anxiety

The purpose of this systematic review was to examine the efficacy of acceptance and commitment therapy (ACT) applied to the treatment of social anxiety disorder (SAD). An exhaustive search was carried out in different databases. After the application of a number of inclusion and exclusion criteria, a total of eight studies conducted between 2005 and 2016 were obtained and then reviewed. In three of these studies, ACT proved efficacious in reducing phobic symptoms and psychological inflexibility. The remaining five, which employed randomized controlled trial design, showed that ACT and cognitive behavioral therapy (CBT) produce similar improvements both at post-treatment and during the follow-up. In some cases, ACT produced better treatment adherence and self-reported quality of life than CBT. All in all, every study included in this paper reported improvements in TAS after ACT, in line with previous evidence. Results are discussed in terms of the strengths and weaknesses of the evidence accumulated so far, and new directions for research are suggested.

El objetivo de la presente revisión sistemática fue examinar la eficacia de la terapia de aceptación y compromiso (ACT) en el tratamiento del trastorno de ansiedad social (TAS). Se realizó una búsqueda exhaustiva en distintas bases de datos, incluyendo, tras la aplicación de diversos criterios, un total de ocho estudios realizados entre los años 2005 y 2016. En tres de ellos se mostró la eficacia de la ACT para reducir la sintomatología fóbica y la inflexibilidad psicológica. En los otros cinco, ensayos controlados aleatorizados, se demostró que la ACT y la terapia cognitivo conductual (TCC) producían efectos similares al final del tratamiento y en el seguimiento. En algunos casos también se observó que la ACT mejoraba los resultados de la TCC en adherencia al tratamiento y en la calidad de vida. El TAS muestra mejoras tras la aplicación de la ACT en todos los estudios analizados en esta revisión, en línea con revisiones anteriores. Se discuten las debilidades de las pruebas acumuladas hasta la fecha sobre la eficacia de la ACT para el tratamiento del TAS y se proponen líneas de trabajo futuro.

Despite the central status of avoidance in explaining the etiology and maintenance of anxiety disorders, surprisingly little behavioral research has been conducted on human avoidance. In the present paper, first we provide a brief review of the empirical literature on avoidance. Next, we describe the implications of research on derived relational responding and the transformation of functions for a contemporary behavioral account of avoidance, before providing several illustrative research examples of laboratory-based analogues of key clinical treatment processes. Finally, we suggest some challenges and opportunities that lie ahead for behavioral research on anxiety and avoidance.

Read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686994/

Fear generalization, in which conditioned fear responses generalize or spread to related stimuli, is a defining feature of anxiety disorders. The behavioral consequences of maladaptive fear generalization are that aversive experiences with one stimulus or event may lead one to regard other cues or situations as potential threats that should be avoided, despite variations in physical form. Theoretical and empirical interest in the generalization of conditioned learning dates to the earliest research on classical conditioning in nonhumans. Recently, there has been renewed focus on fear generalization in humans due in part to its explanatory power in characterizing disorders of fear and anxiety. Here, we review existing behavioral and neuroimaging empirical research on the perceptual and non-perceptual (conceptual and symbolic) generalization of fear and avoidance in healthy humans and patients with anxiety disorders. The clinical implications of this research for understanding the etiology and treatment of anxiety is considered and directions for future research described.

Social anxiety in adolescence can have severe consequences including underachievement and school drop-out, psychopathology, and substance use disorders. The development of social anxiety in adolescents is a complex and poorly understood process. Temperamental predispositions such as behavioural inhibition are significant risk factors but the specific path leading from behavioural inhibition to social anxiety remains unclear. One potential pathway is that temperament leads to social anxiety through learned self-regulation strategies and cognitive predispositions, a hypothesis that has not yet been investigated in adolescents. In an attempt to investigate further this idea, we ran parallel multiple mediation analysis to examine whether greater behavioural inhibition system sensitivity is linked to higher social anxiety via greater anxiety sensitivity and experiential avoidance levels in a random community sample of high-school adolescents (N= 718). The results confirmed our hypotheses. Independently of gender and after controlling for anxiety psychopathology and depression levels, greater behavioural inhibition system sensitivity was associated with more severe social anxiety in adolescents both directly and indirectly through greater experiential avoidance and more severe anxiety sensitivity. Given the fact that social anxiety is a serious cause of academic and social impairment in adolescence, the present findings suggest malleable risk factors that can be effectively addressed in targeted prevention and treatment interventions. Results are discussed in light of previous relevant findings and in relation to relevant theoretical and methodological issues and clinical implications.

Read the whole article on the ACBS website https://contextualscience.org/article/community_sample_evidence_on_the_relations_among_behavioural_inhibition_sys

Only two trials have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) in the treatment of social anxiety disorder (SAD), with both finding no significant differences. These trials did not examine effects on observer-rated behavioral outcomes and did not explicitly quantify the dose of exposure therapy within each treatment. In a replication trial, one hundred and two individuals with SAD (per DSM-IV criteria) were randomized to 12 sessions of ACT (n = 49) or tCBT (n = 53) controlling for exposure dose and assessing behavioral outcomes. Assessments were completed at pre- and post-treatment using clinician-rated and self-report measures of social anxiety, quality of life, and overall functioning. Observer-rated behavioral measures of social performance were completed for a subsample of participants. Results indicated that participants across conditions received equivalent doses of exposure. Those who received tCBT evidenced greater improvements in self-reported social anxiety symptoms and overall functioning, which contrasts with prior studies finding no differences between tCBT and ACT in the treatment of social anxiety. Medium effect sizes, while not statistically significant, indicate that ACT participants may have had greater improvements in observer-rated social behavior than tCBT participants. The discrepancy between these symptom and behavioral outcomes, building upon prior literature, calls for more research to assess the differences between tCBT and ACT treatments in behavioral domains.