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Exposure is an effective treatment for anxiety but many patients do not respond fully. Affect labeling (labeling emotional experience) attenuates emotional responding. The current project examined whether affect labeling enhances exposure effectiveness in participants with public speaking anxiety. Participants were randomized to exposure with or without affect labeling. Physiological arousal and self-reported fear were assessed before and after exposure and compared between groups. Consistent with hypotheses, participants assigned to Affect Labeling, especially those who used more labels during exposure, showed greater reduction in physiological activation than Control participants. No effect was found for self-report measures. Also, greater emotion regulation deficits at baseline predicted more benefit in physiological arousal from exposure combined with affect labeling than exposure alone. The current research provides evidence that behavioral strategies that target prefrontal-amygdala circuitry can improve treatment effectiveness for anxiety and these effects are particularly pronounced for patients with the greatest deficits in emotion regulation.

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.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2010.07.009 Byline: Aaron Baker (a), Jayson Mystkowski (a), Najwa Culver (a), Rena Yi (b), Arezou Mortazavi (a), Michelle G. Craske (a) Abstract: Clinically, there is wide subscription to emotional processing theory (EPT;) as a model of therapeutic effectiveness of exposure therapy: EPT purports that exposure is maximal when (1) fear is activated (IFA), (2) fear subsides within sessions (WSH), and (3) fear subsides between sessions (BSH). This study examined these assumptions, using in vivo exposure therapy for 44 students scoring high on acrophobia measures. Results indicated that no EPT variables were consistently predictive of treatment outcome. No support was found for IFA or WSH; measures of BSH were predictive of short-term change, but these effects were attenuated at follow-up. Furthermore, EPT variables were not predictive of each other as previously hypothesized, indicating the variables are not functionally related. Author Affiliation: (a) University of California, Los Angeles, CA, USA (b) Claremont Graduate University, Claremont, CA, USA Article History: Received 1 July 2009; Revised 10 July 2010; Accepted 14 July 2010 Article Note: (footnote) [star] This work was supported by a grant from the National Institutes of Health to Drs. Barad and Craske (R21 MH072259).

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with 'straying' to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the 1-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent-to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with 'straying' to CBT for comorbid disorders. Keywords: Comorbidity; Cognitive behavioral therapy; Panic disorder; Agoraphobia

Pictures of emotionally aversive, neutral, and pleasant scenes were presented for 500 ms, followed by a probe presented in the same location (valid trials) or an alternate location (invalid trials) as the picture. Response-times to the probes were recorded in low (N = 20) and high (N = 27) trait anxious participants. Results revealed an overall negative cue validity effect of shorter reaction times (RTs) on invalid than valid trials, suggestive of an inhibition of return effect. Moreover, high trait anxious females showed a reduced negative cue validity effect for aversive pictures in comparison with neutral and pleasant pictures, suggestive of selective interference by the unpleasant material. By contrast, low trait anxious females showed an enhanced negative cue validity effect for aversive pictures relative to neutral and pleasant pictures, suggestive of attentional avoidance of the aversive content. The emotional content of picture cues did not significantly affect RTs in males, regardless of anxiety status. The results suggest that biased attention processes for aversive stimuli may contribute to the greater female propensity for anxiety disorders. Keywords: Trait anxiety; Attention allocation; Affective stimuli; Gender differences

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.12.007 Byline: Joanna J. Arch (a), Michelle G. Craske (a)(b) Keywords: Emotion regulation; Behavioral willingness; Mindfulness Abstract: The current study investigated whether a 15min recorded focused breathing induction in a normal, primarily undergraduate population would decrease the intensity and negativity of emotional responses to affectively valenced picture slides and increase willingness to remain in contact with aversive picture slides. The effects of the focused breathing induction were compared with the effects of 15min recorded inductions of unfocused attention and worrying. The focused breathing group maintained consistent, moderately positive responses to the neutral slides before and after the induction, whereas the unfocused attention and worry groups responded significantly more negatively to the neutral slides after the induction than before it. The focusing breathing group also reported lower negative affect and overall emotional volatility in response to the post-induction slides than the worry group, and greater willingness to view highly negative slides than the unfocused attention group. The lower-reported negative and overall affect in response to the final slide blocks, and greater willingness to view optional negative slides by the focused breathing group may be viewed as more adaptive responding to negative stimuli. The results are discussed as being consistent with emotional regulatory properties of mindfulness. Author Affiliation: (a) Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA (b) Department of Psychiatry and Biobehavioral Sciences, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA Article History: Received 27 August 2005; Revised 12 December 2005; Accepted 14 December 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.03.015 Byline: Bonnie G. Zucker, Michelle G. Craske, Michelle A. Blackmore, Ashley Nitz Keywords: Subclinical obsessions and compulsions; OCD; Prevention; Early intervention; Cognitive behavior therapy; Anxiety disorders; Workshop Abstract: The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n=42), individuals assigned to the workshop group (n=43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms. Author Affiliation: University of California, Los Angeles, USA Article History: Received 26 October 2004; Revised 1 March 2005; Accepted 15 March 2005

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. Keywords: Panic disorder; Comorbidity; Cognitive-behavioral therapy; Comorbid conditions; Specific phobia

Meta-cognitive beliefs associated with pathological worry and generalized anxiety disorder (GAD) may encompass the likelihood subtype of thought-action fusion (TAF), the belief that one's thoughts can influence outside events. In the current study of 494 undergraduate college students, positive correlations between scores on the Penn State Worry Questionnaire (PSWQ) and the two Likelihood subscales of the TAF Scale were found, and participants endorsing at least some DSM-IV diagnostic criteria for GAD scored significantly higher on both TAF-Likelihood subscales than participants reporting no GAD symptoms. However, these TAF scales did not predict GAD diagnostic status with PSWQ included as a predictor. In contrast to previous research, the TAF-Moral scale did not correlate with worry. Relationships between TAF, pathological worry, and meta-cognition are discussed in relation to GAD. Keywords: Thought-action fusion; Worry; Generalized anxiety disorder; Meta-cognition

The goal of this study was to investigate whether or not a brief educational intervention delivered prior to engaging in an anxiety-provoking task (writing a sentence about hoping that a friend/relative was in a car accident) would be effective in offsetting anxiety in college students with a strong propensity to endorse statements of thought action fusion (TAF). As hypothesized, individuals receiving the educational intervention were less anxious than a placebo intervention control group at post task; they were also less likely to endorse statements of TAF after receiving the educational intervention. Also, those who chose to neutralize after writing the sentence (regardless of experimental group) were more likely to report feeling guiltier, more immoral and a greater sense of responsibility about writing the sentence prior to neutralizing than those who did not subsequently neutralize. These results are discussed in relation to the cognitive theory of obsessive-compulsive disorder and implications for prevention programs. Keywords: Thought action fusion; Obsessive-compulsive disorder; Anxiety; Non-clinical population; Adults