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Abstract：
Psychotherapy is an effective treatment for anxiety disorders (AD), yet a vast majority of patients do not respond to therapy, necessitating the identification of predictors to enhance outcomes. Several studies have explored the relationship between stress response and treatment outcome, as a potential treatment mechanism. However, the latter remains under-researched in patients with social anxiety disorder (SAD). We studied N = 29 patients undergoing psychodynamic psychotherapy (PDT) within the SOPHONET-Study. Stress reactivity (i.e., area under the curve with respect to the increase; AUCi) was induced by a standardized psychosocial stressor (Trier Social Stress Test; TSST) and assessed by means of adrenocorticotropic hormone (ACTH), blood and salivary cortisol samples before (t1) treatment. Samples of these biomarkers were taken -1 min prior stress exposure and six more blood samples were collected post-TSST ( + 1, + 10, + 20, + 30, + 45, + 60 min.). The participants were diagnosed with SAD based on the Structured Clinical Interview for DSM-IV (SCID) and completed the Liebowitz Social Anxiety Scale as well as the Beck Depression Inventory before (t1) and after psychotherapy (t2). Pre-treatment stress reactivity significantly predicted changes in depression (salivary p < 0.001 and blood cortisol p = 0.001), as well as in avoidance behavior (blood cortisol p = 0.001). None of the biomarkers revealed significant results in fear or in the total LSAS-scores, except for ACTH with a trend finding (p = 0.06). Regarding therapy success, symptoms of social anxiety (p = 0.005) and depression (p < 0.001) were significantly reduced from pre (t1) to post-treatment (t2). Our study showed that stress reactivity pre-treatment may serve as a predictor of psychotherapy outcome. In this regard, alterations in stress response relate to changes in symptoms of social anxiety and depression after PDT. This implies that patients with chronic stress might benefit from a targeted interventions during psychotherapy, especially to manage fear in social contexts.
摘要：
心理治疗是一种有效的治疗焦虑症（AD），然而，绝大多数患者对治疗没有反应，需要确定预测因子以增强结果。一些研究探索了应激反应和治疗结果之间的关系，作为一种潜在的治疗机制。然而,后者在社交焦虑症（SAD）患者中的研究不足。我们在SOPHONET研究中研究了N=29例接受心理动力学心理治疗（PDT）的患者。应激反应性(即，关于增加的曲线下面积；AUCi）是由标准化的心理社会应激源（特里尔社会应激测试；TSST）引起的，并通过促肾上腺皮质激素（ACTH）进行评估，血液和唾液皮质醇样本（t1）治疗前。在应激暴露前-1分钟采集这些生物标志物的样品,并且在TSST后收集另外六个血液样品(+1、+10、+20、+30、+45、+60分钟。).参与者根据DSM-IV的结构化临床访谈（SCID）被诊断为SAD，并在心理治疗之前（t1）和之后（t2）完成了Liebowitz社交焦虑量表以及Beck抑郁量表。治疗前的应激反应性显着预测抑郁症的变化（唾液p<0.001，血液皮质醇p=0.001），以及回避行为(血液皮质醇p=0.001)。没有一个生物标志物在恐惧或总LSAS评分中显示出显著结果，除了具有趋势发现的ACTH(p=0.06)。关于治疗成功，从治疗前(t1)到治疗后(t2),社交焦虑(p=0.005)和抑郁(p<0.001)症状显著减少.我们的研究表明，应激反应性预处理可以作为心理治疗结果的预测指标。在这方面,应激反应的改变与PDT后社交焦虑和抑郁症状的改变有关。这意味着患有慢性压力的患者可能会在心理治疗期间受益于有针对性的干预措施，尤其是在社会环境中管理恐惧。
