Date of Award

2015

Document Type

Dissertation

Degree Name

Clinical Psychology, PhD

School

CAS

Faculty Advisor

Susan Orsillo

Abstract

Social anxiety Disorder (SAD), including public speaking (the most frequently endorsed social fear; Ruscio, Brown, Sareen, Stein, & Kessler, 2008), is prevalent, chronic, and can be vastly debilitating. Cognitive behavioral therapies (CBTs) have garnered substantial empirical support for the treatment of SAD (e.g., Norton & Price, 2007). Although effective in reducing social anxiety, they are not sufficient, as a significant proportion of patients, as many as 40-50%, do not respond to treatment (e.g., Hofmann & Bogels, 2006). This insufficiency may result from shortcomings in the underlying model of SAD. Specifically, CB models fail to account for the role experiential avoidance and values inaction may play in social anxiety related distress. To date, CBT for SAD has also been characterized by high drop-out rates (e.g., Davidson et al., 2004), which could in part reflect the absence of a client-centered rationale for treatment. Treatment for social anxiety might be improved with the integration of strategies aimed at increasing acceptance and engagement in valued action (i.e., Acceptance-based Behavioral Therapies; ABBTs). Clients may be more willing to stay engaged in treatment, if the rationale is focused on facilitating action in the domains of functioning personally valued by the client. Preliminary evidence for ABBTs exists (Block & Wulfert, 2000; Dalrymple & Herbert, 2007; England et al., 2012; Kocovski, Fleming, & Rector, 2009; Ossman, Wilson, Storaasli, & McNeill, 2006), although the specific contribution of values articulation is unknown. The current study had two goals: (1) to examine the relationships among academic values, experiential avoidance, public speaking, and willingness to engage in anxiety-provoking academic activities and (2) to explore the efficacy of a brief values intervention compared to a CBT and control condition in increasing willingness to engage in anxiety-provoking academic activities among students with public speaking anxiety. Findings from a sample of 117 undergraduates demonstrated that public speaking anxiety was negatively associated with a willingness to engage in academic activities such as asking and answering questions in class (r = -.44, p < .01). However the degree to which participants endorsed valuing academics predicted their willingness to engage in them over and above the effects of anxiety (explaining an additional 20.5% of the variance in willingness). In a sample of 27 students with public speaking anxiety, students experienced an increase in willingness to engage in anxiety provoking classroom activities in both the values and the cognitive restructuring conditions (although the values condition demonstrated a moderate to large effect while the cognitive condition exhibited a small effect). Moreover, a significant increase in engagement in valued public speaking activities from baseline to 10 day follow-up was found in the values condition, with a large effect. Comparatively, a non-significant increase was observed in the cognitive condition (with a small effect), while no change was found in the neutral condition. Thus, overall, findings provide support for an acceptance-based model of SAD and suggest that values may play an important role in treatment refinement.

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