J Psychiatry Neurosci 2018;43(6):407-415
Lance M. Rappaport, PhD; Jennifer J. Russell, PhD; Donald Hedeker, PhD; Gilbert Pinard, MD; Pierre Bleau, MD; Debbie S. Moskowitz, PhD
Background: Laboratory-based research with community samples has suggested changes in affective, behavioural and cognitive processes as possible explanations for the effects of serotonergic medications. Examining the effects of serotonergic medications using an ecological momentary measure (such as event-contingent recording) in the daily lives of people with social anxiety disorder would contribute to establishing the effects of these medications on affect, behaviour and one form of cognition: perception of others’ behaviour.
Methods: The present study assessed changes in affect, interpersonal behaviour and perception of others’ behaviour in adults with social anxiety disorder using ecological momentary assessment at baseline and over 4 months of a single-arm, uncontrolled, open-label trial of treatment with the selective serotonin reuptake inhibitor paroxetine.
Results: Anxiety and concurrent depressive symptoms decreased. Participants also reported increased positive and decreased negative affect; increased agreeable and decreased quarrelsome behaviour; increased dominant and decreased submissive behaviour; and increased perception that others behaved agreeably toward them. Moreover, participants demonstrated reduced intraindividual variability in affect, interpersonal behaviour and perception of others’ behaviour.
Limitations: Limitations included the lack of a placebo group, the inability to identify the temporal order of changes and the restricted assessment of extreme behaviour.
Conclusion: The results of the present study demonstrate changes during pharmacotherapy in the manifestation of affect, interpersonal behaviour and interpersonal perception in the daily lives of people with social anxiety disorder. Given the importance of interpersonal processes to social anxiety disorder, these results may guide future research seeking to clarify mechanisms of action for serotonergic medications.
Submitted Jul. 24, 2017; Revised Oct. 31, 2017; Accepted Jan. 18, 2018; Published online Aug. 29, 2018
Acknowledgments: The authors thank Carolina Pansera, Melissa Levesque and David Paul for assistance in data collection, Helen Wang for assistance with computational resources and Daniel S. Pine for feedback on an earlier manuscript draft.
Affiliations: From the Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Va. (Rappaport); the Department of Psychology, McGill University, Montréal, Que. (Rappaport, Russel, Moskowitz); the Department of Psychiatry, McGill University, Montréal, Que. (Russel, Pinard, Bleau); and the Department of Public Health Sciences, University of Chicago, Chicago, Il. (Hedeker).
Funding: This research was funded by a grant from GlaxoSmithKline to D.S. Moskowitz and from fellowship support to L. Rappaport from the National Institute of Mental Health (T32MH020030).
Competing interests: The authors do not have any financial interests that might influence this research. Some data from the present study were previously published in the doctoral dissertation by L. Rappaport; the data were analyzed differently to address different scientific aims. P. Bleau reports a grant from GlaxoSmithKline and other funding from the National Institute of Mental Health during the conduct of the study.
Contributors: J. Russell, P. Bleau and D. Moskowitz designed the study. J. Russell, G. Pinard, P. Bleau and D. Moskowitz acquired the data, which L. Rappaport, D. Hedeker, P. Bleau and D. Moskowitz analyzed. L. Rappaport and D. Moskowitz wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
Correspondence to: L.M. Rappaport, Virginia Institute for Psychiatric and Behavioral Genetics, 800 E. Leigh Street, Suite 101, Richmond, VA 23219-1534; Lance.Rappaport@vcuhealth.org