Phobias Part II, New Social Anxiety Treatments — MDMA, Testosterone & Less Serotoninby Carla Clark, PhD | November 4, 2015
Radical new research is not only giving cause to stop prescribing currently popular medications for social anxiety disorder (also known as social phobia), it’s pointing to new treatments, from sex hormones to popular street drugs, with the potential to rapidly speed up and ensure successful recovery.
Some of you may have a specific social phobia, such as the all too common fear of public speaking, which may involve gelotophobia, the fear of laughter discussed in Phobias Part I. Yet for millions around the globe this fear is a generalized social phobia, also known as social anxiety disorder, where even a simple wedding invitation, never mind the big day itself, could spark severe anxiety and panic attacks.
Research suggests that in America at least, social anxiety is on the rise, with current estimates of prevalence in the US range from a staggering 20 to 40 million. It certainly seems like living in the age of social networking isn’t helping. Yet, with a mixed-bag of research results, we aren’t exactly sure if social sites like Facebook are actually more of a help or a hindrance to those with social phobia.
It is very early explorative days for the new social anxiety treatments described below. However, with current evidence-based treatments failing to provide any benefit for 40-50% of those diagnosed with social anxiety disorder, exploring these new treatments avenues further is not only imperative, they may lead to revolutionizing the treatment of social phobias.
Serotonin overload: SSRIs a problem, not a solution
Science seems to have got it all backwards.
Research in the past promoted the idea that social phobia is related to low levels of the neurotransmitter serotonin. This view has been turned on its head by a new study published in JAMA Psychiatry that shows the exact opposite; individuals with social phobia make too much serotonin. The more serotonin they produce, the more anxious they are in social situations.
Seeing as the most popular social anxiety treatment protocols involve a combination of psychological counseling and antidepressants, the most popular being serotonin reuptake inhibitors, this is cause for concern and psychiatrists should take heed.
Further research is undoubtedly underway and drugs that lower levels of serotonin are likely to be of interest.
Testosterone injection: A study in women
Common submissive behavior in social phobia, such as avoidance of eye contact (gaze avoidance) is thought to play a crucial role in the persistence of social anxiety disorder by hindering the extinction of fear in social situations.
In a double-blind, within-subject design, medication-free women diagnosed with social anxiety disorder where administered with a single dose of testosterone and their eye-movement was monitored as they viewed angry, happy or neutral faces.
They found that testosterone specifically enhances the number of first fixations toward the eyes, and decreases the amount of eye-area avoiding, even for the most avoided type, angry eyes. This is in line with research suggesting that testosterone influences early automatic social mechanisms whereby it biases the brain toward social dominance.
These results are promising and researchers suggest investigating whether testosterone can act as an adjunct in exposure therapies by boosting prosocial behavior in the first few sessions.
MDMA (ecstasy): A study in adults with autism
As discussed in a recent BrainBlogger article, Psychedelic-Assisted Therapy – The Mental Health Trip of the Future?, the use of psychedelic drugs as a tool for mental health therapy has the potential to revolutionize the future of psychiatry and pharmacotherapy.
The first ever study of 3,4-methylenedioxymethamphetamine (MDMA/Ecstasy)-assisted therapy for the treatment of social anxiety in autistic adults began in the spring of 2014 using a placebo-controlled, double-blind methodology, and is still underway.
Regarding social anxiety treatment in general, researchers and therapists alike hope to cash in on MDMA catalyzing a profound shift toward openness and introspection that will not require ongoing administration to achieve lasting therapeutic benefits. Hopes are that by administrating MDMA on only one to several occasions within the context of a supportive and integrative psychotherapy protocol will side-line the higher frequency of adverse events and side-effects that come with daily dosing, as in most psychiatric drugs.
Along with ongoing Phase II pilot studies of MDMA-assisted psychotherapy for treatment of chronic PTSD (following pilot studies whose benefits were maintained an average of 3.8 years later), the potentially game-changing results of the pilot study for social anxiety in autistic adults are eagerly anticipated.
Danforth, A., Struble, C., Yazar-Klosinski, B., & Grob, C. (2016). MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 237-249 DOI: 10.1016/j.pnpbp.2015.03.011
Enter, D., Terburg, D., Harrewijn, A., Spinhoven, P., & Roelofs, K. (2016). Single dose testosterone administration alleviates gaze avoidance in women with Social Anxiety Disorder Psychoneuroendocrinology, 63, 26-33 DOI: 10.1016/j.psyneuen.2015.09.008
Frick, A., Åhs, F., Engman, J., Jonasson, M., Alaie, I., Björkstrand, J., Frans, ?., Faria, V., Linnman, C., Appel, L., Wahlstedt, K., Lubberink, M., Fredrikson, M., & Furmark, T. (2015). Serotonin Synthesis and Reuptake in Social Anxiety Disorder JAMA Psychiatry, 72 (8) DOI: 10.1001/jamapsychiatry.2015.0125
Mithoefer, M., Wagner, M., Mithoefer, A., Jerome, L., & Doblin, R. (2010). The safety and efficacy of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study Journal of Psychopharmacology, 25 (4), 439-452 DOI: 10.1177/0269881110378371
Mithoefer, M., Wagner, M., Mithoefer, A., Jerome, L., Martin, S., Yazar-Klosinski, B., Michel, Y., Brewerton, T., & Doblin, R. (2012). Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study Journal of Psychopharmacology, 27 (1), 28-39 DOI: 10.1177/0269881112456611
Terburg, D., Aarts, H., & van Honk, J. (2012). Testosterone Affects Gaze Aversion From Angry Faces Outside of Conscious Awareness Psychological Science, 23 (5), 459-463 DOI: 10.1177/0956797611433336
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