Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Abstract

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.

Affect labeling enhances exposure effectiveness for public speaking anxiety

“…Also, participants with deficits in incidental emotion regulation benefited more overall, regardless of group, in terms of skin conductance during recovery. The findings for heart rate during anticipation and recovery and for skin conductance during recovery support the compensation hypothesis, which suggests that those with deficits will benefit more from an intervention that compensates that deficit, and are consistent with previous research showing that physiological activation (Davies et al, 2015;McClure et al, 2007) and emotional reactivity during a behavioral task (Niles et al, 2013) predict greater improvement following treatment. These findings are of particular interest because participants with more difficulty regulating emotion show decreased connectivity between areas of the PFC and the amygdala (Banks, Eddy, Angstadt, Nathan, & Phan, 2007).…”

“…Recent studies on depression and suicidality treatment have found support for both capitalization (Cheavens, Strunk, Lazarus, & Goldstein, 2012) and compensation (Wingate, Van Orden, JoinerJr., Williams, & David, 2005). Studies examining amygdala activation (McClure et al, 2007), emotional reactivity to evocative images (Niles, Mesri, Burklund, Lieberman, & Craske, 2013), and heart rate variability (Davies, Niles, Pittig, Arch, & Craske, 2015) as predictors of treatment outcome for anxiety patients, support a compensation model, with superior outcomes for patients with greater reactivity at baseline. We aimed to evaluate whether affect labeling would most benefit those with a deficit or with a strength in affect labeling at baseline.…”

Direction of attention bias to threat relates to differences in fear acquisition and extinction in anxious children

“…The clinical translation of these effects, whether due to underlying associative, non-associative or combined mechanisms, may be that threat avoidant anxious children are slower than threat vigilant anxious children to respond to the same 'dose' of exposure therapy. In accord, several studies have found poorer outcomes following exposure-based CBT in anxious adults and children who are threat avoidant compared to threat vigilant (e.g., Niles, Mesri, Burklund, Lieberman, & Craske, 2013;Price et al, 2011;Waters et al, 2012).…”

The Role of Emotion and Emotion Regulation in Social Anxiety Disorder

“…However, it may be possible to retrain attentional bias from negative information in SAD [39], thereby reducing social anxiety symptoms [40,41]. Furthermore, CBT is also beneficial for patients who are slower to disengage from negative stimuli [42]. The role of various forms of maladaptive and adaptive attentional deployment in SAD is an important area for continued research.…”