Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Psychology


Clinical Psychology

Content Description

1 online resource (ix, 139 pages) : illustrations.

Dissertation/Thesis Chair

John P Forsyth

Committee Members

Edelgard Wulfert, Elana B Gordis


acceptance, anxiety, biological challenge, cognitive restructuring, panic, panicogenic, Panic disorders, Anxiety disorders, Cognitive therapy

Subject Categories

Clinical Psychology


Cognitive-behavioral therapy (CBT), an approach that emphasizes increasing perceptions of control and cognitive change through cognitive restructuring, has proven to be an efficacious treatment for panic disorder. However, significant proportions of patients fail to achieve clinically significant improvement. Acceptance, an alternative contextually-based approach to content- and change-based cognitive strategies, has gained popularity within the field. Research on the utility of acceptance-based strategies for anxiety is promising, particularly in comparison to control-based emotion regulation strategies, such as suppression and distraction. Yet, to date, no studies have rigorously compared acceptance-based strategies to analogs of cognitive-behavioral techniques. The present study is the first to investigate the relative utility of acceptance and cognitive restructuring strategies for coping with acute panicogenic distress. This study used a 15 minute inhalation of 5% CO2-enriched air to slowly induce panic-like symptoms in an anxious, all-female, non-clinical sample (N = 83). Participants were randomized to one of three conditions and received both a rationale for, and training in utilizing, either acceptance-based or cognitive restructuring strategies, relative to a no-instruction (self-directed strategies) control condition. Participants were instructed to use the assigned strategy to approach the induced panic symptoms during the panicogenic challenge and recovery period. Skin conductance, subjective self-report, and behavioral avoidance were assessed before, during, and following the challenge procedure. No group differences were found on physiological response or behavioral avoidance. The no-instruction group reported less physical panic symptoms than the acceptance group at post-recovery. Exploratory analyses examined predictive power of emotion regulation strategies on outcomes. No strategies significantly predicted skin conductance. Overall, cognitive restructuring use was not predictive of outcomes. Acceptance use was predictive of positive outcomes and suppression use was predictive of negative outcomes on self-report and behavioral avoidance measures. These results support the utility of acceptance techniques over cognitive restructuring techniques for approaching acute panicogenic distress.