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

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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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Authors: Roelofs, K., van Peer, J., Berretty, E., Jong, P. D., Spinhoven, P., & Elzinga, B. M.
Affiliations: Leiden University (NL)
ORCID: Spinhoven, Philip
Elzinga, Bernet M.
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: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › 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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Hypothalamus-pituitary-adrenal axis hyperresponsiveness is associated with increased social avoidance behavior in social phobia

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