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Cited by 236Stress Responses and CortisolAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNeuroendocrine regulation and behavior

Hypothalamus-pituitary-adrenal axis hyperresponsiveness is associated with increased social avoidance behavior in social phobia

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Roelofs, Karin, van Peer, Jacobien, Berretty, Ed, Jong, Paula de, Spinhoven, Philip, Elzinga, Bernet M.·2009·Biological Psychiatry
DOI 10.1016/j.biopsych.2008.08.022
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Abstract

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.

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  • The observed negative effect of fAM concentrations before social interactions on fGCM could be explained by a dual-hormone regulation through cortisol's associations with stress and social dominance.

    “The observed negative effect of fAM concentrations before social interactions on fGCM could be explained by a dual-hormone regulation through cortisol’s associations with stress and social dominance [64–66].”

    From Socializing a group of male Asian elephants in a semi-captive facility in Lao PDR (2025) · cites this paper as [66]

    The Stress Measures and Discussion sections (page unavailable) link cortisol responses to social stress and avoidance in patients with social anxiety disorder. The paper does not support the proposed dual-hormone explanation, the negative fAM–fGCM effect, or an association with social dominance; it notes that only free cortisol was measured. (LLM, conf=0.85)

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Authors
Roelofs, K., van Peer, J., Berretty, E., Jong, P. D., Spinhoven, P., & Elzinga, B. M.
Affiliations
Leiden University (NL)
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2009-02
Volume
65
Issue
4
Pages
336-343
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/j.biopsych.2008.08.022
OpenAlex
W2032463135
Cited by
236
References
47
Citations by year
2026: 7 · 2025: 10 · 2024: 6 · 2023: 51 · 2022: 9 · 2021: 10 · 2020: 15 · 2019: 9 · 2018: 8 · 2017: 12 · 2016: 21 · 2015: 13 · 2014: 18 · 2013: 6 · 2012: 10
FWCI
4.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Neuroendocrine regulation and behavior
Keywords
social anxiety disorder, social avoidance, cortisol, hypothalamic-pituitary-adrenal axis, social stress, Trier Social Stress Test, approach-avoidance task, blood pressure, subjective anxiety, post-traumatic stress disorder
MeSH terms
Adult, Anxiety, Blood Pressure, Depressive Disorder, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Phobic Disorders, Pituitary-Adrenal System, Psychiatric Status Rating Scales, Surveys and Questionnaires, Reaction Time, Regression Analysis, Stress Disorders, Post-Traumatic

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