anxiety

Despite the increased attention that researchers have paid to social anxiety disorder (SAD), compared with other anxiety and mood disorders, relatively little is known about the emotional and social factors that distinguish individuals who meet diagnostic criteria from those who do not. In this study, participants with and without a diagnosis of SAD (generalized subtype) described their daily face-to-face social interactions for 2 weeks using handheld computers. We hypothesized that, compared with healthy controls, individuals diagnosed with SAD would experience fewer positive emotions, rely more on experiential avoidance (of anxiety), and have greater self-control depletion (feeling mentally and physically exhausted after socializing), after accounting for social anxiety, negative emotions, and feelings of belonging during social interactions. We found that compared with healthy controls, individuals with SAD experienced weaker positive emotions and greater experiential avoidance, but there were no differences in self-control depletion between groups. Moreover, the differences we found could not be attributed to comorbid anxiety or depressive disorders. Our results suggest that negative emotions alone do not fully distinguish normal from pathological social anxiety, and that assessing social anxiety disorder should include impairments in positive emotional experiences and dysfunctional emotion regulation (in the form of experiential avoidance) in social situations.

Public speaking anxiety (PSA), diagnosed at clinical levels as social anxiety disorder, nongeneralized type, is associated with significant distress and impairment in a substantial portion of the population (Aderka et al., 2012). Empirically supported behavioral treatments for PSA generally include in vivo and/or simulated exposure, usually presented with some form of rationale or context (e.g., habituation). Newer acceptance-based therapies frame exposure as an opportunity to increase one's willingness to experience anxiety, while engaging in valued behaviors. The present study examined the acceptability, feasibility, and preliminary effectiveness of acceptance-based exposure treatment for PSA compared to standard habituation-based exposure in a clinical population. Treatment was delivered in a group format over 6 weekly sessions. Participants receiving acceptance-based exposure (ABE) were significantly more likely than those receiving habituation-based exposure (HAB) to achieve diagnostic remission by 6-week follow-up. Those in the ABE condition rated this intervention equally acceptable and credible compared to participants receiving the habituation-based approach, and improvement on other outcome measures was comparable across conditions. Participants in both groups demonstrated significant and equivalent improvement on measures of public-speaking-related cognitions, confidence, and social skills. Baseline levels of mindful awareness moderated change in public-speaking-related cognitions across conditions, and baseline defusion moderated change in state anxiety for the ABE condition only.

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This report describes three single-case experimental evaluations of Behavioral Activation
Treatment of Anxiety (BATA) applied with a 51-year-old male, a 62-year-old female, and a 53-year-old
female, each of whom met DSM-IV criteria for anxiety. Each case was a clinical replication of an initial
trial of BATA reported in Turner and Leach (2009). Treatment was delivered in twelve weekly 60-minute
individual sessions and evaluated using an A-B-C phase change with repeated measurement design.
Decreased scores in self-reported anxiety were obtained in each case and the improvements were
maintained during a 3-month no treatment maintenance phase. Compared to baseline, each participant also
recorded increases in activity levels in some key life areas during the treatment phase. These preliminary
findings suggest that increased activation in functionally positive areas is associated with reported
decreases in anxiety and that BATA could be an effective stand-alone treatment for anxiety in adults.

This study hypothesized process variables of ACT for Anxiety and examined the effects of an Act program on anxiety. The Korean treatment program is constructed based on Acceptance-Commitment Therapy (ACT) and also includes some of the meditation practices from K-MBSR program. In this research, process variables were hypothesized to be changed through receiving a treatment and exhibit a therapeutic effect on emotional distress. In doing so, the program was administered to undergraduate and graduate students as well as general public for 10 sessions. The analysis included 27 from the treatment group and 27 from the control group. Results of this study showed that the treatment group reported more decreases in anxiety, depression, anxiety sensitivity, and anxiety controllability than the control group. Furthermore, process variables in ACT for anxiety such as mindfulness, thought suppression, acceptance, and self-compassion increased after receiving treatment. Finally, limitations of the present study and suggestion for future study are discussed.

(Note: Original article is in Korean).

We examined whether Anxiety Sensitivity (AS) and Experiential Avoidance (EA), two potentially relevant constructs in the evolution of anxiety and related disorders with significant implications for cognitive-behavioral treatments, differentially relate to symptom expressions of patients with panic disorder and agoraphobia. Within a multi-center study 369 patients meeting the DSM-IV-TR criteria for panic disorder with agoraphobia (PD/AG) completed the multidimensional Panic and Agoraphobia Scale (PAS), the Anxiety Sensitivity Index (ASI), the Acceptance and Action Questionnaire- II (AAQ-II) and the Beck Depression Inventory-II (BDI-II). Overlap, distinctiveness, and predictive validity of AS and EA were examined using explorative item analyses and multiple hierarchical regression analyses. AS and EA moderately correlated with each other (r=-.50, p<.01). EA explained additional variance in PAS-subscales Anticipatory Anxiety and Panic-Related Disability, but not in Panic Attacks, Agoraphobic Avoidance and Health Worries. ASI, AAQ-II and BDI-II explained a low to moderate amount of variation in the five PAS-subscales (R2 =.04-.29; p<.005). AS and EA are overlapping, yet distinct constructs. Results suggest that EA contributes to a significantly improved understanding of vulnerability, at least in patients with PD/AG.

Acceptance and commitment therapy (ACT) for anxiety disorders is a type of cognitive behavioral therapy that focuses on decreasing the behavior regulatory function of anxiety and related cognitions, and has a strong focus on behavior change that is consistent with client values. In this case series, 3 consecutive referrals seeking treatment for anxiety disorders at a private practice were treated with 9–13 sessions of ACT. In-session exposure therapy was not included to determine the effects of ACT without the compounding effects of already proven treatment procedures. The treatment procedure was identical across disorders to test the use of a unified treatment protocol for anxiety disorders: panic disorder with agoraphobia, comorbid social phobia and generalized anxiety disorder, and posttraumatic stress disorder. All participants showed clinical improvement in their specific anxiety disorders as rated on multiple standardized assessments after treatment, with gains maintained at follow-up (8 months or more). Time series assessments, taken throughout treatment, of anxiety and avoidance behaviors showed large decreases in avoidance but not in anxiety, suggesting ACT was effective by changing the way participants responded to anxiety rather than anxiety itself.