(PS9-93) The Bidirectional Relationship Between Sleep Disturbance and Exposure-Based Treatment for Social Anxiety Disorder: A Multi-Method Examination

Abstract Text: Background. Individuals with Social Anxiety Disorder (SAD) often exhibit poor sleep, which may influence treatment outcomes. Despite theoretical models linking sleep to mechanisms of fear extinction, empirical findings remain equivocal, and existing studies rely on subjective measures. This study investigates the bidirectional relationship between sleep duration, sleep efficiency, sleep quality and exposure-based SAD therapy outcomes.

Methods. Participants (N = 32) with SAD completed a five-week exposure-based group therapy. Daily sleep data, including subjective self-reports and actigraphy, were collected for one week pre-treatment, during treatment, and one week post-treatment. Treatment outcomes were assessed using the Liebowitz Social Anxiety Scale (LSAS). Multilevel modeling (MLM) was employed to evaluate relationships between sleep and treatment outcomes.

Results. Poor baseline sleep quality significantly predicted worse treatment outcomes (β = 1.50, p = .047) at mid- and post-treatment when controlling for baseline social anxiety symptoms. Nights after therapy were associated with significant reductions in actigraphy-based sleep duration compared to the weekly average (β = -26.48, p < .01). Post-treatment improvements in global sleep quality and sleep efficiency (actigaphy and self-report) were observed among participants with poor baseline sleep (p’s < .02).

Conclusions. Findings replicate and extend existing work and suggest sleep both influences and is influenced by exposure-based SAD therapy. Poor sleep can hinder treatment efficacy, while exposure therapy seems to acutely disrupt sleep. Assessing sleep prior to and during treatment, and interventions targeting sleep disturbances, will likely optimize SAD treatment outcomes.