Healing anxiety disorders with glucocorticoids

Abstract

Around 6% of the adult population experiences strong anxiety and dizziness when exposed, or in anticipation of exposure, to a wide range of height-related situations (e.g., stairs, elevators, terraces, high floors in tall buildings, plane trips), devoting big efforts to avoid them. Severe fear of heights is known as acrophobia, an anxiety disorder that belongs to the category of specific phobias (e.g., fear of spiders or blood). Specific phobias in general and acrophobia in particular respond quite well to behavioral therapy (1). Behavioral therapies aim at achieving habituation and eventual extinction of the phobic reaction by confronting the patient, either directly or through imagination, with the phobic object or situation, generally in a graduated way. There are many patients who fail to respond effectively to treatment, however, or show reduced symptoms only partially or temporarily (2). In PNAS, a promising combination of behavioral therapy with pharmacotherapy is presented as a successful attempt to improve the efficacy of therapeutical approaches addressed to extinguish fear responses (3). The administration of cortisol (a glucocorticoid hormone whose levels increase under stress) to patients treated with virtual reality exposure to heights is shown to facilitate the efficacy of the exposure therapy, an effect that was evident both in a test performed a few days after discontinuation of the treatment and in a follow-up assessment performed 1 mo afterward.