Social anxiety disorder (SAD) is associated with sleep disturbance, which may, in turn, interfere with learning and memory processes that are integral for exposure therapy. A recent study tested the relationships between exposure therapy outcomes and sleep disturbances both at baseline and before and after exposure-based therapy sessions in adults with SAD (N = 152). Subjects participated in a 5-week, 90-min session/week group-exposure therapy protocol that included treatment with placebo or D-cycloserine, a partial N-methyl-D-aspertate receptor agonist shown to enhance exposure therapy outcomes for SAD. Poorer self-reported baseline sleep quality was associated with slower SAD symptom improvement over time (b = 0.03, t(821) = 3.71, p < 0.001) and worse SAD outcomes at the final 3-month follow-up (b = 0.08, t(285) = 4.51, p < 0.001). Participants who had higher mean levels of self-reported total-sleep-time before the exposure sessions had lower SAD symptoms at the next session (b = -0.09, t(73)= -2.35, p = 0.021), suggestive of better learning (Figure 1a). Higher mean levels of post-session self-reported total-sleep-time were related to lower SAD symptom severity at the last exposure session (b = -0.12, t(110) = -2.59, p = 0.011), suggestive of better memory consolidation (Figure 1b). Self-reported pre- or post-session sleep quality was not associated with SAD symptom outcomes, and D-cycloserine treatment did not moderate any effects of sleep on symptom outcomes. These results replicate findings indicating that poor baseline sleep quality is associated with worse exposure therapy outcomes in SAD. The study also extends findings by showing that self-reported total-sleep-time the night before and after exposure therapy sessions is related to symptom change. Clinicians may consider assessing for sleep difficulties at the onset of treatment and incorporate techniques to improve sleep into their treatment plans in order to optimize therapeutic gains.
Figure 1. Higher mean levels of self-reported total-sleep-time before exposure therapy sessions were associated with lower social anxiety disorder (SAD) symptom severity at the next session, suggestive of better learning during exposure therapy (a). Higher mean levels of post-session self-reported total-sleep-time were related to lower SAD symptom severity at the last exposure session, suggestive of improved memory consolidation (b).
Dutcher CD et al. Depress Anxiety 2021; epub ahead of print. Abstract
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