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Published on: January 13, 2017
Intranasal oxytocin administration prior to exposure therapy for arachnophobia impedes treatment response
Dean T Acheson1, David Feifel1, Mary Kamenski1
1Department of Psychiatry, University of California, San Diego, La Jolla, San Diego, California.
Background:
Recent years have seen the emergence of a new paradigm for treatment of anxiety disorders focusing on development of drugs that facilitate psychotherapies via targeted effects on neuroplasticity. One compound that has generated interest in this regard is oxytocin (OT), a mammalian neuropeptide that modulates activity of the neurocircuit mediating fear extinction and memory processes. Recent research in healthy humans has suggested that intranasal OT administered prior to fear extinction training enhances fear extinction performance, supporting its potential to augment exposure-based psychotherapy. Here, we tested the hypothesis that OT treatment would facilitate response to exposure therapy in patients with specific phobia.
Methods:
We conducted a small proof-of-concept trial investigating the effect of pretreatment intranasal OT administration on a brief, single-session exposure treatment for arachnophobia (fear of spiders). The study was randomized, double-blind, and placebo controlled (n = 13 placebo, 11 females; n = 10 OT, 8 females) with 1-week and 1-month follow-up assessments. Dependent measures attended to arachnophobia symptoms (self-report), phobic behavior (behavioral avoidance of spider task), and treatment credibility/therapeutic alliance.
Results:
Administration of OT prior to exposure therapy tended to impede treatment response as measured by self-report of symptoms at both follow-up periods. OT treatment did not significantly affect behavioral measures of fear. Immediately after OT administration but before therapy, the OT group trended toward less confidence in the treatment. The OT group also trended toward lower ratings of therapeutic alliance than placebo.
Conclusions:
These results suggest that OT administration effects on extinction may vary depending on conditions and population.
Insights
Intranasal oxytocin (OT) did not improve exposure therapy for arachnophobia and may impede treatment response. Further research is needed to understand OT's effects on fear extinction and specific patient populations.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Anxiety disorder treatments increasingly target neuroplasticity to enhance psychotherapy.
- Oxytocin (OT), a neuropeptide, influences fear extinction and memory circuits.
- Intranasal OT in healthy individuals enhanced fear extinction, suggesting potential for psychotherapy augmentation.
Purpose of the Study:
- To test if oxytocin (OT) treatment facilitates response to exposure therapy in patients with specific phobia.
- Investigate OT's effect on arachnophobia treatment outcomes.
Main Methods:
- A randomized, double-blind, placebo-controlled trial.
- Intranasal oxytocin (OT) administered before single-session exposure therapy for arachnophobia.
- Assessed arachnophobia symptoms, behavioral avoidance, treatment credibility, and therapeutic alliance at 1-week and 1-month follow-ups.
Main Results:
- Oxytocin (OT) administration tended to impede symptom reduction in self-reports at both follow-ups.
- No significant effect of OT on behavioral measures of fear.
- OT group showed trends toward lower treatment confidence and therapeutic alliance.
Conclusions:
- Oxytocin (OT) administration effects on fear extinction may be context- and population-dependent.
- Findings suggest OT may not universally enhance exposure therapy for specific phobias.
