Habituation of self-reported anxiety and cortical hyper-vigilance during image-based exposure to spiders.

BACKGROUND AND OBJECTIVES: The aim of the study was to examine habituation of subjective anxiety and electrophysiological correlates of cortical hyper-vigilance during exposure to spider images among high (n = 12) and low (n = 11) spider fear groups. METHODS: Participants viewed a six-stage hierarchy of spider images. The images used at stage 1 and stage 6 were the same. Subjective anxiety was rated at four intervals during each three-minute exposure stage (0, 60, 120, and 180 s) and event-related potentials (ERPs) were averaged across these epochs (0-60, 60-120, 120-180). RESULTS: High spider fearfuls demonstrated greater habituation of self-reported anxiety within and between exposure stages compared to low fearfuls. Consistent with attentional hyper-vigilance, the high-fear group also demonstrated greater P1 amplitude in response to spider images. In both groups, habituation of P1 amplitude was found at later relative to earlier stages, but increased at stage six when the stage 1 image was re-presented, despite low subjective anxiety. LIMITATIONS: While the passive viewing paradigm mirrored image-based exposure, it was not possible to determine whether participants engaged in avoidance strategies. In addition, further research is needed to assess the relevance of habituation and reinstatement of P1 amplitude to therapeutic outcome. CONCLUSIONS: Habituation of subjective anxiety during image-based exposure is not necessarily accompanied by a reduction in measures of cortical hyper-vigilance. The reinstatement of the P1 response may indicate either re-activation of previous associations, less avoidance, or a more generalised dishabituation mechanism.

Imagery rescripting as a stand-alone treatment for patients with social phobia: a case series.

BACKGROUND AND OBJECTIVES: The majority of patients with social phobia reports experiencing negative images, usually linked to memories of earlier aversive social experiences. Several studies have indicated that such negative self-imagery appears to have a causal role in maintaining social phobia, which suggests that interventions aimed at dealing with these images could be beneficial in the treatment of social phobia. One potentially powerful approach is imagery rescripting (IR), a clinical intervention that focuses on changing the meaning and impact of unpleasant memories. In the treatment of social phobia IR was only used as part of a broader cognitive-behavioral treatment package. However, we propose that IR alone might also be an effective treatment for this anxiety disorder. The present study reports an initial evaluation of the application of IR as a stand-alone treatment for six adult outpatients presenting with social phobia. METHODS: A single case series using an A-B replication across patients design was employed. Following a no-treatment baseline period, IR was delivered weekly and patients were followed up for 3 and 6 months. RESULTS: For all patients, substantial reductions were obtained on all outcome measures at post-treatment, and gains were largely maintained at 6-months follow-up. LIMITATIONS: The generalizability of the effects of IR for social phobia is limited by the small number of patients treated by only one therapist. CONCLUSIONS: The results of this preliminary case series suggest that IR as a stand alone treatment is an apparently effective intervention in the treatment of patients with social phobia, and indicate that controlled evaluation of its efficacy might be worthwhile.

Auditory-visual integration of emotional signals in a virtual environment for cynophobia.

Cynophobia (dog phobia) has both visual and auditory relevant components. In order to investigate the efficacy of virtual reality (VR) exposure-based treatment for cynophobia, we studied the efficiency of auditory-visual environments in generating presence and emotion. We conducted an evaluation test with healthy participants sensitive to cynophobia in order to assess the capacity of auditory-visual virtual environments (VE) to generate fear reactions. Our application involves both high fidelity visual stimulation displayed in an immersive space and 3D sound. This specificity enables us to present and spatially manipulate fearful stimuli in the auditory modality, the visual modality and both. Our specific presentation of animated dog stimuli creates an environment that is highly arousing, suggesting that VR is a promising tool for cynophobia treatment and that manipulating auditory-visual integration might provide a way to modulate affect.

Blushing propensity and psychological distress in people with rosacea.

UNLABELLED: Rosacea is a chronic skin disorder, characterized by persistent painful facial flushing and often accompanied by papules and pustules. To evaluate the psychological and social impacts of rosacea, 31 individuals with rosacea filled in the Blushing Propensity Scale, the Fear of Negative Evaluation Questionnaire, the Depression Anxiety and Stress Scale, the Social Interaction Anxiety Scale and the Social Phobia Scale. The questionnaires were also completed by 86 controls. Participants with extensive facial papules and pustules had higher blushing propensity, stress and social phobia scores than controls or others without papules or pustules. Childhood blushing was also reported more frequently by participants with rosacea than controls. Cognitive-behavioural therapy appeared to be helpful for managing social anxiety in three individuals with rosacea with a fear of blushing. These findings suggest that people with severe rosacea are anxious about the social consequences of blushing and generally prefer to avoid situations that might involve scrutiny by others. Persistent facial flushing could prime interoceptive cues of blushing or increase anxiety about facial coloration in provocative situations. Treatments that target fear of blushing may help to reduce social anxiety in people with severe rosacea. KEY PRACTITIONER MESSAGE: Blushing propensity scores are elevated in people with severe rosacea. Fear of blushing may contribute to social anxiety and avoidance in such cases. Cognitive-behavioural therapy for fear of blushing may help to reduce social anxiety in people with severe rosacea.

Intrusive imagery in people with a specific phobia of vomiting.

BACKGROUND: AND OBJECTIVES: Specific phobia of vomiting (SPOV) is a chronic, pervasive and debilitating disorder which is clinically regarded as difficult to treat. Research into its development, maintenance and treatment has been limited. This study explored the prevalence and characteristics of intrusive mental imagery in people with SPOV. It investigated the relationship between presence of imagery and severity of phobia. METHOD: Thirty-six participants meeting DSM-IV criteria for SPOV were recruited from online support groups and outpatient clinics. A semi-structured quantitative interview was administered. RESULTS: Twenty-nine (81%) participants reported multi-sensory intrusive imagery of adult (52%) and childhood memories (31%) and worst case scenarios ("flashforwards") of vomiting (17%). Extent of imagery was significantly related to severity of phobia. Participants primarily fearing others vomiting had less severe phobic symptoms. LIMITATIONS: No control group was used and a heterogeneous sample of clinical and community participants was recruited. Correlational data comparing extent of imagery with severity of SPOV symptoms were derived from as yet unvalidated measures. CONCLUSIONS: Intrusive mental imagery is a clinically important feature of SPOV and may contribute to its maintenance. Causality needs to be demonstrated.

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.

Relaxation therapy, desensitization, and the treatment of anxiety-based disorders.

Evaluated systematic desensitization and relaxation training for the treatment of snake phobia and test anxiety as representatives of two classes of anxiety-based disorders. Treatment outcomes were assessed by examining situational and dispositional components of anxiety as related to these disorders and by behavioral measures of performance in relevant anxiety-provoking situations. Analyses of variance revealed that more pervasive anxiety reductions occurred for the more focalized animal phobia and that there was little difference in the effectiveness of desensitization and relaxation training. The generalizability of research findings based on the treatment of animal phobias was questioned, and the possible role of nonspecific factors in determining success was considered.