[show abstract][hide abstract] ABSTRACT: 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.
Behaviour research and therapy 02/2011; 49(5):305-14. · 3.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: Social phobia is maintained in part by cognitive biases concerning the probability and cost of negative social events. More specifically, individuals with social phobia tend to believe that negative social events are extremely likely to occur, and that if such events were to happen, the consequences would be awful or unbearable. The aim of the present review is to critically evaluate research on the nature and specificity of probability and cost biases in social phobia. Changes in probability and cost estimates during treatment and their relationship to treatment outcome are detailed. The review concludes with a discussion of how current cognitive behavioral interventions target these biases. Directions for future research are proposed.
Journal of Cognitive Psychotherapy 07/2010; 24(3):213-228.
[show abstract][hide abstract] ABSTRACT: Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed.
Behaviour research and therapy 11/2009; 48(4):282-9. · 3.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: Exposure therapy is traditionally conducted with an emphasis on the elimination of safety behaviors. However, theorists have recently suggested that the judicious use of safety behaviors may improve the tolerability of this treatment without reducing its efficacy. The present study tested this notion by randomly assigning participants with high claustrophobic fear to receive a single-session intervention with or without access to safety aids during early exposure trials. Improvement was generally equivalent between the treatment conditions, and no reliable benefits or drawbacks were associated with the judicious use of safety behaviors. The theoretical and clinical implications of these findings are discussed.
Journal of behavior therapy and experimental psychiatry 10/2009; 41(1):71-80. · 2.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined the potential of 11 interoceptive exposure exercises to produce depersonalization and derealization among high anxiety-sensitive undergraduate students. Inspired by a February 2007 thread on the Association for Behavioral and Cognitive Therapies listserv, we identified nine exercises and compared their capacity to produce depersonalization and derealization with two previously validated tasks: mirror and dot staring. Results indicated that five exercises, including hyperventilation (1 minute), hyperventilation (5 minutes), hyperventilation plus spiral staring, hyperventilation plus strobe light, and strobe light alone, were superior to either mirror or dot staring at inducing depersonalization or derealization. If replicated in a clinical sample, our findings may be used to assist clinicians seeking to evoke these states via interoceptive exposure.
Journal of Cognitive Psychotherapy 10/2008; 22(4):321-330.
[show abstract][hide abstract] ABSTRACT: Scrupulosity is often encountered among individuals with obsessive-compulsive disorder (OCD), yet relatively few studies have examined this particular symptom presentation. Using a large sample of OCD patients, the present investigation examined (a) the relationship between religiosity and scrupulosity, (b) the association between scrupulosity and the severity of OCD, anxiety, and depressive symptoms, and (c) the connection between scrupulosity and cognitive domains related to OCD. Scrupulosity was correlated with obsessional symptoms and several cognitive domains of OCD, including beliefs about the importance of, and need to control intrusive thoughts, an inflated sense of responsibility, and moral thought-action fusion. These results are examined in terms of cognitive behavioral conceptualizations of OCD and the treatment implications of these findings are discussed.
Journal of Anxiety Disorders 02/2006; 20(8):1071-86. · 2.96 Impact Factor