دانلود مقاله ISI انگلیسی شماره 39213
عنوان فارسی مقاله

تجویز یک دوز تستوسترون اجتناب از نگاه در زنان مبتلا به اختلال اضطراب اجتماعی را کاهش می دهد

کد مقاله سال انتشار مقاله انگلیسی ترجمه فارسی تعداد کلمات
39213 2015 8 صفحه PDF سفارش دهید 7000 کلمه
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عنوان انگلیسی
Single dose testosterone administration alleviates gaze avoidance in women with Social Anxiety Disorder
منبع

Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)

Journal : Psychoneuroendocrinology, Volume 63, January 2016, Pages 26–33

کلمات کلیدی
حرکات چشم - اجتناب از نگاه - اختلال اضطراب اجتماعی - هراس اجتماعی - وضعیت اجتماعی - تستوسترون
پیش نمایش مقاله
پیش نمایش مقاله تجویز یک دوز تستوسترون اجتناب از نگاه در زنان مبتلا به اختلال اضطراب اجتماعی را کاهش می دهد

چکیده انگلیسی

Abstract Gaze avoidance is one of the most characteristic and persistent social features in people with Social Anxiety Disorder (SAD). It signals social submissiveness and hampers adequate social interactions. Patients with SAD typically show reduced testosterone levels, a hormone that facilitates socially dominant gaze behavior. Therefore we tested as a proof of principle whether single dose testosterone administration can reduce gaze avoidance in SAD. In a double-blind, within-subject design, 18 medication-free female participants with SAD and 19 female healthy control participants received a single dose of 0.5 mg testosterone and a matched placebo, at two separate days. On each day, their spontaneous gaze behavior was recorded using eye-tracking, while they looked at angry, happy, and neutral facial expressions. Testosterone enhanced the percentage of first fixations to the eye-region in participants with SAD compared to healthy controls. In addition, SAD patients’ initial gaze avoidance in the placebo condition was associated with more severe social anxiety symptoms and this relation was no longer present after testosterone administration. These findings indicate that single dose testosterone administration can alleviate gaze avoidance in SAD. They support theories on the dominance enhancing effects of testosterone and extend those by showing that effects are particularly strong in individuals featured by socially submissive behavior. The finding that this core characteristic of SAD can be directly influenced by single dose testosterone administration calls for future inquiry into the clinical utility of testosterone in the treatment of SAD.

مقدمه انگلیسی

1. Introduction Social Anxiety Disorder (SAD) is a common anxiety disorder, characterized by persistent fear and avoidance of social situations (American Psychiatric Association, 2013). SAD has been related to a ubiquitous social hierarchy system, in which individuals with SAD display socially submissive as opposed to socially dominant behavior (Hermans and van Honk, 2006, Maner et al., 2008 and Weisman et al., 2011). Typical submissive behavior, such as avoidance of eye contact plays a crucial role in the persistence of this disorder by hindering extinction of fear in social situations (Clark and Wells, 1995 and Stein and Stein, 2008). Especially angry facial expressions with direct gaze signal social scrutiny or a potential dominance challenge and elicit avoidance tendencies in highly socially anxious individuals (Öhman, 1986 and Roelofs et al., 2010). Indeed, eye-tracking studies investigating gaze behavior in SAD, have demonstrated avoidance of the eye-region of angry faces (Horley et al., 2004, Moukheiber et al., 2012 and Moukheiber et al., 2010). Because avoidance behavior is the major maintaining factor in SAD, it is relevant to develop interventions that directly target this behavior (Clark and Wells, 1995, Gamer and Büchel, 2012, Hofmann et al., 2014 and Roelofs et al., 2010). SAD is associated with reduced endogenous testosterone levels (Giltay et al., 2012), and because testosterone is known to reduce social avoidance (Enter et al., 2014 and Terburg et al., 2012a), it is striking that so far no studies have tested the direct effects of testosterone administration in SAD. Testosterone has an important role in the regulation of social motivational behavior: It has socially anxiolytic effects, and is associated with social dominance and approach behavior (Bos et al., 2012, Enter et al., 2014 and Terburg and van Honk, 2013). Based on recent findings indicating that testosterone administration in healthy females promotes social dominant gaze behavior to angry faces (Terburg et al., 2012a and Terburg et al., 2011), we predicted that testosterone administration would alleviate submissive gaze avoidance to angry faces in individuals with SAD. We tested this hypothesis in a double-blind and placebo controlled within-subject study. A total of 18 medication-free participants with SAD and 19 healthy control participants received a single dose of 0.5 mg testosterone and a matched placebo in two sessions. In each session, their spontaneous gaze behavior was recorded while they looked at angry, happy, and neutral facial expressions. Gaze avoidance of eye contact was reliably indexed as relative reduction of initial gaze fixations on the eye-region (Becker and Detweiler-Bedell, 2009, Gamer et al., 2010, Gamer and Büchel, 2012 and Garner et al., 2006). We predicted that testosterone administration in contrast to placebo would reduce gaze avoidance and increase the number of first fixations to the eyes of angry faces in particular in SAD.

نتیجه گیری انگلیسی

3. Results 3.1. Percentage first fixations The percentage first fixations to the eye region for each condition, emotion and group are presented in Table 2. First we conducted a three-way rmANOVA with all emotions in the analysis for the percentage first fixations, with Treatment (placebo, testosterone) and Emotion (angry, happy, neutral) as within-subject factors, and Group (HC, SAD) as between-subjects factor. There was no significant Treatment × Emotion × Group interaction; this counted both when including the SAD (combined) group, F(2,70) = 1.04, p = .360, and when including the SAD (syndromal) group, F(2,60) = 1.13, p = .331. However, a significant Treatment × Group interaction was present both when including the SAD (combined) group, F(1,35) = 6.67, p = .014, ηp2 = .16, and when including the SAD (syndromal) group, F(1,30) = 7.39, p = .011, ηp2 = .20, indicating that testosterone affects gaze behavior in the HC and SAD groups in a differential manner ( Fig. 1). There were no significant post-hoc effects involving Group with all emotions in the analyses, all Fs < 1.83, ps > .285, but a main effect of Emotion (both with the SAD (combined) group, F(2,70) = 7.32, p = .002, ηp2 = .17, and with the SAD (syndromal) group, F(2,60) = 5.12, p = .009, ηp2 = .15), indicated relative avoidance of angry versus happy faces (both with SAD (combined), F(1,35) = 10.52, p = .003 ηp2 = .23, and with SAD (syndromal), F(1,30) = .8.41, p = .007, ηp2 = .22) and angry versus neutral faces (both with SAD (combined), F(1,35) = 10.46, p = .003 ηp2 = .23, and with SAD (syndromal), F(1,30) = 8.06, p = .008, ηp2 = .21) across groups. Table 2. First fixations (percentage ± SEM) toward the eye-region of angry, happy, and neutral facial expressions after administration of placebo and testosterone for Healthy Control participants (n = 19) and the combined group of participants with syndromal and sub-syndromal Social Anxiety Disorder (n = 18). Healthy Controls Social Anxiety Disorder Emotion Placebo Testosterone Placebo Testosterone Angry 43 (6) 36 (6) 30 (6) 37 (8) Happy 49 (7) 42 (6) 36 (7) 37 (9) Neutral 48 (7) 40 (6) 41 (8) 40 (9) Table options First fixation data for angry, happy, and neutral facial expressions. Percentage ... Fig. 1. First fixation data for angry, happy, and neutral facial expressions. Percentage (mean ± SEM) first fixations toward the eyes of angry, happy and neutral facial expressions after administration of placebo and testosterone for healthy control participants (HC, n = 19) and the combined group of participants with syndromal and sub-syndromal social anxiety disorder (SAD combined, n = 18). A significant Treatment × Group interaction indicates that testosterone differentially affects gaze behavior in SAD and HC groups. The Treatment × Group effect remains significant when tested for angry faces alone but not when tested for happy or neutral faces.**p < .01, *p < .05, °p < .06. Figure options Because of our specific hypothesis on the effects of testosterone on the first fixations toward the eyes of angry faces in SAD, we checked whether the Treatment x Group effect would hold for angry faces alone. Indeed, the significant Treatment × Group interaction remained for angry faces. This occurred both when including the SAD (combined) group, F(1,35) = 8.41, p = .006, ηp2 = .19, and when including the SAD (syndromal) group, F(1,30) = 9.53, p = .004 ηp2 = .24 ( Fig. 2a). A similar rmANOVA did not reveal significant Treatment × Group effects for first fixations on the eyes of happy and neutral faces (again both when including the SAD (combined) group, happy: F(1,35) = 3.22, p = .085, neutral: F(1,35) = 1.61, p = .213; and when including the SAD (syndromal) group, happy: F(1,30) = 3.40, p = .075, neutral: F(1,30) = 1.63, p = .211). These findings confirm that testosterone increases the first fixations toward the eye region of angry faces in SAD versus HC. To further explore the Treatment X Group effect of the omnibus analysis, we conducted analyses for each group separately. A two-way rmANOVA with Treatment (placebo, testosterone) and Emotion (angry, happy, neutral) for the percentage first fixations in the SAD group revealed a significant Treatment × Emotion interaction. This counted both for the SAD (combined) group, F(2,32) = 4.43, p = .020, ηp2 = 0.21, and for the SAD (syndromal) group, F(2,24) = 3.56, p = .044, ηp2 = 0.23. In addition, there was a significant main effect of Emotion in the SAD (combined) group, F(1.5,25.8) = 5.54, p = .016, ϵ = .759, ηp2 = .25, but not in the SAD (syndromal) group: F(1.4,16.9) = 2.76, p = .105, ϵ = .702, ηp2 = .19, nor did this analysis yield a significant main effect of Treatment in either group, all Fs < 1.28, all ps > .280. Subsequent one-way rmANOVA’s for each emotion separately yielded a trend toward a main effect of Treatment for Angry faces, F(1,17) = 4.09, p = .059, ηp2 = .19, in the SAD (combined) group. Critically, the Treatment effect of testosterone for angry faces was significant in the SAD (syndromal) group, F(1,12) = 4.90, p = .047, ηp2 = .29, suggesting that testosterone increased first fixations to the eye-region of angry faces within the SAD patients ( Fig. 2a). There was no such effect for Happy (F(1,17) = 0.12, p = .729 (SAD combined); F(1,12) = 0.39, p = .543 (SAD syndromal)), or Neutral faces (F(1,17) = 0.15, p = .706 (SAD combined); F(1,12) = 0.02, p = .968 (SAD syndromal)). Separate analyses for the SAD participants per condition showed significant avoidance of the eyes of angry faces, when compared to neutral faces in the placebo condition. This Emotion effect was present both in the SAD (combined) group, F(1,17) = 11.73, p = .003, ηp2 = .41, and in the SAD (syndromal) group, F(1,12) = 7.01, p = .021, ηp2 = .37. There was also significant avoidance for angry faces when compared to happy faces, in the SAD (combined) group, F(1,17) = 6.07, p = .025, ηp2 = .26, which was a trend in the SAD (syndromal) group, F(1,12) = 3.95, p = .070, ηp2 = .25. There were no such effects for happy versus neutral faces, not in the SAD (combined) group, F(1,17) = 4.08, p = .059, nor in the SAD (syndromal) group, F(1,12) = 2.02, p = .180. These gaze avoidance effects for the eyes of angry faces in the SAD group were no longer present in the testosterone condition, all Fs < 0.89, ps > .398. To further explore the nature of the avoidance effects in the placebo condition in the subgroup of participants who met the full DSM-IV criteria for SAD, we tested whether gaze avoidance toward the eye-region was correlated to symptom severity. A significant correlation between percentage first fixations on angry eyes and LSAS social anxiety scores in the placebo condition, r = -.561, p = .046, indeed indicated that participants with stronger social anxiety symptomatology showed relatively greater gaze avoidance of angry eye contact ( Fig. 2b). This effect was no longer present after testosterone administration, r = −.384, p = .195. A similar correlation existed for the first fixations toward the eyes of happy faces, r = −.575, p = .040, and neutral faces, r = −.590, p = .034, which became a trend after testosterone administration: happy, r = −.498, p = .083, and neutral, r = −.502, p = .080. Interestingly, none of these effects was significant in the SAD (combined) group, all rs < −.404, all ps > .097. Together these analyses within the SAD group indicate that initial gaze avoidance of eye contact is related to the severity of social anxiety symptomatology in individuals with syndromal SAD, and that the avoidance of angry eyes in particular can be alleviated by single dose testosterone administration. In contrast, in the HC group the two-way rmANOVA with Treatment (placebo, testosterone) and Emotion (angry, happy, neutral) showed no significant Treatment × Emotion interaction, F(2,36) = 0.03, p = .974. However, a main effect of Treatment, F(1,18) = 9.06, p = .008, ηp2 = .34, indicated a relative decrease in the number of first fixations on the eyes of emotional faces after testosterone ( Fig. 1). A main effect of Emotion, F(2,36) = 3.60, p = .038, ηp2 = .17, showed that the HC, like the SAD group, showed relatively less first fixations to the eye-region of angry faces, relative to happy, F(1,18) = 4.80, p = .042, ηp2 = .21, but not relative to neutral faces, F(1,18) = 1.88, p = .187. However, in the HC group avoidance of angry eye-contact in the placebo-condition was not related to the level of social anxiety (all rs < .328.; all ps > .170), as was observed for the syndromal SAD group 3.2. First fixation duration, percentage total fixations, and total fixation duration Separate three-way rmANOVAs with Treatment (placebo, testosterone) and Emotion (angry, happy, neutral) as within-subject factors, and Group (HC, SAD) as between-subjects factor, revealed neither Treatment, nor Group effects for first fixation duration, percentage total fixations, or total fixation duration; not when including the SAD (combined) group, (all Fs < 1.53, ps > .225), nor when including the SAD (syndromal) group, all Fs < 2.25, ps > .148 (see Table S3 and S4). In addition, none of these measurements was significantly related to symptom severity in the SAD (combined) group (all ps > .391), nor in the SAD (syndromal) group (all ps > .05). 3.3. Checks for confounding factors No significant relationship between depression symptoms (Beck Depression Inventory score, Luteijn and Bouman, 1988) and percentage first fixations emerged in the SAD (combined) group, all rs < −.230, ps > .358, nor in the SAD (syndromal) group, all rs < -.454, ps > .119. Finally, the effects of testosterone on the percentage first fixations remained after controlling for testing order and other possibly confounding variables such as time of testing and use of contraceptives (see Supplementary material).

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