Salivary CRP predicts treatment response to virtual reality exposure therapy for social anxiety disorder

Elizabeth E Antici; Kate R Kuhlman; Michael Treanor; Michelle G Craske

doi:10.1016/j.bbi.2024.03.002

Salivary CRP predicts treatment response to virtual reality exposure therapy for social anxiety disorder

Brain Behav Immun. 2024 May:118:300-309. doi: 10.1016/j.bbi.2024.03.002. Epub 2024 Mar 10.

Authors

Elizabeth E Antici¹, Kate R Kuhlman², Michael Treanor³, Michelle G Craske³

Affiliations

¹ Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, USA. Electronic address: eantici@uci.edu.
² Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
³ Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.

PMID: 38467380
DOI: 10.1016/j.bbi.2024.03.002

Abstract

Background: Social anxiety disorder (SAD) places a profound burden on public health and individual wellbeing. Systemic inflammation may be important to the onset and maintenance of SAD, and anti-inflammatory treatments have shown promise in relieving symptoms of SAD. In the present study, we conducted secondary analyses on data from a randomized clinical trial to determine whether C-reactive protein (CRP) concentrations and social anxiety symptoms decreased over the course of virtual reality exposure therapy, and whether changes in social anxiety symptoms as a function of treatment varied as a function of CRP.

Method: Adult participants (N = 78) with a diagnosis of SAD (59 % female) were randomized to receive exposure therapy alone, or exposure therapy supplemented with scopolamine. Social anxiety symptoms, salivary CRP, and subjective units of distress were measured across three exposure therapy sessions, at a post-treatment extinction retest, and at a 1-month follow-up.

Results: CRP decreased over the course of treatment, b = -0.03 (SE = 0.01), p =.02 95 %CI [-0.06, -0.004], as did all social anxiety symptom domains and subjective distress. Higher CRP was associated with greater decreases from pre-treatment to 1-month follow-up in fear, b = -0.45 (SE = 0.15), p =.004 95 %CI [-0.74, -0.15], and avoidance, b = -0.62 (SE = 0.19), p =.002 95 %CI [-1.01, -0.23], and in-session subjective distress from pre-treatment to post-treatment, b = -0.42 (SE = 0.21), p =.05 95 %CI [-0.83, -0.001]. However, declines in CRP were not correlated with declines in fear, r = -0.07, p =.61, or avoidance, r = -0.10, p =.49, within-persons.

Conclusions: Virtual reality exposure therapy may be associated with an improvement in systemic inflammation in patients with severe SAD. Pre-treatment CRP may also be of value in predicting which patients stand to benefit the most from this treatment.

Keywords: C-reactive protein; CRP; Exposure therapy; Social anxiety disorder; Systemic inflammation; Virtual reality.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Anxiety / therapy
C-Reactive Protein
Fear
Female
Humans
Inflammation / therapy
Male
Phobia, Social* / therapy
Virtual Reality Exposure Therapy*

Substances

C-Reactive Protein