Cortisol-induced enhancement of emotional face processing in social phobia depends on symptom severity and motivational context

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Abstract

We investigated the effects of cortisol administration on approach and avoidance tendencies in 20 patients with social anxiety disorder (SAD). Event-related brain potentials (ERPs) were measured during a reaction time task, in which patients evaluated the emotional expression of photographs of happy and angry faces by making an approaching (flexion) or avoiding (extension) arm movement. Patients showed significant avoidance tendencies for angry but not for happy faces, both in the placebo and cortisol condition. Moreover, ERP analyses showed a significant interaction of condition by severity of social anxiety on early positive (P150) amplitudes during avoidance compared to approach, indicating that cortisol increases early processing of social stimuli (in particular angry faces) during avoidance. This result replicates previous findings from a non-clinical sample of high anxious individuals and demonstrates their relevance for clinical SAD. Apparently the cortisol-induced increase in processing of angry faces in SAD depends on symptom severity and motivational context.

Section snippets

Participants

Twenty-one unmedicated patients with SAD participated in the experiment for financial compensation (i.e., €40 and traveling expenses). Demographic variables and group characteristics are presented in Table 1. Patients were recruited at the outpatient anxiety departments of three community mental health centers and through advertisements on Internet forums. Inclusion criteria were: a primary diagnosis of generalized SAD (according to DSM-IV criteria) and a total score >60 at the Liebowitz Social

Cortisol and subjective measures

Salivary cortisol (nmol/L) measures (see Table 2) were skewed and therefore log transformed before statistical analysis. The results of a 2 × 4 ANOVA rm with condition (placebo, cortisol) and time (T0, T1, T2, T3) yielded a significant interaction of condition × time (F(3,48) = 78.47, p = .000, η2 = 0.83). This result indicates that, as expected, salivary cortisol levels did not differ between conditions before capsule intake (T0: F(1,17) = .01, p = .92), but were significantly increased after cortisol

Discussion

The aim of the present study was to investigate the effects of cortisol administration on threat processing and approach and avoidance behavior in a clinical sample of patients with generalized social anxiety disorder. In line with earlier findings of a very similar study with high anxious healthy participants (van Peer et al., 2007) we expected relatively increased avoidance (i.e., slower approach or faster avoidance responses) and enhanced processing (i.e., increased early (P150) and later

Acknowledgements

The authors thank Mark Rotteveel for the response device and task software; Miranda van den Berge, Laila Benbrahim, Liesbeth van Beemen, Janne Hofmeester, and the therapists from the anxiety unit of PsyQ, The Hague and Rivierduinen, Leiden, for their assistance in patient recruitment; the lab assistants of the Department of Clinical Neurophysiology of the Leiden University Medical Centre (LUMC) for their assistance in data collection; Cor Kramer and Robert Reijntjes for the technical support;

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