Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Attentional orienting and awareness: evidence from a discrimination task

We used several cue–target SOAs (100, 500, 1000 ms) and three different degrees of cue predictability (Non-predictive-50%, Predictive-75%, Counter-predictive-25%), to investigate the role of awareness of cue–target predictability on cueing effects. A group of participants received instructions about the informative value of the cue, while another group did not receive such instructions. Participants were able to extract the predictive value of a spatially peripheral cue and use it to orient attention, whether or not specific instructions about the predictive value of the cue were given, and no matter their ability to correctly report it in a post-test questionnaire. In the non-predictive block, bad estimators who received no instructions showed regular cueing effects, while good estimators exhibited smaller and non-significant facilitatory effects at the short SOA and an absence of significant IOR at longer SOAs. However, for the instructions group, the pattern of results reversed.     

Media exposure, internalization of the thin ideal, and body dissatisfaction: comparing Asian American and European American college females

Internalization of the thin ideal mediates the media exposure-body dissatisfaction relation in young adult European American females. There is little related research on Asian Americans. We used structural equations modeling to test: (1) whether media exposure was associated with body dissatisfaction in Asian American young adult females, (2) internalization of the thin ideal mediated any such association, and (3) whether the mediational model provided equivalent fit for European American and Asian American samples. Participants were 287 college females (154 Asian Americans, 133 European Americans). Internalization of the thin ideal explained the media exposure-body dissatisfaction association equally well for both groups. Results suggest that Asian Americans may be employing unhealthy weight control behaviors, and may be prone to developing eating disorders, at rates similar to European American young adult females. Clinicians need to screen carefully for body dissatisfaction, unhealthy weight control behaviors, and eating disorders in Asian American females.     

Impact of Exposure to Community Violence on Anxiety: A Longitudinal Study of Family Social Support as a Protective Factor for Urban Children

In a longitudinal study, we examined the relationship between exposure to community violence and anxiety, and the extent to which family social support moderated this relationship within a predominantly African American sample of 385 children in an urban public school system. Children reported notably lower anxiety levels compared to normative data for African American children. A high percentage reported witnessing a variety of violent acts. Cross-sectional results indicated that among girls exposure to violence was significantly correlated with total, physiological, and concentration anxiety. Among boys violence exposure was not associated with anxiety. Hierarchical regression analyses indicated that after controlling for gender, exposure to violence at Time 1 did not significantly predict changes in anxiety. A significant interaction was found for gender and exposure to violence on concentration anxiety; girls who reported higher initial violence exposure reported greater increases in subsequent concentration anxiety than boys. Whereas findings from our study did not support a moderating relationship of family social support on children's exposure to violence and anxiety, a strong negative relationship was found between anxiety and family support. Among children with initially low worry anxiety, those with low family social support showed greater increases in subsequent worry anxiety.     

Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

Mindfulness,General Trust,and Social Support Among Trauma-Exposed College Students

The purpose of the present study was to examine whether mindfulness predicts general trust and social support among trauma-exposed college students, as well as to examine the potential moderating effect of posttraumatic stress on these relationships. Participants consisted of 536 trauma-exposed college students attending a public university in the southeast United States. After controlling for PTSD symptoms and type of trauma, mindfulness was positively associated with general trust and social support at low and mean levels of PTSD symptomatology; however, the relationships between mindfulness and these variables were nonsignificant at high levels of PTSD symptomatology.