71 The enhancing effects of testosterone in exposure treatment for social anxiety disorder Saliva samples To determine endogenous testosterone levels, saliva samples were collected (2 ml passive drool saliva by Salicap; Hamburg, Germany) at eight time points (see Figure 4.1): (1) at baseline, (2) prior to T/P intake, (3) prior to exposure session 1, (4) immediately after speech delivery in session 1, (5) 30 minutes after speech delivery in session 1, (6) prior to exposure session 2, (7) immediately after speech delivery in session 2, and (8) 30 minutes after speech delivery in session 2. Participants were asked to conform to certain directives regarding food and drink intake to prevent pollution of the saliva samples. Samples were stored at -20 °C until radio-immune assays were performed at Dr. Kirschbaum’s laboratory (Dresden, Germany); for descriptions of the methodology, see (Miller et al., 2013; Reardon et al., 2016). Procedure After having provided their informed consent, participants were screened online for eligibility, to which end they filled out the LSAS and answered general screening questions (e.g., age, treatment status, infertility, menstrual cycle). Eligible participants were telephoned for further screening (MINI, check in/exclusion criteria), after which they learned whether they would be participating in the study (see Chapter 4 - Appendix 1 for details). All other assessments and the exposure sessions took place at the treatment facility. After enrollment (see Figure 4.1 for timing and procedure), participants completed the baseline assessment1, with the first exposure session being scheduled within one week. The morning of the session, the participants took a pregnancy test, saliva was collected, and psychoeducation provided, after which the participants completed a non-speech-related SUD and received T/P (administered by a research assistant). After four hours, during which time participants were instructed to avoid physically and psychologically straining activities and heavy meals, they returned for the exposure session, before which saliva was collected and resting HR was recorded. Another saliva sample was collected immediately upon completion of the speech and 30 minutes thereafter. During the speech, SUDs and HRs were collected. At the end of the session, the therapist checked for adverse drug effects by asking participants about physical complaints. A week later, the second exposure session took place, with all steps being identical to those of the first session barring supplement administration. After a 30-minute break, participants took the post-exposure assessment comprising the SPS and a computer task (reported elsewhere). We asked all participants to refrain from using alcohol, drugs 1 Computerized tasks were also part of the baseline assessment, but outcomes will be reported elsewhere. 4
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