Elsevier

Journal of Psychiatric Research

Volume 85, February 2017, Pages 75-82
Journal of Psychiatric Research

Combined “top-down” and “bottom-up” intervention for anxiety sensitivity: Pilot randomized trial testing the additive effect of interpretation bias modification

https://doi.org/10.1016/j.jpsychires.2016.11.003Get rights and content

Abstract

Objective

Anxiety disorders contribute substantially to the overall public health burden. Anxiety sensitivity (AS), a fear of anxiety-related sensations, is one of the few known malleable risk factors for anxiety pathology. Previous AS reduction treatments have primarily utilized “top-down” (e.g., psychoeducation) interventions. The goal of the current study was to evaluate the effect of adding a “bottom-up” (interpretation bias modification; CBM-I) intervention to an AS psychoeducation intervention.

Design

Single-site randomized controlled trial. Participants completed either a 1) Psychoeducation + active CBM-I or 2) Psychoeducation + control CBM-I intervention. Change in AS was assessed post-intervention and at a one-month follow-up.

Participants

Individuals with elevated levels of AS.

Intervention

Single-session computer-delivered intervention for AS.

Results

Accounting for baseline ASI-3 scores, post-intervention ASI-3 scores were significantly lower in the combined condition than in the psychoeducation + control CBM-I condition (β = 0.24, p < 0.05; d = 0.99). The active CBM-I plus psychoeducation AS intervention was successful in reducing overall AS (59% post-intervention; p < 0.05, Cohen's d = 0.99) and these reductions were maintained through one-month post-intervention (52%; p < 0.05, Cohen's d = 1.18). Participants in the active condition reported significantly lower rates of panic responding to a vital-capacity CO2 challenge (OR = 6.34, 95% CI = 1.07–37.66). Lastly, change in interpretation bias significantly mediated the relationship between treatment condition and post-treatment AS reductions.

Conclusions

The current intervention was efficacious in terms of immediate and one-month AS reductions. Given its brevity, low-cost, low-stigma and portability, this intervention could lead to reducing the burden of anxiety disorders.

Section snippets

Trial design and procedure

Participants were invited for the experiment appointment via the psychology department's secure research participant registration website. They began the appointment by reading and signing an informed consent that ensured confidentiality and thoroughly outlined their proposed study involvement. The study was approved by the university's Institutional Review Board. Participants then completed the battery of baseline measures [e.g., Anxiety Sensitivity Index-3 (ASI-3), Beck Anxiety Index (BAI)]

Sample and preliminary analysis

Random assignment resulted in fairly even division of participants across the ASAT-P+ (n = 30, 49%) and the ASAT-P− conditions (n = 31, 51%). Means of the ASI-3, BAI, and several demographic variables are provided in Table 1. Variables were compared across the active and control condition to determine the success of randomization. There were no differences across the ASI-3, the BAI, gender, and ethnicity, indicating that participants appeared to be successfully randomized. There were a total of

Discussion

The aim of the present study was to evaluate the effect of adding a bottom-up computer-delivered AS intervention to a top-down psychoeducation intervention. Findings indicated that the addition of CBM-I to psychoeducation was successful in reducing self-reported AS, and that these significant reductions were maintained at a one-month follow-up. The study also found significantly fewer participants in the ASAT-P+ condition reported a panic response to a VC breath CO2 challenge. Lastly, mediation

Author contributions

Dr. Capron led the creation of the CBM-I intervention, supervised the revision of the psychoeducation intervention, was principal investigator of the execution of the study and completed the initial draft of the manuscript.

Mr. Norr assisted in the creation of the interventions and revised the manuscript.

Mr. Allan conducted the majority of analyses and wrote the majority of the results section.

Dr. Schmidt supervised the project and provided critical feedback on the manuscript.

Funding

No funding was received for this study.

Conflicts of interest

All authors declare that they have no conflicts of interest.

Acknowledgments

The authors would like to thank Joshua Russell and Brittany Dane for their assistance creating the intervention and running participants.

References (58)

  • R.M. Rapee et al.

    Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: a randomized controlled trial

    Behav. Res. Ther.

    (2013)
  • S.L. Rauch et al.

    Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: a functional MRI study

    Biol. Psychiatry

    (2000)
  • S. Reiss et al.

    Anxiety sensitivity, anxiety frequency and the prediction of fearfulness

    Behav. Res. Ther.

    (1986)
  • N.B. Schmidt et al.

    Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability

    J. Anxiety Disord.

    (2007)
  • N.B. Schmidt et al.

    Anxiety sensitivity: prospective prediction of panic attacks and Axis I pathology

    J. Psychiatry Res.

    (2006)
  • S.A. Steinman et al.

    Modifying interpretations among individuals high in anxiety sensitivity

    J. Anxiety Disord.

    (2010)
  • S. Taylor et al.

    How does anxiety sensitivity vary across the anxiety disorders

    J. Anxiety Disord.

    (1992)
  • B.A. Teachman et al.

    Automaticity in anxiety disorders and major depressive disorder

    Clinical psychology review

    (2012)
  • M.J. Telch et al.

    Unexpected arousal, anxiety sensitivity, and their interaction on CO2-induced panic: further evidence for the context-sensitivity vulnerability model

    J. Anxiety Disord.

    (2011)
  • L.M. Williams et al.

    Trauma modulates amygdala and medial prefrontal responses to consciously attended fear

    NeuroImage

    (2006)
  • APA

    Diagnostic and Statistical Manual of Mental Disorders (DSM-5®)

    (2013)
  • J.A. Bargh

    The four horsemen of automaticity: Awareness, intention, efficiency, and control in social cognition

  • D.H. Barlow et al.

    Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial

    JAMA

    (2000)
  • C. Beard

    Cognitive bias modification for anxiety: current evidence and future directions

    Expert. Rev. Neurother.

    (2011)
  • A.T. Beck et al.

    Anxiety Disorders and Phobias: a Cognitive Perspective

    (1985)
  • A.T. Beck et al.

    An inventory for measuring clinical anxiety – psychometric properties

    J. Consult. Clin. Psych.

    (1988)
  • S. Bishop et al.

    Prefrontal cortical function and anxiety: controlling attention to threat-related stimuli

    Nat. Neurosci.

    (2004)
  • S. Blomhoff et al.

    Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia

    Brit. J. Psychiatry

    (2001)
  • J.J. Broman-Fulks et al.

    Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity

    Anxiety Stress Copin.

    (2008)
  • Cited by (0)

    View full text