Sleep quality and outcome of exposure therapy in adults with social anxiety disorder

Abstract

Introduction: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship.

Methods: Participants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions.

Results: Poorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before 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.

Conclusions: We replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.

Trial registration: ClinicalTrials.gov NCT02066792.

Keywords: cognitive behavioral therapy; d-cycloserine; exposure therapy; sleep difficulties; sleep quality; social anxiety disorder; treatment outcomes.

© 2021 Wiley Periodicals LLC.

Figures

Figure 1.

Cross lag panel model for sleep quality and sleep duration predicting social anxiety symptoms at next session.

Figure 2.

Slope of symptom change for participants with low or high baseline sleep quality. Low PSQI represents 1 standard deviation below the mean and high PSQI represents 1 standard deviation above the mean.