The Role of Glucocorticoids in Enhancing Exposure Therapy for Phobias: A Systematic Review

Abstract

Phobias, a common subset of anxiety disorders, are commonly treated with psychological therapies. However, there are limits to the achievements of these therapies and in some severe or treatment-resistant cases, there are requirements for adjuncts. Glucocorticoids (GC), such as cortisol, can enhance the therapy by modulating the fear responses and facilitating the extinction of the fear memories. This systematic review (SR) examined the role of GCs as adjuncts to psychologies therapies in several phobias. A total of seven papers, eight studies met the inclusion criteria with findings that showed GCs had some effect on improvement and this was seen particularly in spider phobia. Neuroimaging data was also included and showed similar findings such as the normalisation of fear-processing networks with the use of GCs, particularly the salience network. However, the results for social phobia and acrophobia were more variable as some inconsistencies in long-term effectiveness were noted. This SR found that GCs may have potential in the treatment of phobias but further research is required to determine their efficacy, optimal dosing and long-term impact.