Augmenting In Vivo Exposure With Fear Antagonistic Actions: A Preliminary Test⁎⁎We would like to thank David Seivers and Mind Alive, Inc., for supplying the D.A.V.I.D. devices used to conduct the APS treatment and to Melody Otto, Heather Zapalac, Andrea Cubriel, Brian Coquyt, and Mealika Brown for their assistance with data collection.Portions of these data were previously presented at the 2004 annual meeting of the Association for the Advancement of Behavior Therapy.This research was conducted in partial

Wolitzky, Kate B.; Telch, Michael J.

doi:10.1016/j.beth.2007.12.006

Cited by 49 publications

(16 citation statements)

References 51 publications

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“…In the same sense it has been found that physically approaching a feared object will result in positive appraisal of that object ( 59 – 61 ). Based on this premise Wolitzky et al ( 62 ) performed an experiment in which 88 patients with acrophobia (fear of heights) either performed a standard exposure intervention of climbing open stairs and going higher every time anxiety went down below a certain level, or standard exposure intervention augmented with oppositional actions such as actively approaching a ledge by running toward it. Exposure combined with oppositional actions led to better behavioral and self-report outcomes than standard exposure, relaxation, or a waitlist.…”

Section: Rationale For An Innovative Framework For Treatment Of Ptsdmentioning

confidence: 99%

“…It activates patients both physically and mentally and thereby adds substantially to the aim of increased engagement and decreased avoidance. Based on the embodied cognition theories as described in section Embodied Cognition [e.g., ( 59 , 62 )] we expect the action of approaching an image that represents the traumatic memory to substantially decrease or even completely break down the tendency to avoid the traumatic memory. Furthermore, based on the work of Oppezzo et al ( 54 ), walking is presumed to enhance divergent thinking, which facilitates accessing emotional and cognitive networks associated with the traumatic memory.…”

Section: The 3mdr Interventionmentioning

confidence: 99%

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An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

2018

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Despite an array of evidence-based psychological treatments for patients with a posttraumatic stress disorder (PTSD), a majority of patients do not fully benefit from the potential of these therapies. In veterans with PTSD, up to two-thirds retain their diagnosis after psychotherapy and often their disorder is treatment-resistant, which calls for improvement of therapeutic approaches for this population. One of the factors hypothesized to underlie low response in PTSD treatment is high behavioral and cognitive avoidance to traumatic reminders. In the current paper we explore if a combination of personalized virtual reality, multi-sensory input, and walking during exposure can enhance treatment engagement, overcome avoidance, and thereby optimize treatment effectiveness. Virtual reality holds potential to increase presence and in-session attention and to facilitate memory retrieval. Multi-sensory input such as pictures and music can personalize this experience. Evidence for the positive effect of physical activity on fear extinction and associative thinking, as well as embodied cognition theories, provide a rationale for decreased avoidance by literally approaching cues of the traumatic memories. A dual-attention task further facilitates new learning and reconsolidation. These strategies have been combined in an innovative framework for trauma-focused psychotherapy, named Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR). In this innovative treatment the therapeutic setting is changed from the face-to-face sedentary position to a side-by-side activating context in which patients walk toward trauma-related images in a virtual environment. The framework of 3MDR has been designed as a boost for patients with treatment-resistant PTSD, which is illustrated by three case examples. The intervention is discussed in context of other advancements in treatment for treatment-resistant PTSD. Novel elements of this approach are activation, personalization and empowerment. While developed for veterans with PTSD who do not optimally respond to standardized treatments, this innovative framework holds potential to also be used for other patient populations and earlier stages of treatment for patients with PTSD.

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Section: Rationale For An Innovative Framework For Treatment Of Ptsdmentioning

confidence: 99%

Section: The 3mdr Interventionmentioning

confidence: 99%

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

2018

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“…Stair-climbing is a typical anxiety provocation in height fear research and has demonstrated treatment sensitivity (e.g., Emmelkamp, Krijn, Hulsbosch, de Vries, Shuemie, & van der Mast, 2002; Wolitzky & Telch, 2009). Participants were asked to climb as high on a staircase as they were willing.…”

Section: Methodsmentioning

confidence: 99%

Reaching new heights: Comparing interpretation bias modification to exposure therapy for extreme height fear.

Steinman

Teachman

2014

Journal of Consulting and Clinical Psychology

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Objective Cognitive models of anxiety disorders posit that biases in interpretation maintain, and potentially cause, anxiety. This study tested whether it is possible to decrease height fear symptoms through cognitive bias modification for interpretations (CBM-I). Additionally, the clinical utility of CBM-I was tested by comparing it to an already established treatment: exposure therapy. Method Extremely height fearful (N = 110) individuals participated in the study. Acrophobic symptoms were measured before and after two sessions of CBM-I, and compared to the standard treatment for acrophobia (exposure therapy), a combination of CBM-I and exposure therapy, and a Control condition. Results In line with hypotheses, participants in the three active conditions showed greater response to treatment than the Control condition in height-relevant interpretation bias, symptoms, and behavioral avoidance on a height stressor, with few differences between the active conditions. Further, symptom change was mediated by change in interpretation bias. Conclusions Overall, findings suggest that different pathways to fear reduction (exposure vs. shifting interpretations) can lead to similar reductions in height fear. This study provides the first evidence that directly shifting cognitive processing, even with no therapist involvement, can reduce symptoms as effectively as the gold standard, therapist-directed exposure therapy.

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“…Stair climbing is a common provocation in acrophobia research (e.g., Emmelkamp, Krijn, Hulsbosch, de Vries, Shuemie, & van der Mast, 2002; Wolitzky & Telch, 2009). Participants are asked to climb as high on the staircase as they are willing.…”

Section: Methodsmentioning

confidence: 99%

Cognitive processing and acrophobia: Validating the Heights Interpretation Questionnaire

Steinman

Teachman

2011

Journal of Anxiety Disorders

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Three studies were conducted to examine the psychometric properties of a new scale: the Heights Interpretation Questionnaire (HIQ). This scale was designed to measure height fear-relevant interpretation bias to help assess the relationship between biased interpretations and acrophobia symptoms. Studies 1 (N = 553) and 2 (N = 308) established the scale’s factor structure and convergent and discriminant validity among two large undergraduate samples. Study 3 (N = 48) evaluated the predictive validity of the HIQ by examining how well the scale predicted subjective distress and avoidance on actual heights. Factor analysis resulted in four distinct factors, and results suggest that each of the factors, along with the full HIQ, have good reliability and validity. Additionally, the scale predicts subjective distress and avoidance on heights beyond self-reported acrophobia symptoms. Overall, the HIQ shows promise as a new tool to investigate cognitive processing biases in acrophobia.

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Cited by 49 publications

References 51 publications

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

Reaching new heights: Comparing interpretation bias modification to exposure therapy for extreme height fear.

Cognitive processing and acrophobia: Validating the Heights Interpretation Questionnaire

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