Does fear reduction predict treatment response to exposure for social anxiety disorder?

BACKGROUND AND OBJECTIVES

Fear activation and reduction have traditionally been considered important mechanisms of exposure therapy. Evidence to date is mixed and impeded by inadequate methodology. This study examined the extent to which fear activation and reduction within and across exposures predicted treatment outcomes for social anxiety disorder within a paradigm suitable for their measurement.

METHODS

Sixty-eight adults with social anxiety disorder and fear of public speaking completed seven exposure sessions, each consisting of seven speeches conducted in virtual reality. Exposures were identical in duration, task requirements, and virtual public speaking situation. Fear was measured with skin conductance and subjective distress ratings. At baseline and post-treatment, participants completed a public speaking behavioral approach test with a panel of confederate judges; subjective fear was measured. A standardized questionnaire of anxiety symptoms was administered at baseline, post-treatment, and one-month follow-up.

RESULTS

No indices of within- or between-session fear reduction, measured by subjective distress and skin conductance response, predicted treatment outcome. One measure of fear activation was associated with outcomes such that less activation predicted greater symptom reduction; remaining indices did not predict outcomes.

LIMITATIONS

Data were collected in the context of a randomized controlled trial of scopolamine; drug group was included in analytic models to account for drug influence. VR exposures elicited mild levels of distress that may underestimate levels of distress in clinical settings.

CONCLUSIONS

Findings failed to support fear activation or reduction within or across exposure sessions as significant predictors of treatment outcome for social anxiety. Treatment implications are discussed.

Preventing and reducing fear using positive modelling: A systematic review of experimental research with children

Fear of specific stimuli is thought to develop through associative learning mechanisms and research indicates that a form of observational (vicarious) learning known as positive modelling can counter these effects. This systematic review examined and synthesised the experimental positive modelling literature to establish its efficacy for reducing fear. Psych Info, Medline and the Psychology and Behavioural Science Collection databases were systematically searched until August 2021. Of the 1,677 papers identified, 18 experiments across 14 articles met the inclusion criteria. In the majority of these, positive modelling was found to lower fear levels in one or more of three procedures: fear prevention, fear reduction and fear reversal. Procedures inform prevention and treatment initiatives for specific phobias in several ways. The overall efficacy of positive modelling techniques and the ease in which they can be implemented highlight the importance of further research to evaluate their inclusion in prevention and treatment interventions. More research is required to establish the longevity and transferability of positive modelling.