Exposure With Acceptance-Based Versus Habituation-Based Rationale for Public Speaking Anxiety
Condition: Public Speaking; Social Fear
Study type: Interventional

Summary: 
      The purpose of this study is to compare two exposure-based behavioral group treatments for
      public speaking anxiety. Specifically, exposure within the context of psychological
      acceptance will be compared to exposure within a standard habituation context. It is
      hypothesized that participants receiving exposure within the context of psychological
      acceptance will experience a greater decrease in anxiety and greater improvement in quality
      of life compared to the habituation-based group.
    

Detailed description: 
      Social Anxiety Disorder (SAD) is a potentially debilitating condition affecting approximately
      12% of the population at some point in their life (Ruscio et al., 2008). Nongeneralized SAD
      refers to individuals whose fears are limited to one or two social situations, most commonly
      public speaking. Empirically supported treatments for public speaking anxiety generally
      include an exposure component involving participation in anxiety-provoking public speaking
      situations (usually simulated situations using an audience of confederates and/or fellow
      participants, as well as actual public speaking situations in the community). Exposure is
      often presented within the context of habituation, but cognitively- based therapies utilize a
      rationale for exposure based on cognitive restructuring and belief modification. Research
      investigating the incremental benefit of adding other treatment components to exposure has
      yielded mixed results; however, there is preliminary evidence that the context in which
      exposure is presented can have an impact on treatment outcome. Recently, acceptance-based
      therapies have begun to frame exposure as an opportunity to increase one's willingness to
      experience anxiety while engaging in valued behaviors, rather than as a vehicle for modifying
      maladaptive cognitions and reducing anxiety. However, little research has been conducted on
      the efficacy of acceptance-based therapies for public speaking anxiety, and no component
      control studies have examined the utility of an acceptance/cognitive defusion rationale and
      context for exposure for public speaking anxiety. The present study will compare two
      exposure-based treatments for public speaking anxiety in a clinical sample. Specifically,
      exposure within an acceptance/defusion context will be compared to exposure with a
      habituation-based rationale.

      Hypotheses:

        1. Participants receiving exposure within an acceptance/defusion context will experience a
           greater reduction in anxiety and behavioral avoidance, and greater improvement in
           measures of quality of life, compared to participants receiving exposure within a
           habituation rationale, at post-treatment.

        2. Acceptance, defusion, and mindfulness will mediate treatment outcome. Specifically,
           greater changes on measures of these three constructs will account for a significant
           portion of the effect of treatment condition on the dependent variables.

        3. Lower baseline levels of public speaking anxiety and overall anxiety will be associated
           with higher baseline quality of life, mindfulness, acceptance, defusion, and social
           skills.

        4. Baseline levels of acceptance, defusion, and mindfulness will predict overall treatment
           response, regardless of intervention condition.
    

Intervention name(s): Exposure w/ Acceptance-Based Rationale; Exposure w/ Habituation-Based Rationale
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Treatment focuses on the ineffectiveness of participants' past attempts to control or reduce their anxiety in public speaking situations. Acceptance of one's private experiences (thoughts, feelings, sensations) will be introduced. "Willingness" to experience unwanted thoughts and feelings while simultaneously engaging in valued activities, especially those related to public speaking, is stressed. Techniques designed to foster psychological acceptance are practiced prior to and during exposure exercises, as well as assigned for homework between sessions.; Exposure to feared public speaking situations are accompanied by explanations of behavioral principles, including classical/operant conditioning and habituation. The process of associating public speaking situations with unwanted feelings of anxiety will be discussed, as well as negative reinforcement of escape and avoidance behaviors. The underlying principle of habituation is reviewed. When engaging in exposure exercises (both in session and assigned homework exercises), participants will be encouraged to remain in the feared speaking situation until their subjective ratings of anxiety decrease.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment