Table 1

Characteristics and results of clinical trials of DCS-augmented CBT for anxiety disorders
Study Diagnosis N DCS Dose (mg) Dosing timing (hrs before exposure) # of DCS doses CBT type (# of exposure sessions) Primary measures Main results (DCS vs. placebo)
Ressler et al., 2004 [53] Acrophobia 27 50 or 500 2-4 2 VRE (2) SUDS, skin conductance, clinical self-reports Greater subjective improvement (p < .001); greater decrease in skin conductance fluctuations (p < .05); greater clinical improvement (p < .02) effects were maintained at 3-month follow-up
Guastella et al., 2007 [54] Sub-threshold spider phobia 63 50 2-3 1 Exposure (1) SUDS, heart rate No DCS effects
Tart et al., 2013 [55] Acrophobia 29 50 −0.5a 2 VRE (2) SUDS, CGI-I No overall DCS effects.
Smits et al., 2013 [56] DCS effect on CGI-I significantly moderated by fear level at end of exposure session (b = −.05, p < .01); low levels of fear predicted greater symptom improvement
Nave et al., 2012 [57] Snake phobia 20 50 1 1 Exposure (1) Snake Questionnaire No overall DCS effects.
DCS group reached top of fear hierarchy more quickly (p < .05)
Hofmann et al., 2006 [58] SAD 27 50 1 5 Individual/group CBT, emphasis on exposure (5) SPAI, LSAS Greater symptom improvement (p’s < .02); effects maintained at 1-month follow-up
Guastella et al., 2008 [59] SAD 56 50 1 4 Group CBT, emphasis on exposure (4) SPAI, LSAS Greater symptom improvement over time (p = .002).
Rodebaugh et al., in press [60] SAD 34 250 0 1 Exposure (2) SUDS Greater reduction in subjective distress between two exposure sessions (d = 1.06)
Hofmann et al., in press [61] SAD 169 50 1 5 CBT (5) LSAS, SPDS Faster symptom improvement, global illness severity and remission status (p’s < .05)
Wilhelm et al., 2008 [62] OCD 23 100 1 10 Exposure-based behavior therapy (10) YBOCS No overall DCS group effect; significant time by group interaction (p = .02), with greater symptom improvement in DCS group at mid-treatment.
Chasson et al. 2010 [63] Re-analysis showed DCS increased speed of symptom improvement sixfold during the first half of treatment.
Kushner et al., 2007 [64] OCD 25 125 2 10 ERP (10) YBOCS Lower drop-out rate (p < .05); symptoms improved more quickly during first 4 sessions (p = .02, d = .77)
Storch et al., 2007 [65] OCD 24 250 4 12 ERP (12) YBOCS No DCS effects.
Storch et al., 2010 [66] Pediatric OCD (ages 8–17) 30 25 or 50 1 7 ERP (7) CYBOCS, CGI-S, ADIS-CSR Small-to-moderate DCS effects (d = .31-.47)
Otto et al., 2010 [67] PD, PDA 31 50 1 3 Brief CBT (3) PDSS, CGI-S Greater symptom and severity reduction (p = .01, d = 1.11), maintained at follow-up (p < .05)
Siegmund et al., 2011 [68] PDA 39 50 1 3 CBT (3) PAS, CGI No overall DCS effects; statistical trend (p = 0.075) in severely ill patients that DCS accelerated symptom reduction
de Kleine et al., 2012 [69] PTSD 67 50 1 7-9 Prolonged Exposure (7–9) CAPS No overall DCS effects; DCS group more likely to show response (odds ratio 2.83, 95 % confidence interval [CI] 1.05–7.61).
Litz et al., 2012 [70] PTSD 26 50 0.5 4 Brief CBT (4) CAPS, PTSD Checklist DCS associated with poorer outcome on all measures

ADIS-CSR = Anxiety Disorders Interview Schedule-Clinical Severity Rating; CAPS = Clinician-Administered PTSD Scale; CBT = cognitive-behavioral therapy; CGI = Clinical Global Impression; CGI-I = Clinical Global Impression-Improvement; CGI-S = Clinicians’ Global Impressions of Severity; CYBOCS = Child Yale Brown Obsessive Compulsive Scale; ERP = exposure/ritual prevention or exposure and response prevention; LSAS = Liebowitz social anxiety scale; OCD = obsessive compulsive disorder; PAS = Panic and Agoraphobia Scale; PD = Panic disorder; PDA = Panic disorder with agoraphobia; PDSS = Panic Disorder Severity Scale; PTSD = posttraumatic stress disorder; SAD = social anxiety disorder; SPDS = social phobic disorder severity scale; SPQ = spider phobia questionnaire; SPAI = social phobia and anxiety inventory; SUDS = subjective units of discomfort; VRE = Virtual Reality Exposure; YBOCS = Yale Brown Obsessive Compulsive Scale.

aA DCS dosing timing of −0.5 hours indicates that DCS was administered 0.5 hours after the beginning of exposure.

Hofmann et al.

Hofmann et al. Biology of Mood & Anxiety Disorders 2013 3:11   doi:10.1186/2045-5380-3-11

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