Effects of Public Speaking Trait Anxiety and Intensity of Speaking Task on Heart Rate During Performance

The extant research examining the relationship between public speaking trait anxiety and heart rate has produced mixed findings. Some studies observe only weak relationships, whereas others report significant relationships between these variables. H. J. Eysetick has maintained that the degree of relationship between traits and heart rate depends on the stress levels under which the respondents perform when heart rate data are collected. An inspection of the existing studies shows that, consistent with Eysenck's observation, the studies reporting relationships between public speaking trait anxiety and heart rate were conducted under relatively low-intensity conditions in comparison to those reporting no such relationships. In the present study, heart rates of both anxious and nonanxious speakers were measured under both high- and low-intensity conditions. Results indicated that (a) heart rates of anxious speakers were significantly higher than those of nonanxious speakers when both performed under low-intensity conditions, but (b) heart rates were not different for anxious and nonanxious speakers when performing in high-intensity environments. These results provide a reconciliation of the inconsistent research findings and partially support the extension of Eysenck's conceptualization to communication apprehension theory and research.     

A Self-Modeling Intervention for High School Students with Public Speaking Anxiety

ABSTRACT

The study investigated the effectiveness of self-modeling as an intervention for public speaking anxiety. The participants were six high school students with elevated levels of self-reported public speaking anxiety. Students presented public speeches to randomly selected peer audiences. Direct observations measured the behavioral manifestations of public speaking anxiety. In the intervention phase, students viewed self-modeling videotapes that were edited to remove speech dysfluencies and behavioral symptoms of speech anxiety. The self-modeling tapes depicted only adaptive, exemplary behavior with an edited-in audience feature making it appear that the students were producing a fluent speech to an audience of their peers. All of the participants evidenced substantial decreases in behavioral symptoms of speech anxiety and these changes were maintained throughout follow-up. The range of the participants' effect sizes was 2.7 to 4.9. Self-report measures of state anxiety and confidence as a speaker were used to assess additional effects of treatment. For all participants, there were also substantial decreases in self-reported public speaking anxiety and state anxiety from baseline to follow-up. A post-treatment interview revealed high social validity and self-reported generalization of treatment.     

Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking

Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticipatory anxiety and distress during exposure, and increases exposure willingness and duration. Forty-three individuals with moderate public speaking anxiety were randomized to a standardized positive mental imagery exercise about future public speaking or no-task. All participants were then asked to present in a virtual reality environment. Anticipatory anxiety reduced in the positive mental imagery group, but not in the control group. Additionally, the positive mental imagery group reported lower distress during exposure than the control group, but groups did not differ in exposure willingness. Due to limited variance, effects on exposure duration could not be tested. Future-oriented positive mental imagery is promising to prepare individuals for exposure to previously avoided situations.     

Usability and Utility of a Computerized Cognitive-Behavioral Self-Help Program for Public Speaking Anxiety

This study describes the use of a cognitive-behavioral computer-administered self-help program with minimal therapist contact for public speaking anxiety. Participants (N = 10) with social phobia, as measured by a structured clinical interview, completed the self-help program in an open clinical trial. The program was delivered via a CD-ROM during individual sessions at an outpatient clinic, including 4 sessions of psychoeducation/cognitive therapy and 4 sessions of exposure therapy using a virtual audience presented on a computer screen. A therapist was available in another room to answer questions and to debrief for up to 10 minutes after each session. Participants completed standardized self-report questionnaires assessing social anxiety at pretreatment, posttreatment, and 3-month follow-up. Participants also completed measures of computer usability. Results showed decreases on all self-report measures of social anxiety from pre- to posttreatment, which were maintained at follow-up (n = 8). Participants also reported that they were satisfied with treatment, that they felt improved after treatment, and that the computer program was user-friendly. This study provides preliminary evidence that a computer-administered cognitive-behavioral-based program that includes minimal therapist contact may reduce public speaking anxiety and suggests that further research with a controlled design is needed.     

Using Retrieval Cues to Attenuate Return of Fear in Individuals With Public Speaking Anxiety

Even after successful exposure, relapse is not uncommon. Based on the retrieval model of fear extinction (e.g., Vervliet, Craske, & Hermans, 2013), return of fear can occur after exposure due to an elapse of time (spontaneous recovery) or change in context (contextual renewal). The use of external salient stimuli presented throughout extinction (i.e., retrieval cues [RCs]) has been suggested as a potential solution to this problem (Bouton, 2002). The current study examined whether RCs attenuated return of fear in individuals with public speaking anxiety. Sixty-five participants completed a brief exposure while presented with two RC stimuli aimed at a variety of senses (visual, tactile, olfactory, and auditory). Later, half the participants were tested for return of fear in a context different from the exposure context, and the other half in the same context. Half of each context group were presented with the same cues as in exposure, while the other half were not. Return of fear due to an elapse of time, change in context, and effects of RCs were evaluated on subjective, behavioral, and physiological measures of anxiety. Although contextual renewal was not observed, results supported effects of RCs in reducing spontaneous recovery on behavioral and physiological measures of anxiety. There was also evidence that participants who were reminded of feeling anxious during exposure by the RCs benefited more from using them at follow-up, whereas those who perceived the cues as comforting (safety signals) benefited less. Clinical implications of the findings are discussed.     

Adapting Manualized Treatments: Treating Anxiety Disorders Among Native Americans

Although there is a small but growing body of literature examining the psychopathology of anxiety among Native Americans, no data are available regarding the efficacy of empirically supported treatments for anxiety disorders among Native Americans. Moreover, exceptional challenges arise in adapting mainstream approaches to Native Americans, such as language barriers, contrasting beliefs about the cause and treatment of emotional illness between mainstream and traditional Native American culture, problems with homework compliance, allowing extra time for rapport building, and the need for a spiritual component in the treatment of anxiety disorders. Native Americans also confront the challenges of rural living and low socioeconomic status. The focus of this article is largely conceptual in nature, informed by the limited psychopathology data and the first author’s experience with cognitive behavioral treatment protocols for anxiety disorders and the provision of mental health services to Native Americans. In this article we highlight the unique challenges of adapting manualized anxiety treatments for Native American clients.     

Clinical Experiences in Conducting Empirically Supported Treatments for Generalized Anxiety Disorder

Knowledge of the efficacy of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) predominantly derives from randomized controlled trials (RCTs). However, there may be unique or complex issues encountered in practice, but not necessarily in the context of a controlled clinical trial. Therefore, launching a systematic dialogue between researcher and practicing clinician can be instrumental in augmenting evidence-based therapies through identification of variables that promote and interfere with clinical effectiveness. Through an initiative sponsored by the American Psychological Association’s Divisions 12 (Society for Clinical Psychology) and 29 (Psychotherapy), this study aimed to examine clinical experiences conducting CBT for GAD. The participants were 260 psychotherapists who completed an online survey on assessment and therapeutic intervention utilization and their experience of factors that limit successful GAD treatment and symptom reduction. The majority of respondents reported 20 years or less experience using ESTs for GAD, typically treating clients in outpatient clinics, treatment centers, and private practice. Some of the most commonly used interventions address clients’ maladaptive cognitions and elevated anxiety and muscle tension typical of GAD. Approximately one half of respondents reported incorporating integrative techniques into treatment. Factors perceived as limiting effective GAD treatment included severity and chronicity of GAD, presence of comorbid conditions, stressful home and work environments, client motivation and resistance to treatment, and issues encountered when executing therapy techniques. This study provides researchers with clinically derived directions for future empirical investigation into enhancing efficacy of GAD treatment.     

Telepsychology and Self-help: The Treatment of Fear of Public Speaking

This work presents a self-help, Internet-based telepsychology program for the treatment of public speaking fears. The system is comprised of 3 parts: The assessment protocol gives the patient information about his or her problem (i.e., amount of interference it creates in his or her life, severity, degree of fear and avoidance). The system also includes a structured treatment protocol, organized into separate blocks, reflecting the patient’s progress. This ensures that the patient does not skip any steps in the treatment (something quite common in traditional self-help manuals), which provides more control over the process. The treatment protocol is a cognitive-behavioral program that provides exposure to the feared situation using videos of real audiences. Finally, the control protocol assesses treatment efficacy, not only at closure, but also at every intermediate step. Efficacy data from 12 social phobia patients are presented from pretreatment to posttreatment and at 1-month follow-up. These preliminary data support the efficacy of our telepsychology program for the treatment of fear of public speaking. This is a preliminary work in a promising research path that examines the possibility of using the Internet for the treatment of psychological disorders.     

SPECIAL SERIES: Intensive Cognitive-Behavioral Treatments for Child and Adolescent Anxiety Disorders

Cognitive-behavioral treatments are efficacious intervention choices for anxious youth, yet the lack of access to and usage of evidence-based treatments outside of a research context continues to challenge efforts to disseminate and implement such interventions. One potential avenue for reconciling effective care and that most readily accessed by children and their families may be to offer treatment in an intensive format, typically consisting of a more concentrated dose of cognitive-behavioral treatment components. This special series in Cognitive and Behavioral Practice aims to explore the evolution of intensive cognitive-behavioral treatments currently under investigation across a variety of child and adolescent anxiety disorder populations, including specific phobias, obsessive-compulsive disorder, separation anxiety disorder, school refusal, and panic disorder. In addition to delineating the research support to date for intensive cognitive-behavioral treatment among children and adolescents with anxiety disorders, the articles included in this series provide detail on the application of each intensive intervention, highlight innovative treatment elements, and explore clinical and systematic issues unique to an abbreviated treatment format.     

Examining the Relation Between Technical and Global Competence in Two Treatments for Youth Anxiety

Although technical (quality of delivering techniques from a specific treatment) and global (general clinical expertise) competence are believed to be important ingredients of successful psychosocial treatment with youth, there have been few empirical efforts to measure both dimensions. Efforts to understand the role that each competence dimension plays in the process and outcome of youth treatment starts with determining whether the dimensions can be measured separately. This study examined whether scores from measures designed to assess technical and global competence were distinct. Treatment sessions (N = 603) from 38 youths (M age = 9.84 years, SD = 1.65; 60.5% White; 52.6% male) treated for primary anxiety problems within a randomized effectiveness trial were coded. Four coders used observational measures designed to assess technical competence, global competence, protocol adherence, and the alliance. Mean item interrater reliability was .70 (SD = .09) for technical competence and .66 (SD = .05) for global competence. While most components of global competence were distinct from technical competence scores, two components showed redundancy (r > .70). Scores on both competence measures were empirically distinct (r < .70) from scores on measures of protocol adherence and the alliance. Although the measures did not fully distinguish between technical and global competence, our findings do indicate that some components of technical and global competence may provide unique information about competence.     

新型冠状病毒肺炎疫情下普通民众焦虑的影响因素研究

为考察新型冠状病毒肺炎疫情下普通民众焦虑情绪的影响因素,采用自陈式问卷,对新型冠状病毒肺炎疫情防控下的1050位普通民众的疫情经历、媒体信息暴露时长及性质、疫情风险感知和焦虑进行调查。结果发现新型冠状病毒肺炎疫情防控当下民众焦虑情绪的发生率为18.0%,焦虑情绪的发生率在性别、年龄、受教育程度、婚姻状况和月收入等方面没有显著的差异;疫情经历、媒体信息暴露时长、负面信息暴露和感知疫情的严重性会增加焦虑情绪产生的可能性,正面信息暴露、对疫情熟悉度和可控度的感知可以减少焦虑情绪产生的可能性。这些结果说明了疫情经历、媒体信息暴露时长和性质、疫情风险感知是疫情防控当下民众焦虑出现的重要因素。     

Behavior Analysts to the Front! A 15-Step Tutorial on Public Speaking

Mainstream prominence was Skinner’s vision for behavior analysis. Unfortunately, it remains elusive, even as we approach the 110th anniversary of his birth. It can be achieved, however, and there are many routes. One that seems overlooked in many (most?) behavior analytic training programs is what I call the front of the room. The front of the room is a very powerful locus for influencing people. Mastering it can turn a commoner into a king; a middling man into a mayor; or a group of disorganized, dispirited people into an energized force marching into battle. The most powerful members of our species had their most memorable moments at the front of the room. If so much is available there, why is mastery of it in such short supply, not just in behavior analysts but in the population at large? In this paper, I address why, argue that the primary reason can be overcome, and supply 15 behaviorally based steps to take in pursuit of front of the room mastery.     

Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.     

Acute Stress,Depression, and Anxiety Symptoms Among English and Spanish Speaking Children with Recent Trauma Exposure

A growing literature suggests the clinical importance of acute stress disorder symptoms in youth following potentially traumatic events. A multisite sample of English and Spanish speaking children and adolescents (N = 479) between the ages of 8–17, along with their caregivers completed interviews and self-report questionnaires between 2 days and 1 month following the event. The results indicate that children with greater total acute stress symptoms reported greater depressive (r = .41, p < .01) and anxiety symptoms (r = .53, p < .01). Examining specific acute stress subscales, reexperiencing was correlated with anxiety (r = .47, p < .01) and arousal was correlated with depression (r = .50, p < .01) and anxiety (r = .55, p < .01). Age was inversely associated with total acute stress symptoms (r = ?.24, p < .01), reexperiencing (r = ?.17, p < .01), avoidance (r = ?.27, p < .01), and arousal (r = ?.19, p < .01) and gender was related to total anxiety symptoms (Spearman’s ρ = .17, p < .01). The current study supports the importance of screening acute stress symptoms and other mental health outcomes following a potentially traumatic event in children and adolescents. Early screening may enable clinicians to identify and acutely intervene to support children’s psychological and physical recovery.     

Treatments Addressing Pain-Related Fear and Anxiety in Patients with Chronic Musculoskeletal Pain: A Preliminary Review

Abstract

This review covers the current cognitive behavioural treatments available to address fear-avoidance beliefs in patients with chronic musculoskeletal pain (CMP). Four types of treatment protocols were identified for inclusion in the review: (a) graded in vivo exposure (GivE); (b) graded activity (GA); (c) acceptance and commitment therapy (ACT); and (d) mixed cognitive behavioural protocols. Most of the research suggests that GivE and ACT result in the best outcomes for treating fear-avoidance beliefs in patients with CMP. There is also a readily apparent paucity of research from North America; indeed, most of the available studies were conducted in the Netherlands and Scandinavia. This relative absence of North American research raises potentially important questions about the role of compensation status and access to care, which differ between countries, on treatment outcome. Implications and directions for future research are discussed.     

Speaking of Silence

In a previous article (Capps 2011) I discussed a short story and essay I wrote in high school and showed that themes that had figured prominently in my later writings were prefigured in these earlier writings. Invoking John Bunyan’s The Pilgrim’s Progress (1957) I concluded that the high school boy who lives inside of me has been my faithful companion throughout the years. In this article I focus on a sermon I preached in my senior year of high school and on several poems I wrote that year. The sermon and poems reflect my interest at the time in the harmful effects of silence on human relationships. An article that focused on the son of Saint Augustine (Capps 1990b) signaled my return to the issue of silence after a thirty-year hiatus. My subsequent reading of Alice Miller’s Breaking Down the Wall of Silence (1991) and The Truth Shall Set You Free (2001) helped me to understand why silence had been a personal issue for me. It also encouraged me to listen to the fledgling poet who lives within me and to appreciate his insights concerning silence and love.