A comparison of cognitive and behavioral approaches for reducing cost bias in social anxiety

Cognitive-behavioral theories suggest that anxiety is maintained in part by estimates of the probability and cost of feared negative outcomes. Social phobia may be unique among the anxiety disorders in that it is characterized by overestimates of the cost of events that are objectively noncatastrophic (e.g., committing social mishaps). As such, treatment approaches that target cost bias may be particularly effective in reducing social phobia symptoms. This study examined the efficacy of 2 cost-specific techniques in a single-session intervention for social anxiety. Individuals (n = 61) with elevated social interaction anxiety were randomly assigned to an expressive writing control condition, a cognitive restructuring condition, or a behavioral experiment condition. Results demonstrated that the cognitive restructuring condition produced significantly greater improvement in indices of social anxiety than the other conditions. Reduction in cost bias fully mediated the significantly greater improvement in social interaction anxiety in the cognitive restructuring condition relative to the behavioral experiment condition. The present findings highlight the value of techniques designed to reduce cost biases in social anxiety. Clinical implications are discussed

Do cognitive reappraisal and diaphragmatic breathing augment interoceptive exposure for anxiety sensitivity?

Interoceptive exposure (IE) is an effective procedure for reducing anxiety sensitivity (AS) and the symptoms of panic disorder. However, considerable variance exists in how IE is delivered among clinicians, and the extent to which IE is enhanced by the concurrent use of cognitive reappraisal (CR) and diaphragmatic breathing (DB) is unclear. Participants (N = 58) with high AS were randomly assigned to one of four single-session interventions: (a) IE only, (b) IE + CR, (c) IE + CR + DB, or (d) expressive writing control. IE was superior to expressive writing in reducing AS and associated anxiety symptoms. The addition of CR and DB did not enhance the benefits of IE at either posttreatment or 1-week follow-up. These findings highlight the specific efficacy of IE in reducing AS and call into question the common practice of combining IE with cognitive and breathing strategies. Theoretical and clinical implications are discussed