Date of Award

1-1-2017

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

Department of Psychology

Program

Clinical Psychology

Content Description

1 online resource (i, viii, 104 pages) : illustrations (some color)

Dissertation/Thesis Chair

John P Forsyth

Committee Members

Mitch Earleywine, James F Boswell

Keywords

Acceptance and Commitment Therapy, Behavioral approach task, Exposure therapy, Values, Anxiety disorders, Anxiety, Avoidance (Psychology), Operant behavior

Subject Categories

Psychology

Abstract

Exposure therapy is the gold standard treatment for anxiety disorders, yet there remains room for improvement. To date, most exposure-based interventions focus on approaching fear-inducing events. Yet, in natural contexts, fear-based avoidance tends to occur in contexts that demand approaching potentially meaningful and reinforcing consequences (e.g., work, intimacy, friendships, helping others). Thus, to maximize exposure, it may be useful to arrange exposures to include contacting fear while simultaneously approaching rewarding consequences, or what many refer to as values. Values strategies, part of acceptance and commitment therapy, might be one way to optimize exposure therapy by increasing approach toward fear-provoking situations in the context of also approaching rewarding value-guided consequences. However, no work has explored values interventions in the context of fear and existing values studies lack ecological validity. The aim of this dissertation was to evaluate a brief values intervention designed to increase approach toward a feared stimulus. The intervention included two components: (1) a scripted intervention and writing activity designed to create a motivational context using values and (2) values-based reinforcement for approaching fear. Spider fearful participants (N = 120) who endorsed the value of helping others were randomized to one of four conditions and completed a behavioral approach task (BAT) designed to assess avoidance of spiders. That task featured several steps, each of which brought participants closer to a spider. Full values protocol (FP) participants received both components of the protocol, intervention only (IO) participants received only the scripted intervention and writing activity component, reinforcement only (RO) participants received only the values reinforcement component, and task only (TO) condition participants completed the BAT with no intervention. Results showed that FP and RO participants completed more BAT steps relative to TO participants. Moreover, the full values package outperformed the individual components. Support for the purported mechanism of change was mixed. Results suggest values interventions can be used to reinforce and encourage approach toward feared stimuli might be a useful addition to exposure therapy.

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