Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Psychology


Clinical Psychology

Content Description

1 online resource (vii, 129 pages) : illustrations (some color)

Dissertation/Thesis Chair

Mitch Earleywine

Committee Members

Drew A. Anderson, Robert A. Rosellini


acceptance, Acceptance and Commitment Therapy, anxiety, intervention delivery, metaphor, panic, Metaphor, Anxiety, Acceptance and commitment therapy

Subject Categories



Metaphors, or indirect and less literal forms of communication in the therapeutic setting, can be powerful and clinically impactful components of psychosocial interventions. Metaphors are widely used in therapeutic practice, and rest at the core of newer third generation behavior therapies such as Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 2011). Yet, to date, systematic empirical evaluations of the effectiveness of metaphor in the treatment of anxiety disorders and other forms of psychopathology have been largely ignored. Thus, the present study aimed to evaluate the impact of an ACT-relevant metaphor on acute panicogenic distress (i.e., panic-like symptoms). Specifically, this experiment was designed to provide a comparative evaluation of imaginal delivery of metaphor relative to behaviorally enacted delivery of metaphor. Moderate-to-high anxiety sensitive females (N = 98) were randomized to one of two conditions 1) imaginal or 2) behaviorally enacted delivery, consisting of an ACT metaphor (i.e., Chinese Finger Trap Metaphor). Within each condition, there was a core therapeutic message encouraging acceptance of one's unpleasant thoughts, feelings and bodily sensations. Participants were then exposed to two 5-minute inhalations of 10% carbon dioxide enriched air (CO2) that slowly induced panic-like symptoms, while being encouraged to use the strategy that they learned. The acute impact of each condition was assessed after baseline, each 5-minute CO2 trial, and recovery on response domains that included heart rate, subjective self-report and behavioral avoidance. As predicted, the behavioral delivery of metaphor produced better outcomes in all domains than imaginal delivery. These results have clinical implications for the delivery of metaphorical strategies in the treatment of anxiety disorders and psychopathology more generally.

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