title: Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: a randomized controlled trial.
abstract: Cognitive-behavioral treatments for panic disorder (PD) emphasize interoceptive exposure (IE) to target anxiety sensitivity (AS) but vary considerably in its manner of delivery. This randomized controlled trial was conducted to compare the efficacy of the low-dose delivery of IE exercises often prescribed in treatment protocols to an intensive form of IE hypothesized to optimize inhibitory learning. Participants (N = 120) with elevated AS were randomly assigned to one of four single-session interventions: (a) low-dose IE as prescribed in Barlow and Craske's Panic Control Treatment, (b) low-dose IE without controlled breathing or a lengthy between-trial rest period, (c) intensive IE, or (d) expressive writing control. Compared to the other conditions, intensive IE produced significantly greater reductions in AS and fearful responding to a straw breathing task from pretreatment to posttreatment. Maintenance of gains during the follow-up period did not differ between conditions. Changes in fear toleration and negative outcome expectancies fully mediated the superior efficacy of intensive IE over low-dose IE. The two low intensity IE conditions produced particularly high rates of fear sensitization on between-trial and outcome variables. The findings suggest that the intensive delivery of IE exercises has the potential to improve the efficacy of exposure-based treatments for PD.
authors.affiliation: University of Wyoming, Department of Psychology, Dept. 3415, 1000 E. University Ave., Laramie, WY 82071, USA. bdeacon@uwyo.edu
authors.forename: Brett
authors.initials: B
authors.lastname: Deacon
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Kemp
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Dixon
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Sy
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Farrell
authors.forename: Annie R
authors.initials: AR
authors.lastname: Zhang
mesh_terms: D000223:Adaptation, Psychological; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000523:psychology; D007171:Implosive Therapy / Q000379:methods*; D007266:Inhibition, Psychological; D007858:Learning; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016584:Panic Disorder / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011859:Radiography; D014956:Writing; D055815:Young Adult
keywords: Anxiety disorders; Anxiety sensitivity; Cognitive-behavioral therapy; Exposure therapy; Interoceptive exposure; Panic disorder