46 Chapter 3 social approach motivation (Bos et al., 2012; Enter et al., 2014; Terburg et al., 2016). When administered specifically in patients with SAD, testosterone alleviates social avoidance and promotes prosocial behavior, including increased eye contact as well as behavioral approach towards angry faces (Enter, Terburg, et al., 2016). In addition, testosterone administration reduces automatic threat bias to angry faces in SAD patients (Enter, Spinhoven, et al., 2016; van Peer et al., 2017). These findings converge to suggest that enhanced testosterone-reactivity prior to exposure therapy may facilitate its outcomes (Enter, Hutschemaekers, & Roelofs, 2018). In light of the consistently established anxiolytic and prosocial properties of testosterone in SAD, it is remarkable that the association between pre-treatment testosterone and treatment efficacy has not yet been investigated. The present proof-of-principle study sought to test whether endogenous pre-treatment testosterone increases efficacy of a standardized exposure therapy session for adults with social anxiety disorder, as measured by fear levels during exposure and change in social anxiety symptoms following one standardized exposure session. In line with the challenge hypothesis, proposing that testosterone rises in preparation to a challenging encounter, we examined pre-treatment testosterone levels, both before (baseline) and in response to a pre-exposure instruction session (reactive). We hypothesized that participants with higher pre-treatment testosterone reactivity and baseline levels would show more fear decline during the session and greater reductions in self-reported social anxiety symptoms following the session. Materials and Methods Participants Seventy-three participants (52 females, Mage = 25.66, SD = 7.48, range = 18-50) diagnosed with SAD (principal diagnosis; i.e., the most important source of current distress), who endorsed fear of public speaking as their predominant fear were recruited at the University of Texas at Austin and in the Austin community. Exclusion criteria were: A) current use of corticosteroid medicines/testosterone enhancing products, B) a history of bipolar disorder or psychotic disorders, C) alcohol or substance use disorders in the past six months, D) significant suicidal ideation, E) current treatment for SAD and F) prior non-response to exposure therapy. Participants using psychotropic medication were allowed to participate in the study if they were on a stable dose of the medication for three weeks prior to the study. Participants received course credit for their participation. All participants took part in a study examining the effects of pre-treatment power posing (i.e., holding postures associated with high and low power) for augmenting ex-
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