This study used an interdisciplinary approach to examine an intervention for reducing public speaking state anxiety. A quasi-experiment was conducted to determine if a multiple-exposure treatment technique (TRIPLESPEAK) would help to attenuate public speaking anxiety. The treatment group reported experiencing significantly less state anxiety during their post-test presentation than did the control group. This lead to the conclusion that exposure therapy can be used to help students enrolled in basic communication classes begin to overcome their fear of speaking in front of an audience. Follow-up analysis of the treatment group's reported anxiety levels during all five presentations (pre-test, Treatment Presentation 1, Treatment Presentation 2, Treatment Presentation 3, and post-test) revealed an increase in anxiety from the last treatment presentation to the post-test presentation. In order to explore this issue, Shannon's entropy was utilized to calculate the amount of information in each speaking environment. Anderson's functional ontology construction approach served as a model to explain the role of the environment in shaping speakers' current and future behaviors and reports of anxiety. The exploratory analysis revealed a functional relationship between information and anxiety. In addition, a qualitative study was conducted to determine which environmental stimuli speakers perceived contributed to their anxiety levels. Students reported experiencing anxiety based on four categories, which included speaker concerns, audience characteristics, contextual factors and assignment criteria. Students' reports of anxiety were dependent upon their previous speaking experiences, and students suggested differences existed between the traditional presentations and the treatment presentations. Pedagogical and theoretical implications are discussed.

This thesis discusses the intersections of exposure therapy and art therapy in the works and careers of Deborah Orloff, Tracey Emin, and Louise Bourgeois, as well as in my own work. Artists use their practice as a form of mental healing, subconsciously utilizing essential theories of exposure and art therapies.

The amygdala is crucially involved in the acquisition and retention of fear memories. Experimental research on fear conditioning has shown that memory retrieval shortly followed by pharmacological manipulations or extinction, thereby interfering with memory reconsolidation, decreases later fear expression. Fear memory reconsolidation depends on synaptic plasticity in the amygdala, which has been demonstrated in rodents using both pharmacological manipulations and retrieval-extinction procedures. The retrieval-extinction procedure decreases fear expression also in humans, but the underlying neural mechanism have not been studied. Interfering with reconsolidation is held to alter the original fear memory representation, resulting in long-term reductions in fear responses, and might therefore be used in the treatment of anxiety disorders, but few studies have directly investigated this question. The aim of this thesis was to examine the effects of the retrieval-extinction procedure on amygdala activity and behavioral fear expression in humans. The work presented here also investigated whether findings from studies on recent fear memories, established through fear conditioning, extends to naturally occurring long-term phobic fears. Study I, combining fear conditioning and a retrieval-extinction procedure with functional magnetic resonance imaging (fMRI), demonstrated that memory retrieval shortly followed by extinction reduces later amygdala activity and fear expression in healthy subjects. In Study II, these subjects were re-tested 18 months later. The results showed that the effects on fear expression were still present and that initial amygdala activity predicted long-term fear expression. Using an adapted version of the retrieval-extinction procedure, Study III showed that memory retrieval shortly followed by exposure to spider pictures, attenuates subsequent amygdala activity and increases approach behavior in subjects with life-long fear of spiders. In Study IV, these subjects were re-tested 6 months later, and the results showed that effects on amygdala activity as well as approach behavior were maintained. In summation, retrieval-extinction leads to long-lasting reductions in amygdala activity and fear expression. These findings are consistent with the hypothesis that retrieval-extinction alters an amygdala dependent fear memory. Retrieval-extinction can also attenuate long-term phobic fears, indicating that this manipulation could be used to enhance exposure-based treatments for anxiety disorders.

<p>In the present study, we examined the predictions of an attentional-associative model (Schmajuk, Lam, & Gray Journal of Experimental Psychology: Animal Behavior Processes, 22, 321-349, 1996) regarding the effect of attentional manipulations on both discrete and contextual conditioned inhibitors.</p><p>The SLG model assumes that non-reinforced presentations of an inhibitory conditioned stimulus (CS) do not decrease its inhibitory associations. However, the model predicts that extended presentations will decrease attention to the inhibitor, thereby, decreasing both the expression of its inhibitory power in a summation test and the rate of acquisition in a retardation test. The model also predicts that subsequent presentations of the inhibitory CS with a novel CS will increase both its inhibitory power in a summation test and the rate of acquisition in a retardation test. Using a predictive learning design in humans, Experiment 1 examined the predictions involving the summation tests, whereas Experiments 2 and 3 examined the predictions involving the retardation tests. Experimental results were in agreement with the predictions of the model. </p><p>The SLG model also predicts that a salient extinction context (CX) becomes inhibitory and prevents extinction of the excitatory CS-unconditioned stimulus (US) association. Although some data seem to contradict that prediction (e.g., Bouton and King, 1983, Bouton and Swartzentruber, 1986, 1989), Larrauri and Schmajuk (2008) indicated that the CX might not appear inhibitory in a summation test because attention to the CX decreases with many but not few extinction trials. In a human predictive learning experiment, we confirmed the model's predictions that the inhibitory power of the extinction CX can be detected after a few extinction trials when attention to the CX is still high, but not after many extinction trials once attention to the CX has decreased (Experiment 4), and even after many extinction trials by presenting novel CSs to increase attention to the unattended CX (Experiment 5). Furthermore, using an eye-tracker, we confirmed the model's explanation of Experiment 4 results by showing decreased overt attention to the CX after many but not after few extinction trials (Experiment 6).</p><p> Importantly, the view that the extinction CX becomes inhibitory allows the model to explain spontaneous recovery (because attention to the excitatory CS increases before attention to the inhibitory CX), renewal (because the inhibition provided by the extinction CX disappears), and reinstatement (the inhibitory CX becomes neutral or excitatory), as well as a very large number of other experimental results related to extinction. Based on the prediction of the SLG, model the implications of our results for the treatments of anxiety disorders were discussed.</p> / Dissertation

Social anxiety disorder (SAD) is the 3rd most common psychiatric diagnosis, and is associated with significant social, occupational, health, and educational impairment. Fortunately, both pharmacological and psychological treatments can reduce symptoms. Cognitive behavioral therapy is considered the gold standard treatment for SAD, and a robust literature supports its effectiveness. In contrast, process related factors, including the role of the working alliance, have received less attention in treatment of SAD. The current study examined development of the working alliance for a SAD sample. The working alliance is characterized as the collaborative relationship between a client and therapist, and includes shared goals, strategies, and an attachment bond. Within the context of SAD, the working alliance is particularly interesting, as the alliance itself is a social relationship that may elicit anxiety, which, in turn, may impact development of the alliance. The present study also investigated whether treatment type, that is, exposure group therapy (EGT) versus virtual reality exposure (VRE) therapy, or pre-treatment symptom severity influenced the working alliance trajectory. Data were provided by an adult sample presenting with a primary diagnosis of SAD. Participants were randomly assigned to one of two treatment conditions, both involved use of a manualized CBT treatment approach. Standardized measures of social anxiety were administered pre-treatment whereas working alliance ratings were obtained after each session. Results indicated high levels of working alliance and significant change in ratings over time. Treatment condition did not contribute to significant differences in the working alliance trajectory. Regarding the impact of SAD symptoms, initially high ratings of fear was associated with progressively increasing rates of growth in the working alliance whereas high initial ratings of avoidance signified steeper increase in the working alliance earlier in treatment followed by a declining rate of change over time. The current study contributes to the limited literature regarding the working alliance trajectory for clients with SAD, and is the first to consider the impact of VRE treatment on this trajectory. Findings also provide preliminary evidence for the differential impact of initial fear and avoidance as well as a potential curvature for the working alliance trajectory when using CBT.

Homework compliance has been identified as a robust predictor of treatment outcome for depression and, to a lesser extent, anxiety disorders, including social phobia. The current study tested the following hypotheses: (1) homework compliance is positively related to ratings of global improvement, (2) homework compliance is negatively related to symptom reduction, (3) the relation between homework compliance and treatment outcome varies according to the nature of the homework exercise, and (4) expectancy is positively related to early homework compliance, in a clinical sample of individuals with social phobia. Results provided limited support for the relation between compliance and ratings of improvement, but did not support a negative relation between compliance and symptom reduction. Further, the results provided limited support for the hypothesis that compliance with exposure versus non-exposure homework would differ significantly in terms of their relation to treatment outcome, but did not support the relation between compliance and expectancy.

Die Spezifischen Phobien stellen die häufigste Gruppe der Angststörungen dar. Die Angst vor dem Verschlucken bzw. dem Ersticken wurde jedoch nur sehr selten beschrieben. Bei der Behandlung der Spezifischen Phobien wird fast immer eine Konfrontation in vivo eingesetzt. Die Angst vor dem Verschlucken scheint aber eine der Spezifischen Phobien zu sein, bei der eine Konfrontation schwierig ist. Die hier vorgestellte Fallgeschichte schildert eine mögliche Vorgehensweise, die Ängste vor dem Verschlucken mit einer Reizkonfrontation in vivo zu behandeln. Dabei werden die verschiedenen Schwierigkeiten, die aufgetreten sind, und ihre Lösungen geschildert. Die Therapie wurde erfolgreich abgeschlossen, und auch die Ergebnisse der Nachuntersuchungen zeigten eine stabile Verbesserung. / Specific phobias are the most common anxiety disorders. However, the fear of swallowing the wrong way and choking has rarely been described. Specific phobias are usually treated using exposure therapy. The excessive fear of swallowing the wrong way does not seem to be very well suited for an exposure in vivo. In this case study, a patient afflicted with the fear of swallowing and choking was treated with flooding. The various difficulties encountered during treatment and their remedies will be described. The therapy was successful. The patient showed stable and lasting improvements at posttreatment and at one-year follow-up. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Fear memories, here defined as learned associations between a stimulus and a physiological fear reaction, are formed through fear conditioning. In animals, fear memories, present in the lateral amygdala, undergo reconsolidation after recall. Moreover, this reconsolidation process can be disrupted both pharmacologically and behaviourally, resulting in a reduced fear response to the stimulus. This thesis examines the attenuation of fear memories by disrupting reconsolidation in humans, using measures of both the central and peripheral nervous system activity. Serotonergic and dopaminergic genes have previously been tied to both fear conditioning and anxiety disorders, where fear conditioning mechanisms are important. In order to evaluate the possible role of fear memory reconsolidation mechanims in the effect on fear and anxiety by these genes, this thesis also compare the reconsolidation disruption effect between different serotonergic and dopaminergic genotypes. Study I examined the attentuation of fear memories by disrupting reconsolidation in humans using reacquisition as a measure of the return of fear. Moreover, study I investigated the impact of differences in serotonergic and dopaminergic alleles on this process. Study II examined the attentuation of fear memories by disrupting reconsolidation in humans using reinstatement as a measure of the return of fear. Study II also investigated the impact of differences in serotonergic and dopaminergic alleles on the process of fear memory reconsolidation. Study III used psychophysiology and fMRI to localize the functional neural activity mediating the fear memory reconsolidation disruption effect. In summary, this thesis provides evidence that fear memories are attenuated by reconsolidation disruption in humans and that serotonergic and dopaminergic alleles influence this process. Moreover, this thesis support that human fear memory reconsolidation is amygdala-dependent, suggesting an evolutionary shared memory mechanism.

The present research sought to understand patient experiences during Hyperbaric Oxygen Therapy (HBOT) by using 24 HBOT patients (17 men, 7 women) to examine the relationship between individual variables and anxiety, and providing One Session Exposure Therapy (OSET; Öst, 1989) if necessary. Pre-HBOT participants completed the following measures: State-Trait Anxiety Inventory (STAI; Spielberger, 1983), Claustrophobia Questionnaire (CLQ; Radomsky, Rachman, Thordarson, McIsaac, & Teachman, 2001), Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), and Treatment Credibility/Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000). State Anxiety was assessed pre-HBOT and at the tenth and last sessions. Findings suggest Dispositional Anxiety (STAI-Trait + ASI), Expectancy of symptom improvement (CEQ), and gender were significantly predictive of State Anxiety before and during HBOT. Limitations and directions for future research are discussed.

Despite evidence supporting a robust relation between common factors- aspects of the therapeutic setting that are common across all types of treatment- and treatment response, little is known about the mechanisms by which these common factors effect change. Two of the most well-researched common factors include the client’s expectations about the effectiveness of treatment (termed outcome expectancy), and the quality of the therapeutic relationship (termed working alliance). Using archival data, the present study tests the hypothesis that the relation between outcome expectancy and symptom reduction is mediated by the alliance following treatment for social anxiety disorder. Data were collected in a sample of 65 individuals who received cognitive behavioral therapy for social phobia with public speaking fears. Mediation analyses were conducted using Andrew Hayes’ Process Macro (Hayes, 2013). None of the mediation analyses were significant. These findings suggest that the mechanisms of common factor variables may vary by disorder.