(provided by candidate): Recent evidence suggests that for at least some anxiety disorders, the combination of medication plus CBT may result in greater relapse (return of fear) than CBT alone. One possibility to account for this finding is that medication taking for anxiety disorders can be conceptualized within the framework of safety behavior theory. Anxiety-maintaining safety behaviors consist of actions that people perform when confronting fear-provoking situations in an effort to avert or attenuate a perceived threat. These behaviors may be covert (e.g., distraction) or overt (e.g., carrying or ingesting rescue medication). Paradoxically, the use of such safety-behaviors during exposure to fear-provoking cues has been shown to undermine the therapeutic efficacy of exposure. Misattributional processes have been proposed as one possible factor accounting for the disruptive effects of safety behaviors on fear reduction during exposure.
The aim of the current study is to shed light on how attributional processes influence the effects of medication taking on subsequent return of fear (ROF) following exposure-based treatment. To test this hypothesis, participants meeting DSM-IV criteria for specific phobia with primary claustrophobia complaints will be randomly assigned to one of five treatment conditions: (a) Exposure - no pill (ENP), (b) Exposure + Pill Placebo with Arousal expectation (EPA), (c) Exposure + Pill Placebo with relaxation expectation (EPR), (d) Exposure + Pill Placebo with neutral expectation (EPN), or (e) credible placebo treatment (PLT). We expect those receiving exposure and later told that the pill was an anxiolytic will respond with greater return of fear at follow-up relative to those in the other three exposure conditions. Moreover, if the hypothesized increase in ROF is observed among the EPR condition, follow-up mediational analyses will be conducted to test whether the increase in ROF associated with attributing improvement to the pill's anxiolytic properties will be mediated by perceived coping self-efficacy.
| Powers, Mark B; Smits, Jasper A J; Whitley, Diana et al. (2008) The effect of attributional processes concerning medication taking on return of fear. J Consult Clin Psychol 76:478-90 |
