Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia

The aim of the present study was to evaluate the effectiveness of low-budget virtual reality (VR) exposure versus exposure in vivo in a between-group design in 33 patients suffering from acrophobia. The virtual environments used in treatment were exactly copied from the real environments used in the exposure in vivo program. VR exposure was found to be as effective as exposure in vivo on anxiety and avoidance as measured with the Acrophobia Questionnaire (AQ), the Attitude Towards Heights Questionnaire (ATHQ) and the Behavioral Avoidance Test (BAT). Results were maintained up to six months follow-up. The present study shows that VR exposure can be effective with relatively cheap hardware and software on stand-alone computers currently on the market. Further studies into the effectiveness of VR exposure are recommended in other clinical groups as agoraphobics and social phobics and studies in which VR exposure is compared with more emerging virtual worlds as presented in CAVE-type systems.     

The moderating role of emotional stability in the relationship between exposure to violence and anxiety and depression

This study investigated the associations among exposure to violence, emotional stability, and psychological symptoms. The moderating role of emotional stability in the relationship between exposure to violence and anxiety and depression was examined in a sample of 482 high school students in Hong Kong. Results showed that both witnessing violence and low levels of emotional stability were positively associated with symptoms of anxiety and depression. Low levels of emotional stability exacerbated the relation between witnessing violence and symptoms of anxiety and depression; the opposite pattern was found among adolescents with high levels of emotional stability. This study sheds light on the role of emotional stability in ameliorating the detrimental effects of witnessing violence on symptoms of anxiety and depression among adolescents. Findings of this study also have implications for the development of emotionally healthy personalities.     

Negative priming and sequence learning

Three experiments used a novel sequence learning task, in which participants responded to changes in location of one visual stimulus whilst ignoring another. Experiment 1 demonstrated negative priming effects in this task, in that responses to individual sequence elements were disrupted when the attended stimulus (e.g., red asterisk) appeared at the location taken by the unattended stimulus (e.g., blue asterisk) on the immediately preceding trial. Experiments 2 and 3 found that negative priming effects extended beyond sensitivity to individual items, suggesting that people may be able to learn about sequential features of ignored events as well as about single events in isolation. The results are discussed in relation to current theories of negative priming.     

Addressing Dropout From Prolonged Exposure: Feasibility of Involving Peers During Exposure Trials

Posttraumatic stress disorder (PTSD) is a significant problem for combat veterans. Fortunately, effective treatments, such as Prolonged Exposure (PE), are available and widely disseminated in the Veterans Affairs (VA) health-care system. Nonetheless, despite well-documented effectiveness, attrition remains high at approximately 30% across evidence-based interventions. Early studies indicated that dropout was largely related to stigma and logistical barriers (e.g., travel time and cost). However, research demonstrates that eliminating these logistical and stigma-based barriers (e.g., through home-based telemedicine) has little effect on dropout. We surveyed 82 veterans who dropped out of PE treatment regarding reasons for leaving treatment. Approximately half indicated that in vivo homework assignments caused significant problems, and when asked to consider the possibility of peer support during in vivo exposure assignments, 52% indicated that they would consider returning to treatment with such assistance. In response to this feedback, we constructed an in vivo therapy peer support program wherein peers are directly involved with in vivo exposure exercises. The following brief report presents the rationale for, outline of, and initial feasibility data supporting this program to enhance both return to, and completion of, exposure therapy treatment for PTSD.     

Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial

Cognitive-behavioral treatments for panic disorder (PD) emphasize interoceptive exposure (IE) to target anxiety sensitivity (AS) but vary considerably in its manner of delivery. This randomized controlled trial was conducted to compare the efficacy of the low-dose delivery of IE exercises often prescribed in treatment protocols to an intensive form of IE hypothesized to optimize inhibitory learning. Participants (N = 120) with elevated AS were randomly assigned to one of four single-session interventions: (a) low-dose IE as prescribed in Barlow and Craske's Panic Control Treatment, (b) low-dose IE without controlled breathing or a lengthy between-trial rest period, (c) intensive IE, or (d) expressive writing control. Compared to the other conditions, intensive IE produced significantly greater reductions in AS and fearful responding to a straw breathing task from pretreatment to posttreatment. Maintenance of gains during the follow-up period did not differ between conditions. Changes in fear toleration and negative outcome expectancies fully mediated the superior efficacy of intensive IE over low-dose IE. The two low intensity IE conditions produced particularly high rates of fear sensitization on between-trial and outcome variables. The findings suggest that the intensive delivery of IE exercises has the potential to improve the efficacy of exposure-based treatments for PD.     

Failure to replicate the deleterious effects of safety behaviors in exposure therapy

The current study attempted to replicate the finding obtained by Powers, Smits, and Telch (2004; Journal of Consulting and Clinical Psychology, 72, 448–545) that both the availability and utilization of safety behaviors interfere with the efficacy of exposure therapy. An additional goal of the study was to evaluate which explanatory theories about the detrimental effects of safety behaviors best account for this phenomenon. Undergraduate students (N = 58) with high claustrophobic fear were assigned to one of three treatment conditions: (a) exposure only, (b) exposure with safety behavior availability, and (c) exposure with safety behavior utilization. Participants in each condition improved substantially, and there were no significant between-group differences in fear reduction. Unexpectedly, exposure with safety behavior utilization led to significantly greater improvement in self-efficacy and claustrophobic cognitions than exposure only. The extent to which participants inferred danger from the presence of safety aids during treatment was associated with significantly less improvement on all outcome measures. The findings call into question the hypothesized deleterious effects of safety behaviors on the outcome of exposure therapy and highlight a possible mechanism through which the mere presence of safety cues during exposure trials might affect treatment outcomes depending on participants’ perceptions of the dangerousness of exposure stimuli.     

Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome

We conducted a follow-up of a previously reported study of internet-delivered cognitive behavior therapy (CBT) for IBS, based on exposure and mindfulness exercises (Ljótsson et al. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome – a randomized controlled trial. Behaviour Research and Therapy, 48, 531–539). Seventy-five participants from the original sample of 85 (88%) reported follow-up data at 15–18 months (mean 16.4 months) after completing treatment. The follow-up sample included participants from both the original study’s treatment group and waiting list after it had been crossed over to treatment. Intention-to-treat analysis showed that treatment gains were maintained on all outcome measures, including IBS symptoms, quality of life, and anxiety related to gastrointestinal symptoms, with mainly large effect sizes (within-group Cohen’s d = 0.78–1.11). A total of fifty participants (59% of the total original sample; 52% of the original treatment group participants and 65% of the original waiting list participants) reported adequate relief of symptoms. Improvements at follow-up were more pronounced for the participants that had completed the full treatment and maintenance of improvement did not seem to be dependent on further treatment seeking. This study suggests that internet-delivered CBT based on exposure and mindfulness has long-term beneficial effects for IBS-patients.     

Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.     

Specifying the Interrelationship Between Exposure to Violence and Parental Monitoring for Younger Versus Older Adolescents: A Five Year Longitudinal Test

Five waves of longitudinal data collected from 349 African American youth living in extreme poverty were used to examine the interrelationship between exposure to violence and parenting during adolescence. Semi-parametric group based modeling was used to identify trajectories of parental monitoring and exposure to violence from T1 to T5. Results from these analyses revealed: (1) a trajectory of declining parental monitoring for 48% of youth; and (2) four distinct trajectories of exposure to violence. Multivariate findings were largely consistent with the ecological-transactional model of community violence. Youth with stable and/or increasing trajectories of exposure to violence were more likely than youth with stable-low exposure to violence to have declining parental monitoring, but additional analyses revealed a similar pattern of findings for younger adolescents (age 9–11 T1), but no evidence of linkages between trajectories of exposure to violence and parental monitoring for older adolescents (age 12–16 T1). The theoretical and policy implications of these findings as well as areas for future research are also discussed.     

Can the Media Help Women Be Better at Math? Stereotype Threat,Selective Exposure,Media Effects,and Women's Math Performance

This study examines women's media selections when under the gender–math stereotype threat and the subsequent media effects on their math performance through the lens of the Selective Exposure Self‐ and Affect‐Management (SESAM) model, mood management theory, and social comparison theory. Female college students were randomly assigned to the stereotype threat condition or the control condition; then, they selectively browsed magazine pages showing female role models in stereotypical domains (beauty or family) and counterstereotypical domains (career or science) before taking the math test. The results show that women spent more time on career magazines when under threat, and this selective exposure's effect on their math performance was moderated by their assimilation to the role models.