Effects of acute stress on exposure therapy outcome and generalization in woman: considering the modulatory role of hormonal contraceptive use

The administration of glucocorticoids (GC) as an adjunct to exposure might represent a promising strategy to improve exposure therapy outcome in anxiety disorders (AD). The beneficial effects, however, might be sex-dependent and/or further modulated by hormonal factors (e.g., contraceptive usage in women). In the present study, we investigated whether acute stress before exposure therapy affects its efficacy in women using oral contraceptives (OC) relative to free-cycling (FC) women. In addition, possible effects of stress on generalization of therapy effects towards untreated stimuli were examined. Women with fears of spiders and cockroaches were randomly assigned to a stress (n=24) or no-stress (n=24) group prior to a standardized one-session exposure. Acute stress did not influence exposure-induced reduction in fear and avoidance of the treated stimuli (spiders). However, stress led to a less pronounced beneficial exposure outcome for treated stimuli in OC women relative to FC women. This effect occurred on the level of subjective fear and self-report questionnaires at post-treatment (24 hours after exposure) and follow-up (4 weeks after exposure). No effects of stress on generalization of therapy effects towards untreated stimuli (cockroaches) were found. Our findings suggest that OC usage diminishes the beneficial effects of stress on exposure therapy outcome seen in FC women. We present first clinical findings regarding the interaction of stress (and possibly GCs) and OC in exposure therapy of AD. OC intake in women constitutes a crucial factor to be considered in augmentation studies using stress and GCs.