title: Augmentation of exposure therapy with post-session administration of D-cycloserine.
abstract: BACKGROUND
  Pre-session administration of d-cycloserine (DCS) has been found to augment exposure therapy outcomes in a variety of anxiety disorders. To be able to enhance learning only for successful exposure sessions, it would be beneficial to have the option of administering DCS after rather than before the session, a strategy encouraged by pre-clinical work. We believe the present study is the first published report on the efficacy of post-session administration of DCS in humans.
  
  
  METHODS
  Adults (N = 29) with a DSM-IV diagnosis of acrophobia were randomized to receive two sessions of virtual reality exposure therapy (VRE) in combination with placebo or 50 mg of DCS. Instead of administering the pill prior to each of the sessions, as has been done in extant work, we administered the pill immediately following each session. Measures of acrophobia severity were collected at baseline, at each treatment session, 1-week post-treatment, and at 1-month follow-up.
  
  
  RESULTS
  Mixed-effects repeated-measures ANOVAs and GLMMs revealed significant improvement in all outcome measures over time, but no between-group differences were observed. At post-treatment, 63.5% of patients in the placebo condition vs. 60.0% of those in the DCS condition were in remission. At 1-month follow up, 63.4% of those in the placebo condition vs. 66.6% of those in the DCS condition were in remission.
  
  
  CONCLUSIONS
  These findings do not support the application of post-session DCS administration for augmenting the efficacy of exposure-based treatments. Possible reasons for these findings are discussed.
  
  
  BACKGROUND
  The Trial is registered at ClinicalTrials.gov (NCT01102803).
authors.affiliation: Department of Psychology, Southern Methodist University, USA. candycetart@gmail.com
authors.forename: Candyce D
authors.initials: CD
authors.lastname: Tart
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Handelsman
authors.forename: Lindsey B
authors.initials: LB
authors.lastname: Deboer
authors.forename: David
authors.initials: D
authors.lastname: Rosenfield
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Hofmann
authors.forename: Mark B
authors.initials: MB
authors.lastname: Powers
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Jasper A J
authors.initials: JA
authors.lastname: Smits
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000963:Antimetabolites / Q000627:therapeutic use*; D001362:Avoidance Learning; D003523:Cycloserine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010698:Phobic Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000963:Antimetabolites; D003523:Cycloserine