The effects of acceptance versus control contexts on avoidance of panic-related symptoms.

The present study compared the effects of creating an acceptance versus a control treatment context on the avoidance of aversive interoceptive stimulation. Sixty high anxiety sensitive females were exposed to two 10-min periods of 10% carbon dioxide enriched air, an anxiogenic stimulus. Before each inhalation period, participants underwent a training procedure aimed at encouraging them either to mindfully observe (acceptance context) or to control symptoms via diaphragmatic breathing (control context). A third group was given no particular training or instructions. We hypothesized that an acceptance rather than control context would be more useful in the reduction of anxious avoidance. Compared to control context and no-instruction participants, acceptance context participants were less avoidant behaviorally and reported less intense fear and cognitive symptoms and fewer catastrophic thoughts during the CO(2) inhalations. We discuss the implications of our findings for an acceptance-focused vs. control-focused context when conducting clinical interventions for panic and other anxiety disorders.

[1]  Jacob Cohen.  Statistical Power Analysis , 1992 .

[2]  S. Hayes,et al.  Why behavior analysts should study emotion: the example of anxiety. , 1998, Journal of applied behavior analysis.

[3]  J. Pennebaker,et al.  Confronting a traumatic event: toward an understanding of inhibition and disease. , 1986, Journal of abnormal psychology.

[4]  J. Kabat-Zinn,et al.  Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. , 1995, General hospital psychiatry.

[5]  Teuscher Gw,et al.  Prediction and control. , 1996 .

[6]  G. Eifert,et al.  The Language of Feeling and the Feeling of Anxiety: Contributions of the Behaviorisms Toward Understanding The Function-Altering Effects of Language , 1996 .

[7]  Steven Taylor,et al.  Role of anxiety sensitivity in pain-related fear and avoidance , 1996, Journal of Behavioral Medicine.

[8]  M. Heffner,et al.  Pretend You Are a Turtle: Children's Responses to Metaphorical versus Literal Relaxation Instructions , 2003 .

[9]  T. Brown,et al.  The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder , 2004 .

[10]  G. Eifert,et al.  The triple response approach to assessment: a conceptual and methodological reappraisal. , 1991, Behaviour research and therapy.

[11]  R. McNally.  Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic, 2nd ed. , 2002 .

[12]  M. Kelly,et al.  Emotional avoidance and panicogenic responding to a biological challenge procedure , 2004 .

[13]  C. Lejuez,et al.  Devices and methods for administering carbon dioxide-enriched air in experimental and clinical settings. , 1998, Journal of Behavior Therapy and Experimental Psychiatry.

[14]  M. Zvolensky,et al.  Prediction and control: operational definitions for the experimental analysis of anxiety. , 2000, Behaviour research and therapy.

[15]  S. Hayes,et al.  The Impact of Acceptance Versus Control Rationales on Pain Tolerance , 1999 .

[16]  E. Foa,et al.  Enhanced Stroop interference for threat in social phobia. , 2002, Journal of anxiety disorders.

[17]  S. Hayes,et al.  Clinical and experimental perspectives on metaphorical talk , 1992 .

[18]  M. Zvolensky,et al.  The effects of offset control over 20% carbon-dioxide-enriched air on anxious responding. , 1999, Journal of abnormal psychology.

[19]  G. Eifert,et al.  Systemic alarms in fear conditioning II: An experimental methodology using 20% carbon dioxide inhalation as an unconditioned stimulus , 1996 .

[20]  D H Barlow,et al.  Response to hyperventilation and inhalation of 5.5% carbon dioxide-enriched air across the DSM-III-R anxiety disorders. , 1992, Journal of abnormal psychology.

[21]  N. Schmidt,et al.  Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. , 1999, Journal of abnormal psychology.

[22]  D. Schotte,et al.  Paradoxical intention and recursive anxiety. , 1999, Journal of behavior therapy and experimental psychiatry.

[23]  David H. Barlow,et al.  Mastery of Your Anxiety and Panic II and Agoraphobia Supplement: Therapist Guide , 1999, Journal of Cognitive Psychotherapy.

[24]  R. McNally,et al.  Anxiety sensitivity and panic attacks in a nonclinical population. , 1990, Behaviour research and therapy.

[25]  R. McNally,et al.  How does anxiety sensitivity vary across the anxiety disorders , 1992 .

[26]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[27]  M. Linehan,et al.  Cognitive-behavioral treatment of chronically parasuicidal borderline patients. , 1991, Archives of general psychiatry.

[28]  M. Telch,et al.  Effects of distraction and guided threat reappraisal on fear reduction during exposure-based treatments for specific fears. , 2000, Behaviour research and therapy.

[29]  M. Otto.  Stories and metaphors in cognitive-behavior therapy , 2000 .

[30]  B. Leupen,et al.  Design and analysis , 1997 .

[31]  G. Keppel,et al.  Design and Analysis: A Researcher's Handbook , 1976 .

[32]  T. Borkovec,et al.  Relaxation-induced anxiety: paradoxical anxiety enhancement due to relaxation training. , 1983, Journal of consulting and clinical psychology.

[33]  Z. Segal,et al.  How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? , 1995, Behaviour research and therapy.

[34]  N. Schmidt,et al.  Dismantling Cognitive—Behavioral Treatment for Panic Disorder Questioning the Utility of Breathing Retraining , 2000 .

[35]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[36]  Eric R. Levensky,et al.  Dialectical behavior therapy for domestic violence: Rationale and procedures , 2000 .

[37]  Maria Karekla,et al.  Measuring experiential avoidance: A preliminary test of a working model , 2004 .

[38]  G. Eifert,et al.  Response intensity in content-specific fear conditioning comparing 20% versus 13% CO2-enriched air as unconditioned stimuli. , 1998, Journal of abnormal psychology.

[39]  S. Haves,et al.  Experiential Avoidance and Behavioral Disorders: A Functional Dimensional Approach to Diagnosis and Treatment , 2003 .

[40]  M. Craske,et al.  Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia. , 1997, The British journal of clinical psychology.

[41]  D. Wegner.  Ironic processes of mental control. , 1994, Psychological review.

[42]  M. Zvolensky,et al.  Offset control during recurrent 20% carbon dioxide-enriched air induction: relation to individual difference variables. , 2001, Emotion.

[43]  Joseph Wolpe,et al.  The practice of behavior therapy , 1969 .

[44]  M. Zvolensky,et al.  A review of psychological factors/processes affecting anxious responding during voluntary hyperventilation and inhalations of carbon dioxide-enriched air. , 2001, Clinical psychology review.

[45]  R. Rapee,et al.  Measurement of perceived control over anxiety-related events. , 1996 .

[46]  D. Cioffi,et al.  Delayed costs of suppressed pain. , 1993, Journal of personality and social psychology.

[47]  M. Zvolensky,et al.  Avoidance-oriented coping as a predictor of panic-related distress: a test using biological challenge. , 2004, Journal of anxiety disorders.

[48]  L. Pbert,et al.  Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. , 1992, The American journal of psychiatry.

[49]  M. Zvolensky,et al.  Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge. , 2003, Behaviour research and therapy.

[50]  Richard J. McNally,et al.  Panic Disorder: A Critical Analysis , 1994 .

[51]  S. Reiss,et al.  Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. , 1986, Behaviour research and therapy.

[52]  D H Barlow,et al.  Instructions to focus upon or distract from internal cues during exposure treatment of agoraphobic avoidance. , 1989, Behaviour research and therapy.

[53]  M. Zvolensky,et al.  Avoidance of 20% carbon dioxide-enriched air with humans. , 1998, Journal of the experimental analysis of behavior.

[54]  S. Hayes,et al.  Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change , 1999 .

[55]  S. Hayes,et al.  Assessing the field effectiveness of acceptance and commitment therapy: An example of the manipulated training research method * , 1998 .

[56]  M. Craske,et al.  Definitions of panic attacks and panic disorder in the DSM-IV: implications for research. , 1994, Journal of abnormal psychology.