Effect of D-cycloserine Plus Cognitive Behavioral Therapy on People With Social Phobia

• Social Phobic Disorders Severity and Change Form [ Time Frame: Measured at Months 3, 6, and 9 post-treatment ] [ Designated as safety issue: No ]
• Liebowitz Social Anxiety Scale (LSAS) [ Time Frame: Measured at Months 3, 6, and 9 post-treatment ] [ Designated as safety issue: No ]

• Social Phobic Disorders Severity and Change Form
• Liebowitz Social Anxiety Scale

• Social Phobia and Anxiety Inventory [ Time Frame: Measured at Months 3, 6, and 9 post-treatment ] [ Designated as safety issue: No ]
• Quality of Life Enjoyment and Satisfaction Questionnaire [ Time Frame: Measured at Months 3, 6, and 9 post-treatment ] [ Designated as safety issue: No ]
• Liebowitz Self-Rated Disability Scale [ Time Frame: Measured at Months 3, 6, and 9 post-treatment ] [ Designated as safety issue: No ]
• Range of Impaired Functioning Tool [ Time Frame: Measured at Months 3, 6, and 9 post-treatment ] [ Designated as safety issue: No ]

• Social Phobia and Anxiety Inventory
• Quality of Life Enjoyment and Satisfaction Questionnaire
• Liebowitz Self-Rated Disability Scale
• Range of Impaired Functioning Tool

This study will assess the effectiveness of D-cycloserine combined with cognitive-behavior therapy in treating people with social anxiety disorder.

Social anxiety disorder (SAD) is among the most common psychiatric conditions and is associated with significant distress and dysfunction in social situations. Although treatment with cognitive-behavior therapy (CBT) is known to help remedy SAD, many patients do not respond to this treatment and most do not reach full recovery. In CBT, patients undergo repeated and prolonged exposure practices to feared social situations to learn better ways to deal with anxiety in these settings. Exposure therapy is based on animal models of extinction of conditioned fears, and recent animal research has identified some of the core pathways and neurotransmitters involved in fear extinction. D-cycloserine (DCS) is a drug that appears to facilitate learning and the process of extinction of conditioned fear in both animals and humans. This study will assess the effectiveness of DCS combined with CBT in treating people with SAD.

Participants in this double-blind study will be randomly assigned to an active or control group. All participants will attend 18 study visits at the Center for Anxiety and Related Disorders over a 9-month period. There will be 12 CBT sessions of 90 minutes each and 6 assessment visits. The CBT sessions will help participants to become more comfortable with social situations. During 5 of the CBT sessions, participants will receive a pill containing either DCS or sugar (placebo). Assessment visits will include interviews, self-report questionnaires, and laboratory tests. These visits will occur at Weeks 1, 7, and 12 during treatment and at Months 3, 6, and 9 post-treatment.

• Drug: D-cycloserine
  50 mg
  Other Name: Seromycin
• Behavioral: Cognitive behavioral therapy (CBT)
  CBT sessions aim to help participants become more comfortable with social situations.
• Drug: Placebo
  Same dosage as active pill

• Experimental: 1
  Participants will receive D-cycloserine augmented cognitive behavioral therapy
  Interventions:

  • Drug: D-cycloserine
  • Behavioral: Cognitive behavioral therapy (CBT)
• Placebo Comparator: 2
  Participants will receive placebo augmented cognitive behavioral therapy
  Interventions:

  • Behavioral: Cognitive behavioral therapy (CBT)
  • Drug: Placebo

• Hofmann SG, Pollack MH, Otto MW. Augmentation treatment of psychotherapy for anxiety disorders with D-cycloserine. CNS Drug Rev. 2006 Fall-Winter;12(3-4):208-17. Review.
• Otto MW, Basden SL, Leyro TM, McHugh RK, Hofmann SG. Clinical perspectives on the combination of D-cycloserine and cognitive-behavioral therapy for the treatment of anxiety disorders. CNS Spectr. 2007 Jan;12(1):51-6, 59-61. Review.
• Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, Shiekh M, Otto MW. Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Arch Gen Psychiatry. 2006 Mar;63(3):298-304.

Inclusion Criteria:

• Meets DSM-IV criteria for generalized social anxiety disorder (GSAD)
• Total score of greater than or equal to 60 on the LSAS
• Physical examination, electrocardiogram, and laboratory findings without clinically significant abnormalities

Exclusion Criteria:

• Lifetime history of bipolar disorder, schizophrenia, psychosis, delusional disorders, or obsessive-compulsive disorder
• Eating disorder within the 6 months prior to study entry
• History of organic brain syndrome, mental retardation, or other cognitive dysfunction
• Substance or alcohol abuse or dependence (other than nicotine) within the 6 months prior to study entry or inability to refrain from alcohol use during the acute period of study participation
• Post-traumatic stress disorder within 6 months prior to study entry; entry of patients with other mood or anxiety disorders will be permitted if the social anxiety disorder is judged to be the predominant disorder
• Suicidal thoughts
• Taking concurrent psychotropic medication (e.g., antidepressants, anxiolytics, beta blockers) within 2 weeks of study entry
• Significant personality dysfunction
• Serious medical illness or instability for which hospitalization may be likely within the next year