Do Cognitive Reappraisal and Diaphragmatic Breathing Augment Interoceptive Exposure for Anxiety Sensitivity?
| Autor: | Elizabeth Possis, Jonathan S. Abramowitz, James J. Lickel, Kate Wolitzky-Taylor, Brett J. Deacon, Brittain Mahaffey |
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| Rok vydání: | 2012 |
| Předmět: |
Psychotherapist
Interoceptive exposure Panic disorder medicine.medical_treatment Panic Experimental and Cognitive Psychology medicine.disease Cognitive behavioral therapy Cognitive reappraisal Psychiatry and Mental health Clinical Psychology medicine Anxiety sensitivity Derealization Anxiety medicine.symptom Psychology |
| Zdroj: | Journal of Cognitive Psychotherapy. 26:257-269 |
| ISSN: | 1938-887X 0889-8391 |
| Popis: | Interoceptive exposure (IE) is an effective procedure for reducing anxiety sensitivity (AS) and the symptoms of panic disorder. However, considerable variance exists in how IE is delivered among clinicians, and the extent to which IE is enhanced by the concurrent use of cognitive reappraisal (CR) and diaphragmatic breathing (DB) is unclear. Participants (N 5 58) with high AS were randomly assigned to one of four single-session interventions: (a) IE only, (b) IE 1 CR, (c) IE 1 CR 1 DB, or (d) expressive writing control. IE was superior to expressive writing in reducing AS and associated anxiety symptoms. The addition of CR and DB did not enhance the benefits of IE at either posttreatment or 1-week follow-up. These findings highlight the specific efficacy of IE in reducing AS and call into question the common practice of combining IE with cognitive and breathing strategies. Theoretical and clinical implications are discussed. Keywords: interoceptive exposure; anxiety sensitivity; treatment; diaphragmatic breathing; cognitive reappraisal Anxiety sensitivity (AS) refers to the fear of anxiety-related sensations based on beliefs about their harmful consequences (Reiss & McNally, 1985). A large body of research has demonstrated a specific and robust association between AS and panic-related psychopathology (McNally, 2002). Among the physical, cognitive, and social domains of AS, the fear of physical symptoms is a particularly strong predictor of fearful responding to sensation induction procedures (e.g., Brown, Smits, Powers, & Telch, 2003). Individuals with panic disorder exhibit higher AS in general and greater fears of physical anxiety-related symptoms in particular than those with other anxiety disorders (e.g., Deacon & Abramowitz, 2006). Reductions in AS appear to mediate improvement in cognitive behavioral therapy (CBT) for panic disorder (Smits, Powers, Cho, & Telch, 2004). Prospective studies implicate AS being a risk factor for the subsequent development of panic attacks (Hayward, Killen, Kraemer, & Taylor, 2000; Schmidt, Lerew, & Jackson, 1997, 1999). Given the importance of AS in cognitive behavioral conceptualizations of panic disorder (e.g., Clark, 1986), a central aim of CBT for panic is to reduce catastrophic misinterpretations of benign arousal-related body sensations. Interoceptive exposure (IE) is a CBT procedure that accomplishes this aim via repeated confrontation with panic-related sensations (e.g., breathlessness, dizziness, racing heart; Abramowitz, Deacon, & Whiteside, 2010). In IE, the patient voluntarily induces feared sensations by engaging in various symptom induction exercises. For example, hyperventilation effectively induces breathlessness, dizziness, and tingling; running in place induces shortness of breath and heart palpitations; and standing in a dark room with a strobe light produces depersonalization/derealization sensations (Antony, Ledley, Liss, & Swinson, 2006; Lickel, Nelson, Lickel, & Deacon, 2008; Schmidt & Trakowski, 2004). IE is an effective treatment for reducing AS in nonclinical participants and panic symptoms in clinical samples (e.g., Gould, Otto, & Pollack, 1995; Smits, Berry, Tart, et al., 2008; Watt, Stewart, Birch, & Bernier, 2006). The manner in which IE is delivered varies substantially across studies and practitioners. Clinical scientists have studied IE used as a stand-alone technique (e.g., Arntz, 2002), concurrently with cognitive reappraisal techniques (e.g., Carter, Marin, & Murrell, 1999), or in combination with cognitive reappraisal and diaphragmatic breathing (DB; e.g., Barlow, Gorman, Shear, & Woods, 2000). There is also considerable variance among exposure therapists in the use of this technique. In a survey of 73 therapists who use IE in the treatment of panic disorder (Lickel, Deacon, & Iverson, 2010), 72.1% reported using cognitive reappraisal techniques during IE, and 42. … |
| Databáze: | OpenAIRE |
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