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A Randomized Controlled Trial of D-Cycloserine Enhancement of Exposure Therapy for Social Anxiety Disorder
Abstract
Background Pilot research has suggested that D-cycloserine (DCS) enhances treatment outcomes for anxiety disorders when employed as an adjunct to exposure therapy (ET). The aim of this study was to determine whether 50 mg of DCS enhances ET for social anxiety disorder (SAD) according to a comprehensive set of symptom and life impairment measures.Methods In a randomized double-blind placebo-controlled trial, we administered 50 mg of DCS or placebo in combination with ET to 56 participants who met primary diagnosis for SAD.Results Participants administered DCS reported greater improvement on measures of symptom severity, dysfunctional cognitions, and life-impairment from SAD in comparison with placebo-treated participants. Effect sizes were mostly in the medium range. Results also indicated that the amount of adaptive learning about one's ability to give speeches in front of an audience interacted with DCS to enhance treatment outcome.Conclusions This study shows that the administration of DCS before ET enhances treatment outcomes for SAD. Results also provide the first preliminary evidence to suggest that DCS moderates the relationship between a reduction in negative appraisals about one's speech performance and improvement in overall SAD symptoms.
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“For SAD, early studies on D-cycloserine administration during exposure in vivo have yielded promising results (Guastella et al., 2008; Hofmann et al., 2006; Rodrigues et al., 2014)”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Guastella et al., 2008
In the citing paper
“Recently, DCS combined with imaginal or virtual reality exposure (VRE) therapy has been shown to reduce length of treatment for some anxiety disorders, including acrophobia (Ressler et al, 2004), social phobia (Guastella et al, 2008; Hofmann et al, 2006), and panic disorder (Otto et al, 2010), which, like PTSD, include learned avoidance and cued emotional distress as salient symptoms.”
From D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial (2014) · cites this paper as Guastella et al, 2008
In the citing paper
“In humans, DCS administration can likewise facilitate the loss of fear resulting from exposure that causes incomplete fear loss in controls (acrophobia: Ressler, Rothbaum, Tannenbaum, Anderson, Graap, Zimand, Hodges, & Davis, 2004; social phobia: Guastella, Richardson, Lovibond, Rapee, Gaston, Mitchell, & Dadds, 2008; Hofmann, Meuret, Smits, Simon, Pollack, Eisenmenger, Shiekh, & Otto, 2006;”
From D-cycloserine facilitates context-specific fear extinction learning (2008) · cites this paper as Guastella, Richardson, Lovibond, Rapee, Gaston, Mitchell, & Dadds, 2008
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Metadata
- Authors
- Guastella, A. J., Richardson, R., Lovibond, P. F., Rapee, R. M., Gaston, J. E., Mitchell, P., & Dadds, M. R.
- Affiliations
- UNSW Sydney (AU)
- Macquarie University (AU)
- Corresponding author
- Guastella, Adam J.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2008-03
- Volume
- 63
- Issue
- 6
- Pages
- 544-549
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2028445187
- Semantic Scholar
- e41984c470918166ac39c6aec20bd21dfc842860
- Cited by
- 326
- References
- 30
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 9 · 2020: 5 · 2019: 9 · 2018: 13 · 2017: 23 · 2016: 12 · 2015: 15 · 2014: 41 · 2013: 32 · 2012: 31
- FWCI
- 53.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council (350963)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- D-cycloserine, social anxiety disorder, exposure therapy, adjunctive pharmacotherapy, treatment enhancement, speech performance, dysfunctional cognitions, negative appraisals
- MeSH terms
- Adolescent, Adult, Combined Modality Therapy, Cycloserine, Desensitization, Psychologic, Double-Blind Method, Fear, Female, Humans, Male, Middle Aged, New South Wales, Phobic Disorders, Premedication, Speech
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