48 Chapter 3 Symptom severity Social anxiety symptom severity was assessed with the Liebowitz Social Anxiety Scale (LSAS) (Liebowitz, 1987), which asks participants to rate how fearful they would feel and how often they would try to avoid 24 different social situations during the past week. Scores range from 0 to 144 and the scale has sound psychometric properties (Heimberg et al., 1999; Safren et al., 1999). The LSAS was completed at pre-and post-treatment (one week after completion of the standardized exposure session). Saliva Measures To assess endogenous testosterone, saliva samples were collected from the participants during their first visit to the clinic (i.e. pre-treatment and standardized exposure session) (2 ml passive drool saliva by Salicap; Hamburg, Germany) at different time points illustrated in Figure 3.1: T1) 50 minutes prior to exposure (30 minutes after arrival), T2) 25 minutes prior to exposure, see procedure paragraph), T3) directly prior to exposure, T4) after exposure (around 20 minutes after start exposure) and T5) 50 minutes after the start of exposure. 35 40 45 50 55 60 65 70 75 80 -50 -25 0 + 7 + 14 + 20 + 50 ~1 week Time in reference to onset of exposure (0 minutes) T1 T2 T3 T4 T5 Pre-exposure instruction Speech 1 Speech 2 Speech 3 Speech4 Fear (subjective units of distress – SUD) Figure 3.1 The mean peak and mean end Subjective Units of Distress (SUDs) per Speech exposure from all 73 participants (speech 4, N= 66). The Figure also depicts the timing of testosterone samples (T1-5) relative to the Speech exposures that took place either during the exposure session (in the middle (blue) area: Speech 1–3) or at post-assessment (in the right (orange) area: Speech 4). The Exposure session was preceded by a pre-exposure instruction phase (black and white striped area) from which the relevant baseline and reactive testosterone samples were taken (T 1-3) to test effects of pre-treatment testosterone reactivity on therapy efficacy and outcome.
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