Does threatening imagery sensitize distress during contaminant exposure?

Prominent models of fear focus on the role of cognition in the development and maintenance of maladaptive responses. Little research, however, has evaluated the impact of cognition on distress reduction. The current study uses an experimental design to examine the effect of different types of imagery (moving harm, static harm, and safety) on reduction of distress associated with a contaminating stimulus in a normal university sample. Results indicate that use of moving harm imagery sensitizes distress during a 30-min exposure, whereas static harm and safety imagery reduce distress. These findings demonstrate that cognitive factors can moderate affective response during exposure. Clinical implications for the treatment of anxiety disorders are discussed.     

Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were analyzed with mixed models. Weekly changes in the process variables derived from the cognitive model (self-focus, estimated probability and estimated cost of negative social events, safety behaviors) predicted subsequent weekly changes in social anxiety. Changes in the interpersonal variable perceived acceptance by others also predicted subsequent changes in social anxiety. On the other hand, changes in social anxiety predicted changes in the four cognitive variables. There were no interactive effects of process with treatment. The cognitive variables decreased during treatment to a similar degree in both treatments. The results indicate that, to reduce social anxiety, therapy should target self-focus, estimated probability and cost of feared social events, safety behaviors, and perceived acceptance by others. The process of improvement may involve positive cycles in that a reduction of social anxiety, in turn, appeared to impact self-focus, probability, cost, and safety behaviors.     

Cognitive Behavior Therapy for Women With Generalized Anxiety Disorder in the Perinatal Period: Impact on Problematic Behaviors

Generalized anxiety disorder (GAD) is the most frequently diagnosed anxiety disorder among women in the perinatal period (pregnancy to one year postpartum). Recent studies have examined the relationship between problematic behaviors and GAD symptoms. Studies in nonperinatal samples indicate that adults with GAD engage in avoidance and safety behaviors and these behaviors are associated with greater symptom severity. Little research has examined the use of problematic behaviors among pregnant or postpartum women. However, preliminary research suggests that these behaviors may have a negative impact on both anxious women and their children. Our aim was to examine the extent to which women with GAD in pregnancy or the postpartum engage in problematic behaviors and whether cognitive behavioral therapy is effective in reducing these behaviors. Fifty-eight women with GAD in pregnancy or postpartum were recruited from a larger clinical trial (Clinicaltrials.gov ID NCT02850523) evaluating the effectiveness of group-based cognitive behavioral therapy (CBGT) for perinatal anxiety disorders. The results indicated that women with perinatal GAD reported high levels of avoidance and safety behaviors and greater engagement in these behaviors was associated with higher levels of worry and related symptoms. CBGT was effective in reducing GAD symptoms and problematic behaviors and a bidirectional relationship was found between changes in worry and problematic behaviors during treatment. Limitations and future directions are discussed.     

Evaluation of the effectiveness of Face IT, a computer-based psychosocial intervention for disfigurement-related distress

Some people who have a visible difference (disfigurement) experience psychosocial adjustment problems that can lead to social anxiety and isolation. The aim of this study was to assess the effectiveness of a new computerised CBT-based intervention (Face IT) in reducing anxiety and appearance-related distress for individuals with visible differences. Face IT was tested against a non-intervention control group and standard CBT-based face-to-face delivery. Eighty-three participants were assessed at four time points using the Hospital Anxiety and Depression Scales, Derriford Appearance Scale-24, Body Image Quality of Life Inventory and Fear of Negative Evaluation (FNE). The findings indicate a significant reduction in anxiety and appearance-related distress in both the Face IT intervention and the face-to-face condition. Similar findings were reported for depressive symptoms and FNE. Results at the three and six months follow-up demonstrate increased improvements in psychological functioning with both interventions. This new online psychosocial intervention has been found to be effective at reducing anxiety, depression and appearance concerns amongst individuals with disfigurements, whilst increasing positive adjustment. A remote-access, computer-based intervention offers the potential to provide psychosocial support more easily and in a cost-effective manner to adults with appearance-related distress.     

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

Comparison of water- and land-based exercise in the reduction of state anxiety among older adults

This study examined the effect of an acute exercise program of different exercise conditions on state anxiety among older adults. 73 healthy subjects were recruited and randomly assigned to either water exercise group (n = 36) or land exercise group (n = 37). State anxiety was assessed before exercise and following exercise. Subjects in the water exercise performed a 70-min. exercise program consisting of a 10-min. warm-up, a 20-min. brisk walking, a 20-min. rhythmic dancing, a 10-min. resistance training, and a 10-min. cool down exercise. The land exercise program contained a 10-min. warm up and a 30-min. combined endurance and resistance exercise, followed by a 10-min. cool down exercise. Analysis showed that both exercise groups scored significantly (p<.001) lower on anxiety after exercise, but there was no significant interaction for group by trial for scores on state anxiety. The data indicate that elderly persons who participate in these types of exercise report lower state anxiety.     

The Effects of Animal-Assisted Activities on College Students Before and After a Final Exam

Final exams at colleges and universities have proven to be a time of anxiety and stress for students. This paper contains an exploration the effects of Animal-Assisted Activities (AAA) on exam anxiety through the use of blood pressure readings before and after interacting with therapy dogs. A comparison of the experimental and control groups interacting with therapy dogs has shown statistical significance for the reduction of blood pressure for those students who will or have taken a final exam. Having owned a pet, as well, as the age of the participant were not significant predictors of whether or not therapy dogs would reduce blood pressure.     

Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.     

The effects of safety behaviors on the fear of contamination: an experimental investigation

The strategies used by anxious individuals to prevent feared outcomes, known as safety behaviors, are thought to maintain pathological anxiety by preventing the disconfirmation of inaccurate threat beliefs. However, it is possible that safety behaviors might also contribute to the development and exacerbation of anxiety symptoms. The present study tested this notion in a sample of undergraduate participants with either low (n=30) or high (n=26) levels of contamination fear. After a week-long baseline period, participants spent 1 week engaging in a clinically representative array of contamination-related safety behaviors on a daily basis, followed by a second baseline period. Subsequent to the safety behavior manipulation, participants evidenced statistically significant increases in threat overestimation, contamination fear symptoms, and emotional and avoidant responses to three contamination-related behavioral avoidance tasks (BATs). In contrast, anxiety and depressive symptoms remained stable. The magnitude of change in contamination concerns was equivalent among participants in both contamination fear groups. Our findings suggest that contamination-related safety behaviors elicit a modest and specific increase in the fear of contamination. Possible mechanisms for this effect, as well as implications for the role of safety behaviors in the psychopathology of anxiety disorders, are discussed.     

Graduated exposure plus feedback in the treatment of speech anxiety

This study investigated the effectiveness of a graduated exposure procedure, combined with peer feedback, in the treatment of speech anxiety. Subjects were assigned to one of two conditions: (a) graduated exposure/shaping plus feedback or (b) no-treatment control. Results indicated that the graduated exposure/shaping plus feedback treatment group demonstrated significantly greater speech anxiety reduction than the no-treatment control group at post- and follow-up assessment.     

Safety Behaviors in Adults With Social Anxiety: Review and Future Directions

Safety behaviors are considered an important factor in the maintenance of social anxiety disorder (SAD). Safety behaviors are typically employed by socially anxious individuals to reduce anxiety in feared social situations. However, by preventing individuals with social anxiety from gathering evidence that would disconfirm their maladaptive beliefs about social situations, the use of safety behaviors ultimately maintains social anxiety over time. Twenty years ago, Wells and colleagues (1995) demonstrated that use of safety behaviors diminishes the efficacy of exposure treatment for SAD, suggesting that reduction in the use of safety behaviors during exposure can enhance treatment response. Research on safety behaviors has expanded considerably since Wells et al.’s seminal publication, and our understanding of the role safety behaviors may play in the maintenance of social anxiety has grown in breadth and depth. In this paper, we present a detailed review of the published research on safety behaviors relevant to social anxiety and social-anxiety-related processes. Finally, we evaluate the impact of safety behaviors on the outcome of treatment for SAD, and we look to the literature on safety behaviors in other anxiety disorders to inform our understanding of use of safety behaviors during exposure and to facilitate future research in SAD.     

Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study

Despite studies claiming Adjustment Disorders (AD) affect up to 10% of the general population, research is severely lacking for effective treatment recommendations and screening tools. This article presents the treatment of a 30-year old Caucasian male diagnosed with AD - mixed anxiety and depression subtype. After 12 standard 60-minute sessions, treatment using a Symbolic-Experiential Family Therapy (SEFT) approach resulted in the alleviation of depression and anxiety symptoms. This case study provides preliminary evidence for the effectiveness of SEFT using a mixed methods case study. Implications for further study, and the usefulness of SEFT for the treatment of AD, is presented.     

Effectiveness of a Classroom Mindfulness Coloring Activity for Test Anxiety in Children

To evaluate the effectiveness of mindfulness-based structured versus unstructured coloring on test anxiety, 52 participants (53.8% female; M_age = 10.92 years, SD =.82) were randomly assigned to either a structured mandala (n = 26) or free coloring condition (n = 26), and completed a standardized anxiety measure to assess anxiety before and after coloring, immediately before a spelling test. Results revealed an overall decrease in anxiety for both groups. However, a significant gender by group interaction demonstrated that while both genders experienced anxiety reduction in the mandala condition, males reported a greater anxiety reduction in the free coloring condition while females only benefited from the mandala condition. Possible explanations for these gender effects are explored and future directions discussed.     

Source Characteristics in Denying Rumors of Organizational Closure: Honesty Is the Best Policy

Effect of source honesty and appropriateness on effectiveness of rumor denial was tested. When the source was perceived as high on honesty, the denial was more successful in reducing belief and anxiety associated with the rumor. Source appropriateness (operationalized as a combination of source knowledgeability and status) did not have a main effect on belief or anxiety reduction. Honesty and appropriateness had an additive effect, such that the denial was most successful in reducing belief when the source was perceived as high on both honesty and appropriateness.     

A Preliminary Examination of the Acceptability,Feasibility, and Effectiveness of a Telehealth Cognitive-Behavioral Therapy Group for Social Anxiety Disorder

In light of the growing interest in, and need for, the telehealth delivery of health care, additional research is needed on the acceptability and effectiveness of these types of interventions. This study examined the acceptability, feasibility, and preliminary effectiveness of an adapted telehealth-delivered group cognitive-behavioral therapy (CBT) intervention for adults with social anxiety disorder (SAD). This report describes the adaptation and subsequent implementation of an 8-week telehealth-delivered group treatment designed to reduce symptoms of SAD. Specific adaptations for delivering treatment during the COVID-19 pandemic and the subsequent enactment of social distancing measures are discussed. Posttreatment data indicated that the intervention was feasible to implement in an outpatient mental health clinic, acceptable to participants, and associated with reduction in symptoms of social anxiety, general anxiety, depression, and stress.     

Safety behaviors and judgmental biases in social anxiety disorder

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD.     

Effectiveness of group cognitive-behavioral treatment for childhood anxiety in community clinics

This study evaluated the effectiveness of cognitive-behavioral treatment for childhood anxiety in a community clinic setting in Hong Kong, China. Forty-five clinically-referred children (age 6-11 years) were randomly assigned to either a cognitive-behavioral treatment program or a waitlist-control condition. Children in the treatment condition showed significant reduction in anxiety symptoms—both statistically and clinically—whereas children in the waitlist condition did not. After the waitlist period was over, the control group also received the treatment program and showed a similar reduction in symptoms. For the full sample of 45 children, the effectiveness of the intervention was significant immediately after treatment and in 3- and 6-month follow-ups. In addition, children’s anxiety cognition and their ability to cope with anxiety-provoking situations fully mediated the treatment gains. These results offer empirical support for cognitive-behavioral treatment programs in a non-Western cultural context and plausible mediators for how cognitive-behavioral therapy works.     

CONTINGENT REINFORCEMENT FOR CARBON MONOXIDE REDUCTION: WITHIN-SUBJECT EFFECTS OF PAY AMOUNT

The relationship between reinforcer amount and daytime smoking reduction in smokers offered money for reduced afternoon breath carbon monoxide (CO) levels was examined. Twenty-three hired regular smokers with average baseline CO levels of about 30 ppm were exposed in random order to five sliding scale payment schedules that changed daily or weekly. Money was available for afternoon CO readings between 0 and 21 ppm with pay amount inversely related to the absolute CO reading obtained. Maximum pay amount for readings below 7 ppm varied among $0, $1.50, $3, $6, and $12 per day. Contingent reinforcement promoted CO and daytime cigarette reduction within individuals with the amount of behavior change related to the amount of payment available. Average CO levels decreased from 30 to 15 ppm as a function of pay amount whereas self-reported daytime cigarettes decreased from 12 to 5 per day. Average minutes of cigarette abstinence prior to the afternoon study contact increased from 62 to 319 minutes as a function of pay amount, whereas the percentage of available money earned increased from 22% to 48%. Nontargeted evening cigarette use also decreased during periods of daytime smoking reduction. The orderly effects of this contingent reinforcement intervention on daytime smoking of regular smoker volunteers suggest that this is a sensitive model for continued evaluation of factors that influence smoking reduction and cessation.     

Leverpress Escape/Avoidance Conditioning in Rats: Safety Signal Length and Avoidance Performance

Leverpress escape/avoidance is an excellent model for assessing coping in rats. Acquisition of the leverpress response is determined by the interstimulus (signal-shock) interval, as well as the type and duration of the aversive event. One factor that has received less research attention is the safety or feedback signal. The safety signal presumably negatively reinforces leverpress responding through fear reduction. Here, we present a parametric manipulation of safety signal length and avoidance performance. All rats were trained with a 60-s tone conditioned stimulus and an intermittent 1-s, 1.0-mA footshock. Training was further accomplished with a 1-, 2-, 4-, or 6-min safety signal. Acquisition of the avoidance response was comparable at all safety signal durations. Rats trained with the shortest safety signal (1 min) exhibited more leverpresses during the safe period, a measure of anxiety. Thus, acquisition of the leverpress avoidance response was efficient regardless of safety signal duration, even though shorter periods were associated with greater anxiety.     

Leverpress escape/avoidance conditioning in rats: Safety signal length and avoidance performance

Leverpress escape/avoidance is an excellent model for assessing coping in rats. Acquisition of the leverpress response is determined by the interstimulus (signal-shock) interval, as well as the type and duration of the aversive event. One factor that has received less research attention is the safety or feedback signal. The safety signal presumably negatively reinforces leverpress responding through fear reduction. Here, we present a parametric manipulation of safety signal length and avoidance performance. All rats were trained with a 60-s tone conditioned stimulus and an intermittent 1-s, 1.0-mA footshock. Training was further accomplished with a 1−, 2−, 4−, or 6-min safety signal. Acquisition of the avoidance response was comparable at all safety signal durations. Rats trained with the shortest safety signal (1 min) exhibited more leverpresses during the safe period, a measure of anxiety. Thus, acquisition of the leverpress avoidance response was efficient regardless of safety signal duration, even though shorter periods were associated with greater anxiety.