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Cited by 40Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMemory and Neural MechanismsSleep and Wakefulness Research

Effects of post-exposure naps on exposure therapy for social anxiety

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Pace-Schott, Edward F., Bottary, Ryan M., Kim, Se-Yun, Rosencrans, Peter L., Vijayakumar, Shilpa, Orr, Scott P., Lasko, Natasha B., Goetter, Elizabeth M. +6 more·2018·Psychiatry Research
DOI 10.1016/j.psychres.2018.10.015PMC PMC6292728
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Abstract

Exposure therapy for social anxiety disorder (SAD) utilizes fear extinction, a memory process enhanced by sleep. We investigated whether naps following exposure sessions might improve symptoms and biomarkers in response to social stress in adults undergoing 5-week exposure-based group SAD therapy. Thirty-two participants aged 18-39 (18 females) with SAD were randomized. Before and after treatment, participants completed the Liebowitz Social Anxiety Scale (LSAS) and underwent a Trier Social Stress Test with psychophysiological monitoring (mpTSST) that included skin conductance (SCL), electromyographic (EMG) and electrocardiographic recording, and an auditory startle procedure while anticipating the social stressor. At sessions 3 and 4, exposure was followed by either a 120-min polysomnographically monitored sleep opportunity (Nap, N = 17) or wakefulness (Wake, N = 15). Primary hypotheses about SAD symptom change (LSAS) and EMG blink-startle response failed to differ with naps, despite significant symptom improvement (LSAS) with therapy. Some secondary biomarkers, however, provided preliminary support for enhanced extinction learning with naps, with trend-level Time (pre-, post-treatment) × Arm interactions and significant reduction from pre- to post treatment in the Nap arm alone for mpTSST SCL and salivary cortisol rise. Because of the small sample size and limited sleep duration, additional well-powered studies with more robust sleep interventions are indicated.

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  • In the socially anxious adult study, both sleep and wake groups showed significant improvements in symptom measures.

    “However, both groups showed significant improvements in symptom measures.”

    From Using sleep to enhance exposure treatment for anxious children: A pilot study. (2026) · cites this paper as Pace‐Schott et al., 2018

    The Results (Clinical outcome variables; page not available) report significant improvement across treatment on the LSAS and secondary self-report measures, with no significant difference between Nap and Wake arms. The reported significance tests are for improvement across participants, not for each arm separately, so they do not establish that both groups individually improved significantly. (LLM, conf=0.81)

    Experimental — accuracy not yet measured

  • In adults, the study designs and outcome measures have been mixed.

    “In adults, the study designs and outcome measures have been mixed (Pace‐Schott et al., 2018).”

    From Using sleep to enhance exposure treatment for anxious children: A pilot study. (2026) · cites this paper as Pace‐Schott et al., 2018

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Authors
Pace-Schott, E. F., Bottary, R. M., Kim, S.-Y., Rosencrans, P. L., Vijayakumar, S., Orr, S. P., Lasko, N. B., Goetter, E. M., Baker, A. W., Bianchi, M. T., Gannon, K., Hoeppner, S. S., Hofmann, S. G., & Simon, N. M.
Affiliations
  • University of Washington (US)
  • Boston College (US)
  • Harvard University (US)
  • Boston University (US)
Corresponding author
Pace-Schott, Edward F.
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2018-12
Volume
270
Pages
523-530
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2018.10.015
PMC
PMC6292728
OpenAlex
W2896820795
Cited by
40
References
15
Citations by year
2025: 5 · 2024: 4 · 2023: 6 · 2022: 8 · 2021: 10 · 2020: 3 · 2019: 4
FWCI
5.25
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Psychiatry Research (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIH/NIMH (R21MH103484)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords
social anxiety disorder, exposure therapy, napping, sleep, fear extinction, memory extinction, group therapy, Trier Social Stress Test, skin conductance, salivary cortisol, sleep interventions
MeSH terms
Phobia, Social, Adolescent, Adult, Female, Humans, Hydrocortisone, Implosive Therapy, Male, Middle Aged, Psychotherapy, Group, Saliva, Sleep, Wakefulness, Treatment Outcome, Polysomnography, Young Adult

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