Sleep and exposure therapy in adults with social anxiety disorder

Exposure therapy is an effective treatment for Social Anxiety Disorder (SAD), yet many patients do not respond to treatment, experience partial remission, or relapse following initial therapy success. Deficits in therapeutic learning may explain why some individuals derive little or no benefit from exposure-based therapy. Sleep is one potential mechanism that contributes to therapeutic learning deficits. Poor sleep has been found to impair learning and memory processes and may compromise extinction learning that is thought to take place with exposure. Furthermore, sleep disturbance is prevalent among individuals with SAD and may negatively affect exposure therapy outcomes within this population. The aim of this dissertation is to further our understanding of the relationship between sleep and exposure therapy. Our first study examined poor sleep as a predictor of exposure therapy outcomes for SAD. Specifically, we examined the role of baseline sleep quality on treatment outcome, as well as sleep duration and sleep quality the nights prior to and after treatment sessions. The moderating role of D-cycloserine (DCS) on these relationships was tested. Results suggest poorer baseline sleep quality was significantly associated with slower symptom improvement and worse symptom outcomes at the end of treatment and follow-up, after controlling for baseline symptoms of depression and social anxiety. We also found that greater sleep duration the night prior to treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS. Our second study examined sleep, extinction learning, and extinction retention in a sample diagnosed with SAD. We found that baseline sleep did not predict extinction learning or extinction retention, which were indexed via SCR and US expectancy ratings. Exploratory analyses revealed sleep duration was significantly associated with worse threat extinction via US expectancy ratings, but not expectancy extinction retention. Taken together, our findings add to the premilitary evidence linking sleep to exposure therapy outcomes in a sample diagnosed with SAD. Specific areas for methodological improvement are highlighted, and future directions are discussed.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Psychology - Clinical Psychology

Grantor

The University of Texas at Austin

Year dc:date.issued

2025

Author dc:creator

• Dutcher, Christina Danielle

Advisor dc:contributor.advisor

• Smits, Jasper A. J.

Committee members dc:contributor.committeemember

• Carlson, Caryn
• Beevers, Chris G
• Rosenfield, David

• CBT
• Anxiety
• Exposure therapy

Identifier URI

https://doi.org/10.26153/tsw/63149

OAI identifier oai:identifier

oai:repositories.lib.utexas.edu:2152/135835