.M., O.C.B., B.K.W., J.M., and F.H.W. designed research; D.B. and O.C.B. performed research; D.J.-F.d.Q., D.B., T.M., O.C.B., B.K.W., J.M., and F.H.W. analyzed data; and D.J.-F.d.Q., D.B., T.M., O.C.B., B.K.W., J.M., and F.H.W. wrote the paper.
The authors declare no conflict of interest.
↵*This Direct Submission article had a prearranged editor.
This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1018214108/-/DCSupplemental.
Freely available online through the PNAS open access option.
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