A randomized controlled trial of intranasal oxytocin as an adjunct to exposure therapy for social anxiety disorder
Abstract
In humans, oxytocin nasal administration reduces social-threat perception and improves processes involved in communication and the encoding of positive social cues. The aim of this study was to determine whether oxytocin given as an adjunct to exposure therapy improves treatment for social anxiety disorder (SAD) as indicated by a comprehensive set of symptom outcome measures. In a randomized, double-blind, placebo-controlled trial, we administered 24 IU of oxytocin or a placebo in combination with exposure therapy to twenty-five participants who met primary diagnosis for SAD. Participants administered with oxytocin showed improved positive evaluations of appearance and speech performance as exposure treatment sessions progressed. These effects did not generalize to improve overall treatment outcome from exposure therapy. Participants who received oxytocin or placebo reported similar levels of symptom reduction following treatment across symptom severity, dysfunctional cognition, and life-impairment measures. This study shows that the administration of oxytocin improves mental representations of self, following exposure therapy. These effects may be either short term or situation specific. Future research is now needed to determine whether oxytocin can enhance treatment outcomes for SAD when used with greater frequency, with a wider variety of social learning experiences, and in conjunction with interventions that more specifically target change in broader dysfunctional cognitions.
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The partial correlation between likeability and oxytocin-altered functional connectivity was computed controlling for STAI and PANAS scores.
“The partial correlation between likeability and extraction of OXT-altered functional connectivity was computed controlling for STAI and PANAS scores because OXT might modulate anxiety and mood (45, 46).”
From Oxytocin, the peptide that bonds the sexes also divides them (2016) · cites this paper as [45]
The acute increase in pro-social behavior, specifically time spent in contact, in male prairie voles following intranasal oxytocin resembles findings in many human studies.
“The acute effects of intranasal OT that we found here resemble those found in many human studies, consisting of an increase in pro-social behavior and engagement (specifically time spent in contact in males)(13,15,64–66).”
From Chronic intranasal oxytocin causes long-term impairments in partner preference formation in male prairie voles (2013) · cites this paper as [65]
Some evidence suggests OXT can be an effective treatment for GSAD.
“Interestingly, some evidence has suggested that OXT can be an effective treatment for GSAD (Guastella et al, 2009).”
From Modulation of Resting-State Amygdala-Frontal Functional Connectivity by Oxytocin in Generalized Social Anxiety Disorder (2014) · cites this paper as Guastella et al, 2009
OT is being explored as a therapeutic agent in human disorders affecting social behavior and cognition, such as social anxiety and ASD.
“Since OT is being explored as a therapeutic agent in human disorders affecting social behavior and cognition, such as social anxiety and ASD (Alvares et al., 2017, Guastella et al., 2009, Ooi et al., 2017), these findings are crucial to consider.”
From Wireless Optogenetic Stimulation of Oxytocin Neurons in a Semi-natural Setup Dynamically Elevates Both Pro-social and Agonistic Behaviors (2020) · cites this paper as Guastella et al., 2009
Two small preliminary studies augmented a single-session exposure therapy for social anxiety (N=25) and arachnophobia (N=44) with only one low dose (24 IU) of oxytocin with null findings.
“two small preliminary studies augmented a single-session exposure therapy for social anxiety (N=25) and arachnophobia (N=44) with only one low dose (24 IU) of oxytocin with null findings (Acheson et al., 2015; Guastella et al., 2009).”
From Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial (2018) · cites this paper as Guastella et al., 2009
Two small studies involving OXT augmentation for EBT in patients with SAD and arachnophobia had disappointing preliminary outcomes.
“Two small studies involving OXT augmentation for EBT in patients with SAD (Guastella, Howard, Dadds, Mitchell, & Carson, 2009) and arachnophobia (Acheson, Feifel, Kamenski, McKinney, & Risbrough, 2015) had disappointing preliminary outcomes.”
From Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders (2019) · cites this paper as Guastella, Howard, Dadds, Mitchell, & Carson, 2009
Previous research has shown modest effects of OT on people suffering from social deficits, such as autism spectrum disorders, schizophrenia, or social anxiety disorder.
“Previous research has shown modest effects of OT on people suffering from social deficits, such as autism spectrum disorders (Hollander et al., 2007), schizophrenia (Pedersen et al., 2011) or social anxiety disorder (Guastella et al., 2009).”
From OT promotes closer interpersonal distance among highly empathic individuals (2015) · cites this paper as Guastella et al., 2009
Another study found that intranasal oxytocin did not improve self-reported anxiety among people with social anxiety disorder following exposure therapy.
“Additionally, another study found that intranasal oxytocin did not improve self-reported anxiety among people with social anxiety disorder following exposure therapy (Guastella et al., 2009).”
From Meta-analytic review of the effects of a single dose of intranasal oxytocin on threat processing in humans (2018) · cites this paper as Guastella et al., 2009
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- Authors
- Guastella, A. J., Howard, A. L., Dadds, M. R., Mitchell, P., & Carson, D. S.
- Affiliations
- The University of Sydney (AU)
- UNSW Sydney (AU)
- Black Dog Institute (AU)
- Corresponding author
- Guastella, Adam J.
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2009-07
- Volume
- 34
- Issue
- 6
- Pages
- 917-923
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2124566592
- Cited by
- 366
- References
- 47
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 23 · 2023: 10 · 2022: 16 · 2021: 13 · 2020: 14 · 2019: 17 · 2018: 17 · 2017: 34 · 2016: 23 · 2015: 29 · 2014: 41 · 2013: 33 · 2012: 25
- FWCI
- 33.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of New South Wales
- LG Display
- National Health and Medical Research Council
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Neuroendocrine regulation and behavior
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- oxytocin, intranasal administration, social anxiety disorder, exposure therapy, adjunctive therapy, self-perception, dysfunctional cognitions, speech performance, appearance evaluation, social threat perception
- MeSH terms
- Administration, Intranasal, Adult, Aged, Anxiety, Desensitization, Psychologic, Humans, Male, Middle Aged, Oxytocin, Phobic Disorders, Placebos, Social Behavior Disorders, Psychological Distance, Speech, Task Performance and Analysis
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