Skip to main content
main-content
Top

Tip

Swipe om te navigeren naar een ander artikel

Gepubliceerd in: Cognitive Therapy and Research 2/2014

01-04-2014 | Original Article

The Effects of Approach–Avoidance Modification on Social Anxiety Disorder: A Pilot Study

Auteurs: Anu Asnaani, Mike Rinck, Eni Becker, Stefan G. Hofmann

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 2/2014

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Cognitive bias modification has recently been discussed as a possible intervention for mental disorders. A specific form of this novel treatment approach is approach–avoidance modification. In order to examine the efficacy of approach–avoidance modification for positive stimuli associated with social anxiety, we recruited 43 individuals with social anxiety disorder and randomly assigned them to a training (implicit training to approach smiling faces) or a control (equal approach and avoidance of smiling faces) condition in three sessions over the course of a 1-week period. Dependent measures included clinician ratings, self-report measures of social anxiety, and overt behavior during behavioral approach tasks. No group differences in any of the outcome measures were observed after training. In addition, while individuals in the training group showed increased approach tendency in one of the sessions, this effect was inconsistent across the three sessions and did not result in long-term changes in implicit approach tendencies between the groups over the course of the entire study. These results suggest that approach–avoidance modification might result in short-lasting effects on implicit approach tendencies towards feared positive stimuli, but this modification may not result in meaningful behavioral change or symptom reduction in individuals with social anxiety disorder.
Literatuur
go back to reference American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed., text revision). Washington, DC: American Psychiatric Association. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed., text revision). Washington, DC: American Psychiatric Association.
go back to reference Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., Burns, M., et al. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 961–973. PubMedCrossRefPubMedCentral Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., Burns, M., et al. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 961–973. PubMedCrossRefPubMedCentral
go back to reference Amir, N., Kuckertz, J. M., & Najmi, S. (2013). The effect of modifying automatic action tendencies on overt avoidance behaviors. Emotion, 13(3), 478–484. Amir, N., Kuckertz, J. M., & Najmi, S. (2013). The effect of modifying automatic action tendencies on overt avoidance behaviors. Emotion, 13(3), 478–484.
go back to reference Amir, N., Taylor, C. T., & Donohue, M. C. (2011). Predictors of response to an attention modification program in generalized social phobia. Journal of Consulting and Clinical Psychology, 79, 533–541. PubMedCrossRefPubMedCentral Amir, N., Taylor, C. T., & Donohue, M. C. (2011). Predictors of response to an attention modification program in generalized social phobia. Journal of Consulting and Clinical Psychology, 79, 533–541. PubMedCrossRefPubMedCentral
go back to reference Beard, C., Sawyer, A. T., & Hofmann, S. G. (2012). Efficacy of attention bias modification using threat and appetitive stimuli: A meta-analytic review. Behavior Therapy, 43, 724–740. PubMedCrossRefPubMedCentral Beard, C., Sawyer, A. T., & Hofmann, S. G. (2012). Efficacy of attention bias modification using threat and appetitive stimuli: A meta-analytic review. Behavior Therapy, 43, 724–740. PubMedCrossRefPubMedCentral
go back to reference Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. PubMedCrossRef Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. PubMedCrossRef
go back to reference Campbell, D. W., Sareen, J., Stein, M. B., Kravetsky, L. B., Paulus, M. P., Hassard, S., et al. (2009). Happy but not so approachable: The social judgments of individuals with generalized social phobia. Depression and Anxiety, 26(5), 419–424. Campbell, D. W., Sareen, J., Stein, M. B., Kravetsky, L. B., Paulus, M. P., Hassard, S., et al. (2009). Happy but not so approachable: The social judgments of individuals with generalized social phobia. Depression and Anxiety, 26(5), 419–424.
go back to reference Carlbring, P., Apelstrand, M., Sehlin, H., Amir, N., Rousseau, A., Hofmann, S., et al. (2012). Internet-delivered attention modification training in individuals with social anxiety disorder—A double blind randomized controlled trial. BMC Psychiatry, 12, 66. PubMedCrossRefPubMedCentral Carlbring, P., Apelstrand, M., Sehlin, H., Amir, N., Rousseau, A., Hofmann, S., et al. (2012). Internet-delivered attention modification training in individuals with social anxiety disorder—A double blind randomized controlled trial. BMC Psychiatry, 12, 66. PubMedCrossRefPubMedCentral
go back to reference Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
go back to reference Connor, K. M., Davidson, J. T., Churchill, L., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176, 379–386. PubMedCrossRef Connor, K. M., Davidson, J. T., Churchill, L., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176, 379–386. PubMedCrossRef
go back to reference Dasgupta, N. (2010). Implicit measures of social cognition common themes and unresolved questions. Journal of Psychology, 218, 54–57. Dasgupta, N. (2010). Implicit measures of social cognition common themes and unresolved questions. Journal of Psychology, 218, 54–57.
go back to reference DiNardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Client interview schedule. New York, NY: Oxford University Press. DiNardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Client interview schedule. New York, NY: Oxford University Press.
go back to reference Dunlap, W. P., Cortina, J. M., Vaslow, J. B., & Burke, M. J. (1996). Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods, 1, 170–177. CrossRef Dunlap, W. P., Cortina, J. M., Vaslow, J. B., & Burke, M. J. (1996). Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods, 1, 170–177. CrossRef
go back to reference Enock, P. M., Hofmann, S. G., & McNally, R. J. (under review). Attention bias modification treatment via iPhone and other handheld devices to reduce social anxiety and worry: A randomized controlled trial. Enock, P. M., Hofmann, S. G., & McNally, R. J. (under review). Attention bias modification treatment via iPhone and other handheld devices to reduce social anxiety and worry: A randomized controlled trial.
go back to reference Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., et al. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990. PubMedCrossRefPubMedCentral Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., et al. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990. PubMedCrossRefPubMedCentral
go back to reference Hallion, L. S., & Ruscio, A. M. (2011). A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 137, 940–958. PubMedCrossRef Hallion, L. S., & Ruscio, A. M. (2011). A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 137, 940–958. PubMedCrossRef
go back to reference Harb, G. C., Heimberg, R. G., Fresco, D. M., Schneier, F. R., & Liebowitz, M. (2002). The psychometric properties of the Interpersonal Sensitivity Measure in social anxiety disorder. Behaviour Research and Therapy, 40, 961–980. PubMedCrossRef Harb, G. C., Heimberg, R. G., Fresco, D. M., Schneier, F. R., & Liebowitz, M. (2002). The psychometric properties of the Interpersonal Sensitivity Measure in social anxiety disorder. Behaviour Research and Therapy, 40, 961–980. PubMedCrossRef
go back to reference Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R., et al. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine, 29, 199–212. PubMedCrossRef Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R., et al. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine, 29, 199–212. PubMedCrossRef
go back to reference Heinrichs, N., & Hofmann, S. G. (2001). Information processing in social phobia: A critical review. Clinical Psychology Review, 21, 751–770. PubMedCrossRef Heinrichs, N., & Hofmann, S. G. (2001). Information processing in social phobia: A critical review. Clinical Psychology Review, 21, 751–770. PubMedCrossRef
go back to reference Heinrichs, N., & Hofmann, S. G. (2005). Cognitive assessment of social anxiety: A comparison of self-report and thought listing methods. Cognitive Behaviour Therapy, 34, 3–15. PubMedCrossRef Heinrichs, N., & Hofmann, S. G. (2005). Cognitive assessment of social anxiety: A comparison of self-report and thought listing methods. Cognitive Behaviour Therapy, 34, 3–15. PubMedCrossRef
go back to reference Heuer, K., Rinck, M., & Becker, E. S. (2007). Avoidance of emotional facial expressions in social anxiety: The approach–avoidance task. Behaviour Research and Therapy, 45, 2990–3001. PubMedCrossRef Heuer, K., Rinck, M., & Becker, E. S. (2007). Avoidance of emotional facial expressions in social anxiety: The approach–avoidance task. Behaviour Research and Therapy, 45, 2990–3001. PubMedCrossRef
go back to reference Hofmann, S. G., Heering, S., Sawyer, A. T., & Asnaani, A. (2009). How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal. Behaviour Research and Therapy, 47, 389–394. PubMedCrossRefPubMedCentral Hofmann, S. G., Heering, S., Sawyer, A. T., & Asnaani, A. (2009). How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal. Behaviour Research and Therapy, 47, 389–394. PubMedCrossRefPubMedCentral
go back to reference Hofmann, S. G., Moscovitch, D. A., Kim, H., & Taylor, A. N. (2004). Changes in self-perception during treatment of social phobia. Journal of Consulting and Clinical Psychology, 72, 588–596. PubMedCrossRef Hofmann, S. G., Moscovitch, D. A., Kim, H., & Taylor, A. N. (2004). Changes in self-perception during treatment of social phobia. Journal of Consulting and Clinical Psychology, 72, 588–596. PubMedCrossRef
go back to reference Kawakami, K., Phills, C. E., Steele, J. R., & Dovidio, J. F. (2007). (Close) distance makes the heart grow fonder: Improving implicit racial attitudes and interracial interactions through approach behaviors. Journal of Personality and Social Psychology, 92, 957–971. PubMedCrossRef Kawakami, K., Phills, C. E., Steele, J. R., & Dovidio, J. F. (2007). (Close) distance makes the heart grow fonder: Improving implicit racial attitudes and interracial interactions through approach behaviors. Journal of Personality and Social Psychology, 92, 957–971. PubMedCrossRef
go back to reference Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627. PubMedCrossRefPubMedCentral Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627. PubMedCrossRefPubMedCentral
go back to reference Kuckertz, J. M., & Amir, N. (in preparation). A selective meta-analysis comparing cognitive bias modification to other evidence-based psychosocial programs for social anxiety disorder. Kuckertz, J. M., & Amir, N. (in preparation). A selective meta-analysis comparing cognitive bias modification to other evidence-based psychosocial programs for social anxiety disorder.
go back to reference Lange, W. G., Keijsers, G., Becker, E. S., & Rinck, M. (2008). Social anxiety and the evaluation of social crowds: Explicit and implicit measures. Behaviour Research and Therapy, 46, 932–943. PubMedCrossRef Lange, W. G., Keijsers, G., Becker, E. S., & Rinck, M. (2008). Social anxiety and the evaluation of social crowds: Explicit and implicit measures. Behaviour Research and Therapy, 46, 932–943. PubMedCrossRef
go back to reference Langner, O., Dotsch, R., Bijlstra, G., Wigboldus, D. J., Hawk, S. T., & van Knippenberg, A. (2010). Presentation and validation of the Radboud Faces Database. Cognition and Emotion, 24, 1377–1388. CrossRef Langner, O., Dotsch, R., Bijlstra, G., Wigboldus, D. J., Hawk, S. T., & van Knippenberg, A. (2010). Presentation and validation of the Radboud Faces Database. Cognition and Emotion, 24, 1377–1388. CrossRef
go back to reference Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173. PubMed Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173. PubMed
go back to reference Mennin, D. S., Fresco, D. M., Heimberg, R. G., Schneier, F. R., Davies, S. O., & Liebowitz, M. R. (2002). Screening for social anxiety disorder in the clinical setting: Using the Liebowitz Social Anxiety Scale. Journal of Anxiety Disorders, 16, 661–673. PubMedCrossRef Mennin, D. S., Fresco, D. M., Heimberg, R. G., Schneier, F. R., Davies, S. O., & Liebowitz, M. R. (2002). Screening for social anxiety disorder in the clinical setting: Using the Liebowitz Social Anxiety Scale. Journal of Anxiety Disorders, 16, 661–673. PubMedCrossRef
go back to reference Najmi, S., Kuckertz, J., & Amir, N. (2010). Automatic avoidance tendencies in individuals with contamination-related obsessive-compulsive symptoms. Behaviour Research and Therapy, 48, 1058–1062. PubMedCrossRefPubMedCentral Najmi, S., Kuckertz, J., & Amir, N. (2010). Automatic avoidance tendencies in individuals with contamination-related obsessive-compulsive symptoms. Behaviour Research and Therapy, 48, 1058–1062. PubMedCrossRefPubMedCentral
go back to reference Reinecke, A., Becker, E. S., & Rinck, M. (2010). Three indirect tasks assessing implicit threat associations and behavioral response tendencies: Test-retest reliability and validity. Journal of Psychology, 218, 4–11. Reinecke, A., Becker, E. S., & Rinck, M. (2010). Three indirect tasks assessing implicit threat associations and behavioral response tendencies: Test-retest reliability and validity. Journal of Psychology, 218, 4–11.
go back to reference Rinck, M., & Becker, E. S. (2007). Approach and avoidance in fear of spiders. Journal of Behavior Therapy and Experimental Psychiatry, 38, 105–120. PubMedCrossRef Rinck, M., & Becker, E. S. (2007). Approach and avoidance in fear of spiders. Journal of Behavior Therapy and Experimental Psychiatry, 38, 105–120. PubMedCrossRef
go back to reference Rodebaugh, T. L., Weeks, J. W., Gordon, E. A., Langer, J. K., & Heimberg, R. G. (2012). The longitudinal relationship between fear of positive evaluation and fear of negative evaluation. Anxiety, Stress & Coping: An International Journal, 25, 167–182. CrossRef Rodebaugh, T. L., Weeks, J. W., Gordon, E. A., Langer, J. K., & Heimberg, R. G. (2012). The longitudinal relationship between fear of positive evaluation and fear of negative evaluation. Anxiety, Stress & Coping: An International Journal, 25, 167–182. CrossRef
go back to reference Roelofs, K., Putman, P., Schouten, S., Lange, W. G., Volman, I., & Rinck, M. (2010). Gaze direction differentially affects avoidance tendencies to happy and angry faces in socially anxious individuals. Behaviour Research and Therapy, 48, 290–294. PubMedCrossRef Roelofs, K., Putman, P., Schouten, S., Lange, W. G., Volman, I., & Rinck, M. (2010). Gaze direction differentially affects avoidance tendencies to happy and angry faces in socially anxious individuals. Behaviour Research and Therapy, 48, 290–294. PubMedCrossRef
go back to reference Schuck, K., Keijsers, G. P. J., & Rinck, M. (2012). Implicit responses to skin irregularities predict symptom severity and treatment susceptibility in pathological skin picking. Journal of Behavior Therapy and Experimental Psychiatry, 43, 685–691. PubMedCrossRef Schuck, K., Keijsers, G. P. J., & Rinck, M. (2012). Implicit responses to skin irregularities predict symptom severity and treatment susceptibility in pathological skin picking. Journal of Behavior Therapy and Experimental Psychiatry, 43, 685–691. PubMedCrossRef
go back to reference Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (form Y). Palo Alto, CA: Consulting Psychologists Press. Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (form Y). Palo Alto, CA: Consulting Psychologists Press.
go back to reference Stins, J. F., Roelofs, K., Villan, J., Kooijman, K., Hagenaars, M. A., & Beek, P. J. (2011). Walk to me when I smile, step back when I’m angry: Emotional faces modulate whole-body approach–avoidance behaviors. Experimental Brain Research, 212, 603–611. PubMedCrossRefPubMedCentral Stins, J. F., Roelofs, K., Villan, J., Kooijman, K., Hagenaars, M. A., & Beek, P. J. (2011). Walk to me when I smile, step back when I’m angry: Emotional faces modulate whole-body approach–avoidance behaviors. Experimental Brain Research, 212, 603–611. PubMedCrossRefPubMedCentral
go back to reference Taylor, C. T., & Amir, N. (2012). Modifying automatic approach action tendencies in individuals with elevated social anxiety symptoms. Behaviour Research and Therapy, 50, 529–536. PubMedCrossRefPubMedCentral Taylor, C. T., & Amir, N. (2012). Modifying automatic approach action tendencies in individuals with elevated social anxiety symptoms. Behaviour Research and Therapy, 50, 529–536. PubMedCrossRefPubMedCentral
go back to reference Weeks, J. W., Jakatdar, T. A., & Heimberg, R. G. (2010). Comparing and contrasting fears of positive and negative evaluation as facets of social anxiety. Journal of Social and Clinical Psychology, 29, 68–94. CrossRef Weeks, J. W., Jakatdar, T. A., & Heimberg, R. G. (2010). Comparing and contrasting fears of positive and negative evaluation as facets of social anxiety. Journal of Social and Clinical Psychology, 29, 68–94. CrossRef
go back to reference Wiers, R. W., Eberl, C., Rinck, M., Becker, E. S., & Lindenmeyer, J. (2011). Retraining automatic action tendencies changes alcoholic patients approach bias for alcohol and improves treatment outcome. Psychological Science, 22, 490–497. PubMedCrossRef Wiers, R. W., Eberl, C., Rinck, M., Becker, E. S., & Lindenmeyer, J. (2011). Retraining automatic action tendencies changes alcoholic patients approach bias for alcohol and improves treatment outcome. Psychological Science, 22, 490–497. PubMedCrossRef
go back to reference Wiers, R. W., Rinck, M., Kordt, R., Houben, K., & Strack, F. (2010). Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction, 105, 279–287. PubMedCrossRef Wiers, R. W., Rinck, M., Kordt, R., Houben, K., & Strack, F. (2010). Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction, 105, 279–287. PubMedCrossRef
Metagegevens
Titel
The Effects of Approach–Avoidance Modification on Social Anxiety Disorder: A Pilot Study
Auteurs
Anu Asnaani
Mike Rinck
Eni Becker
Stefan G. Hofmann
Publicatiedatum
01-04-2014
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 2/2014
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-013-9580-x