Page L. Anderson

Virtual reality exposure in the treatment of social anxiety

Virtual reality as a medium for exposure therapy in the treatment of social anxiety was utilized in a private-practice setting for two different courses of individual treatment: weekly psychotherapy and a 3-day intensive course of therapy. Participants met diagnostic criteria for social phobia with prominent public speaking fears, and completed self-report questionnaires at pretreatment and posttreatment. During exposure therapy, participants were presented with a virtual audience, consisting of video of actual people embedded within a virtual classroom environment. Results indicated that treatment was successful as measured by completion of a behavioral avoidance test at the end of treatment, decreases in self-reported measures of public speaking anxiety comparable to controlled clinical outcome trials for social phobia, and qualitative feedback. Follow-up data, obtained from 1 participant, showed continued improvement after therapy was completed. These preliminary findings suggest that virtual reality may be a useful tool for exposure therapy within a comprehensive treatment of social anxiety.

Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial.

OBJECTIVE This is the first randomized trial comparing virtual reality exposure therapy to in vivo exposure for social anxiety disorder. METHOD Participants with a principal diagnosis of social anxiety disorder who identified public speaking as their primary fear (N = 97) were recruited from the community, resulting in an ethnically diverse sample (M age = 39 years) of mostly women (62%). Participants were randomly assigned to and completed 8 sessions of manualized virtual reality exposure therapy, exposure group therapy, or wait list. Standardized self-report measures were collected at pretreatment, posttreatment, and 12-month follow-up, and process measures were collected during treatment. A standardized speech task was delivered at pre- and posttreatment, and diagnostic status was reassessed at 3-month follow-up. RESULTS Analysis of covariance showed that, relative to wait list, people completing either active treatment significantly improved on all but one measure (length of speech for exposure group therapy and self-reported fear of negative evaluation for virtual reality exposure therapy). At 12-month follow-up, people showed significant improvement from pretreatment on all measures. There were no differences between the active treatments on any process or outcome measure at any time, nor differences on achieving partial or full remission. CONCLUSION Virtual reality exposure therapy is effective for treating social fears, and improvement is maintained for 1 year. Virtual reality exposure therapy is equally effective as exposure group therapy; further research with a larger sample is needed, however, to better control and statistically test differences between the treatments.

Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia

Virtual reality exposure (VRE) has been shown to be effective for treating a variety of anxiety disorders, including social phobia. Presence, or the level of connection an individual feels with the virtual environment, is widely discussed as a critical construct both for the experience of anxiety within a virtual environment and for a successful response to VRE. Two published studies show that whereas generalized presence relates to fear ratings during VRE, it does not relate to treatment response. However, presence has been conceptualized as multidimensional, with three primary factors (spatial presence, involvement, and realness). These factors can be linked to other research on the facilitation of fear during exposure, inhibitors of treatment response (e.g., distraction), and more recent theoretical discussions of the mechanisms of exposure therapy, such as Boutons description of expectancy violation. As such, one or more of these components of presence may be more strongly associated with the experience of fear during VRE and treatment response than the overarching construct. The current study (N=41) evaluated relations between three theorized components of presence, fear ratings during VRE, and treatment response for VRE for social phobia. Results suggest that total presence and realness subscale scores were related to in-session peak fear ratings. However, only scores on the involvement subscale significantly predicted treatment response. Implications of these findings are discussed.

Greater expectations: Using hierarchical linear modeling to examine expectancy for treatment outcome as a predictor of treatment response.

A clients expectation that therapy will be beneficial has long been considered an important factor contributing to therapeutic outcomes, but recent empirical work examining this hypothesis has primarily yielded null findings. The present study examined the contribution of expectancies for treatment outcome to actual treatment outcome from the start of therapy through 12-month follow-up in a clinical sample of individuals (n=72) treated for fear of flying with either in vivo exposure or virtual reality exposure therapy. Using a piecewise hierarchical linear model, outcome expectancy predicted treatment gains made during therapy but not during follow-up. Compared to lower levels, higher expectations for treatment outcome yielded stronger rates of symptom reduction from the beginning to the end of treatment on 2 standardized self-report questionnaires on fear of flying. The analytic approach of the current study is one potential reason that findings contrast with prior literature. The advantages of using hierarchical linear modeling to assess interindividual differences in longitudinal data are discussed.

Help-Seeking Attitudes, Mental Health Stigma, and Self-Concealment Among African American College Students

Stigma has been noted as a major obstacle of mental health service use among African Americans. The present study investigated whether mental health stigma and self-concealment were uniquely associated with attitudes toward seeking professional psychological services in African American college students. Data of 163 African Americans (n Female = 127; 78% female) were used for present analyses. Results revealed that both mental health stigma and self-concealment were uniquely associated with help-seeking attitudes after controlling for gender, age, and previous experience of seeking professional psychological services.

Vigilant and avoidant attention biases as predictors of response to cognitive behavioral therapy for social phobia.

Background: Attention bias for socially threatening information, an empirically supported phenomenon, figures prominently in models of social phobia. However, all published studies examining this topic to date have relied on group means to describe attention bias patterns; research has yet to examine potential subgroups of attention bias among individuals with social phobia (e.g., vigilant or avoidant). Furthermore, almost no research has examined how attention biases in either direction may predict change in symptoms as a result of treatment. Methods: This study (N = 24) compared responses to cognitive behavioral therapy (CBT) for social phobia between individuals with avoidant and vigilant biases for threatening faces at pretreatment. Results: Participants with avoidant biases reported significantly and clinically higher symptom levels at posttreatment than did those with vigilant biases. Conclusions: These findings suggest that an avoidant attention bias may be associated with reduced response to CBT for social phobia. Depression and Anxiety, 2011.

The impact of cognitive behavioral therapy on post event processing among those with social anxiety disorder.

Individuals with social anxiety are prone to engage in post event processing (PEP), a post mortem review of a social interaction that focuses on negative elements. The extent that PEP is impacted by cognitive behavioral therapy (CBT) and the relation between PEP and change during treatment has yet to be evaluated in a controlled study. The current study used multilevel modeling to determine if PEP decreased as a result of treatment and if PEP limits treatment response for two types of cognitive behavioral treatments, a group-based cognitive behavioral intervention and individually based virtual reality exposure. These hypotheses were evaluated using 91 participants diagnosed with social anxiety disorder. The findings suggested that PEP decreased as a result of treatment, and that social anxiety symptoms for individuals reporting greater levels of PEP improved at a slower rate than those with lower levels of PEP. Further research is needed to understand why PEP attenuates response to treatment.

Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder.

Outcome expectancy, the extent that clients anticipate benefiting from therapy, is theorized to be an important predictor of treatment response for cognitive-behavioral therapy. However, there is a relatively small body of empirical research on outcome expectancy and the treatment of social anxiety disorder. This literature, which has examined the association mostly in group-based interventions, has yielded mixed findings. The current study sought to further evaluate the effect of outcome expectancy as a predictor of treatment response for public-speaking fears across both individual virtual reality and group-based cognitive-behavioral therapies. The findings supported outcome expectancy as a predictor of the rate of change in public-speaking anxiety during both individual virtual reality exposure therapy and group cognitive-behavioral therapy. Furthermore, there was no evidence to suggest that the impact of outcome expectancy differed across virtual reality or group treatments.

Won't You be My Neighbor? Using an Ecological Approach to Examine the Impact of Community on Revictimization

An ecological model is used to explore the moderating effects of community-level variables on the relation between childhood sexual, physical, and emotional abuse and adult intimate partner violence (IPV) within a sample of 98 African American women from low incomes. Results from hierarchical, binary logistics regressions analyses show that community-level variables (perceived neighborhood disorder and community cohesion) moderated the relation between childhood emotional abuse and adult physical IPV. Findings support the use of an ecological approach in examining the phenomena of revictimization. Clinical implications from a community and ecological perspective are discussed.

Disordered Eating-Related Cognition and Psychological Flexibility as Predictors of Psychological Health among College Students.

The present cross-sectional study investigated the relation among disordered eating-related cognition, psychological flexibility, and poor psychological outcomes among a nonclinical college sample. As predicted, conviction of disordered eating-related cognitions was positively associated with general psychological ill-health and emotional distress in interpersonal contexts. Disordered eating-related cognition was also inversely related to psychological flexibility, which was inversely related to poor psychological health and emotional distress in interpersonal contexts. The combination of disordered eating-related cognition and psychological flexibility accounted for the proportion of variance of these poor psychological outcomes greater than disordered eating-related cognition alone. Finally, psychological flexibility accounted for the proportion of variance of these negative psychological variables greater than did disordered eating-related cognition.