Challenges to the traditional exposure paradigm: variability in exposure therapy for contamination fears.

BACKGROUND AND OBJECTIVES: Traditional models and methods of exposure therapy utilize a fear hierarchy, whereby patients complete sets of exposures in a graduated manner, with the goal of fear habituation within and between sessions. In the current experiment, we examined whether this typical exposure paradigm was necessary to achieve clinical improvement. METHOD: Fifty undergraduate participants scoring in the top quartile of a self-report measure of contamination fears were randomly assigned to one of two groups: blocked and constant exposure (BC Group) and random and variable exposure (RV Group). Both groups completed three weekly sessions of exposure treatment, with subjective and psychophysiological indices of fear recorded throughout. Subjective, behavioral, and psychophysiological dependent measures were evaluated by an independent assessor at pre-treatment (PRE), post-treatment (POST), and two-week follow-up (2WFU). RESULTS: Both the BC Group and RV Group exhibited decreases in subjective fear from PRE to POST and 2WFU, with no significant differences between groups. Partialing group, greater variability in subjective fear during exposure predicted lower subjective fear at 2WFU. LIMITATIONS: Despite significant findings for subjective fear, behavioral and psychophysiological findings were limited. Follow-up studies should investigate questions regarding traditional exposure within a clinical group. CONCLUSIONS: These results support the notion that traditional exposure is sufficient, but not necessary, to produce clinical improvement in contamination-related fears. There may be benefits to variability in fear level during exposure, and evaluation of emotion variability during exposure therapy for other anxiety disorders is warranted.

Mental reinstatement of context and return of fear in spider-fearful participants.

Extant findings in the animal and human conditioning literature demonstrate that renewal, termed return of fear in studies with humans, occurs when reexposure to a previously feared phobic stimulus occurs in a context different than the one present during extinction. The present study investigated whether mental reinstatement of the treatment context at follow-up could attenuate context-based return of fear. Forty-eight spider-fearful individuals received exposure therapy in one of two contexts, and were followed-up 1 week later in the treatment or a new context. Half of the participants received instructions to mentally reinstate the treatment context before the follow-up test. Self-report data replicated previous research on contextually driven return of fear. Furthermore, participants who mentally reinstated the treatment context, before encountering the phobic stimulus in a new context at follow-up, had less return of fear than those who did not. Limitations of the current study, as well as implications for phobia treatment, are discussed.

Impact of cognitive-behavioral therapy for panic disorder on comorbidity: a controlled investigation.

This study examined the effects of cognitive-behavioral therapy (CBT) for principal panic disorder with or without agoraphobia, on comorbidity in 30 individuals (16 female). To test the hypothesis that improvements in co-existing conditions were not due to spontaneous fluctuations across time, patients receiving immediate CBT were compared to those assigned to wait list (n = 11). Results indicated clinician-rated severity of comorbid specific phobia declined significantly following immediate CBT compared to no change after wait list. The number of patients without comorbidity of any severity increased after immediate CBT, with no such increase following wait list. However, the groups did not differ in the frequency of additional diagnoses or overall severity of comorbidity. In the total sample, results indicated reductions in comorbidity by 9-month follow-up, with marked declines in the severity of comorbid generalized anxiety disorder (GAD), social and specific phobia. Our findings suggest that targeted CBT for panic disorder has beneficial effects on comorbidity over the longer term and that some of its immediate effects exceed those due to the passage of time alone.

Changes in caffeine states enhance return of fear in spider phobia.

Treatment of phobias is sometimes followed by a return of fear. Animal and human research has shown that changes in external and internal contexts between the time of treatment and follow-up tests often enhance return of fear. The present study examined whether shifts in caffeine (C) state would enhance return of fear. Participants who were highly afraid of spiders (n = 43) were treated in 1-session exposure-based therapy and tested for follow-up 1 week later. Participants were randomly assigned to 1 of 4 groups and received either placebo (P) or C at treatment and follow-up sessions: CC, PP, CP, and PC. Results demonstrated state-dependent learning. Participants experiencing incongruent drug states during treatment and follow-up (CP and PC) exhibited greater return of fear than those experiencing congruent drug states (CC and PP).

Does nocturnal panic represent a more severe form of panic disorder?

Nocturnal panic (NP), or waking from sleep in a state of panic, occurs in 18% to 45% of panic disorder patients. This relatively common phenomenon, however, is not well understood. In this study, the authors tested the hypotheses that NP represents a more severe form of panic disorder or is a manifestation of heightened vulnerability to sleep disturbance. Patients with NP ( = 51) were compared with patients with panic disorder without a history of NP ( = 41) on measures of panic disorder severity, comorbidity, interpersonal functioning, and sleep disturbance. There was no evidence for more severe psychopathology and only weak evidence for more sleep disturbance. Instead, patients with NP showed less agoraphobic avoidance, perhaps suggesting that they are less likely to associate panic with situational factors. The authors conclude that NP may be a specific version of panic disorder characterized by fearful associations with sleep and sleeplike states.