This dissertation is a three-paper investigation of ways to improve treatment outcomes for anxiety disorders.
Study 1 investigates whether training implicit approach or avoidance to feared stimuli augments or impedes fear extinction. We also investigate whether baseline explicit avoidance predicts extinction performance or future avoidance behavior. Extinction performance is used as a proxy for exposure therapy. Results revealed no effect of training implicit approach or avoidance on extinction performance nor future behavioral avoidance. Baseline explicit avoidance did not predict extinction performance, whereas it did predict future behavioral avoidance. Findings suggest that explicit avoidance may not affect fear extinction in an unambiguous fear-conditioning paradigm, but that it may affect future tendency to approach feared stimuli.
Study 2 investigates behavioral avoidance as a moderator of treatment outcome for two behavioral therapies for social anxiety disorder. Individuals who were highly behaviorally avoidant on a public speaking task had better long-term treatment outcomes following cognitive behavioral therapy (CBT) than acceptance and commitment therapy. From a deficit correction model, individuals who are more behaviorally avoidant may benefit from a treatment that more systematically targets that avoidance. A version of this work has been published in the Journal of Behavior Therapy and Experimental Psychiatry (2017).
Study 3 investigates interoceptive and in vivo avoidance as moderators of treatment outcome for two different CBTs for panic disorder. Individuals who displayed more in vivo avoidance at baseline had better outcome following CBT with interoceptive exposures than CBT with interoceptive and in vivo exposures. This suggests that avoidant individuals benefit more from a therapy that targets their primary interoceptive concerns as opposed to one that expands to in vivo avoidance.
Taken together, these studies aim to improve treatment outcomes in behavioral therapies for anxiety disorders. Study 1 suggests that retraining implicit approach avoidance behavior does not augment fear extinction in an unambiguous fear conditioning design. Studies 2 and 3 suggest that individuals with anxiety disorders who are highly avoidant at baseline may benefit from treatments that explicitly target their primary avoidance. This line of research can provide evidence-based methods for treatment selection to better match individuals to specific therapies. Additionally, all three studies contribute to our understanding of implicit and explicit avoidance in fear and anxiety.
