Background
Social avoidance and inhibition in animals is associated with hyperresponsiveness
of the glucocorticoid stress-system. In humans, the relation between glucocorticoid
stress-reactivity and social avoidance behavior remains largely unexplored. We investigated
whether increased cortisol stress-responsiveness is linked to increased social avoidance
behavior in patients with social anxiety disorder (SAD).
Methods
Patients with SAD (n = 18) as well as two control groups of healthy participants (n = 22) and patients with posttraumatic stress disorder (PTSD; n = 17), respectively, performed a social approach-avoidance task (AA-task) in a baseline
condition and in a social stress condition (provided by the Trier Social Stress Test).
The AA-task is a computerized reaction-time task measuring the speed of manual approach
and avoidance responses to visually presented social threat cues (angry faces). Salivary
cortisol, blood pressure, and subjective anxiety were assessed throughout the experiment.
Results
Patients with SAD showed larger cortisol responses to the social stress test, as compared
with healthy and PTSD control subjects. Most crucially, these increased cortisol responses
were significantly correlated to the increase in social avoidance behavior measured
by the AA-task in the social stress condition in SAD. An additional regression analysis
showed that the cortisol responses predicted the stress-induced increase in social
avoidance tendencies over and above the effects of blood pressure and subjective anxiety.
Conclusions
These findings provide the first evidence for a direct link between increased cortisol
stress-responsiveness and social avoidance behavior in patients with SAD. The results
support animal models of social avoidance and inhibition and might have important
treatment implications.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Recent advances in the treatment of social phobia.J Cogn Psychoth. 2006; 20: 3-5
- Generalized social phobia.Arch Gen Psychiatry. 1995; 52: 230-237
- A cognitive model of social phobia.in: Heimberg R.G. Liebowitz M.R. Hope D.A. Schneier F.R. Social Phobia: Diagnosis, Assessment and Treatment. Guilford Press, New York1995: 69-93
- Safety behaviors and social performance in patients with generalized social phobia.J Cogn Psychoth. 2006; 20: 17-31
- Adrenocortical function, social rank, and personality among wild baboons.Biol Psychiatry. 1990; 28: 862-878
- Individual differences in freezing and cortisol in infant and mother Rhesus monkeys.Behav Neurosci. 1998; 112: 251-254
- Effects of postnatal handling of rats on emotional, HPA-axis, and prolactin reactivity to novelty and conflict.Physiol Behav. 1996; 60: 1355-1359
- Behavioral inhibition and glucocorticoid dynamics in a rodent model.Physiol Behav. 2007; 92: 897-905
- Baseline salivary cortisol levels and preconscious selective attention for threat: A pilot study.Psychoneuroendocrinology. 1998; 23: 741-747
- Conscious and preconscious selective attention to social threat: Different neuroendocrine response patterns.Psychoneuroendocrinology. 2000; 25: 577-591
- The effects of stress-induced cortisol responses on approach-avoidance behavior.Psychoneuroendocrinology. 2005; 30: 665-677
- The effects of stress and cortisol on the preconscious selective attention to social threat.Biol Psychol. 2007; 75: 1-7
- HPA axis response to a psychological stressor in generalized social phobia.Psychoneuroendocrinology. 2002; 27: 693-704
- Salivary cortisol levels in socially phobic adolescent girls.Depress Anxiety. 1999; 10: 25-27
- Responses of “generalized” and “discrete” social phobics during public speaking.J Anxiety Disord. 1993; 7: 207-221
- Abnormal salivary cortisol levels in social phobic patients in response to acute psychological but not psysical stress.Biol Psychiatry. 2001; 50: 254-259
- Toward a framework for defective emotion processing in social phobia.Cogn Neuropsychiatry. 2006; 11: 307-331
- Automatic affective evaluation does not automatically predsipose for arm flexion and extension.Emotion. 2004; 4: 156-172
- Avoidance of emotional facial expressions in social anxiety: The Approach–Avoidance Task.Behav Res Ther. 2007; 45: 2990-3001
- The effects of cortisol administration on approach-avoidance behavior: An event-related potential study.Biol Psychol. 2007; 76: 135-146
- Increased amygdala activation to angry and contemptuous faces in generalized social phobia.Arch Gen Psychiatry. 2002; 59: 1027-1034
- Effect of task conditions on brain responses to threatening faces in social phobics: An event-related functional magnetic resonance imaging study.Biol Psychiatry. 2004; 56: 921-929
- Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia.Biol Psychiatry. 2006; 59: 424-429
- The Trier Social Stress Test: A tool for investigating psychobiological stress response in a laboratory setting.Neuropsychobiology. 1993; 28: 76-81
- Structured Clinical Interview for DSM-IVAxis I Disorders, Version 2.0.Biometrics Research, New York1996
- Pictures of Facial Affect.Consulting Psychologist Press, Palo Alto, California1976
- Japanes and Caucasian Facial Expressions of Emnotion (JACFEE) [Slides].University of California, Human Interaction Laboratory, San Francsico1988
- The Karolinska Directed Emotional Faces (KDEF) [CD ROM].Department of Clinical Neuroscience, Stockholm1998 (Psychology Section, Karolinska Institute)
Martinez AM, Benavente R (1998): The AR Face Database. CVC tech. Rep. No. 24.
- Automated measurement of cortisol.Clin Chem. 2003; 49: 1408-1409
- An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory.Psychol Assess. 1989; 1: 35-40
- Validity of two questionnaires to assess social fears: The Dutch Social Phobia and Anxiety Inventory and the Blushing, Trembling and Sweating Questionnaire.J Psychopathol Behav Assess. 1999; 21: 51-66
- An inventory for measuring depression.Arch Gen Psychiatry. 1961; 4: 561-571
Bouman TK, Luteijn F, Albersnagel FA, Ploeg FAE van der (1985): Some experiences with the Beck Depression Inventory. Gedrag 13:13–24.
- The psychometric characteristics of the Traumatic Experiences Questionnaire (TEC): First findings among psychiatric outpatients.Clin Psych Psychother. 2002; 9: 200-210
- Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change.Psychoneuroendocrinology. 2003; 28: 916-931
- Estimating and testing mediation and moderation in within-subject designs.Psychol Meth. 2001; 6: 115-134
- Social anxiety and attention away from faces.Cogn Emotion. 1999; 13: 673-690
- Stress and cognition: Are corticosteroids good or bad guys?.Trends Neurosci. 1999; 22: 422-426
Roelofs K, Minelli A, Mars R, van Peer J, Toni I (in press): On the cerebral control of social-emotional behavior. Soc Cogn Aff Neurosci.
- Modulation of attentional inhibition by norepinephrine and cortisol after psychological stress.Int J Psychophysiol. 2000; 36: 59-68
- Stress-level cortisol treatment impairs inhibitory control of behavior in monkeys.J Neurosci. 2000; 20: 7816-7821
- Salivary cortisol in psychoneuroendocrine research: Recent developments and applications.Psychoneuroendocrinology. 1994; 19: 313-333
- Cognitive Behavioural Processes Across Psychological Disorders, A Transdiagnostic Approach to Research and Treatment.Oxford University press, Oxford2004
- Psychotherapy by Reciprocal Inhibition.Stanford University Press, Stanford, California1958
Article info
Publication history
Published online: October 24, 2008
Accepted:
August 26,
2008
Received in revised form:
August 24,
2008
Received:
April 16,
2008
Identification
Copyright
© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
