The effects of approach-avoidance modification on social anxiety disorder
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Recent empirical studies using approach-avoidance modification have found a reduction in symptoms and relapse in individuals with substance use, achieved by modifying unhealthy approach tendencies. This raises the question as to whether the benefits of such an intervention can generalize to reduction of unhealthy avoidance tendencies as observed in social anxiety. In the current double-blind study, 43 adults (aged 18 to 53) with social anxiety disorder were randomly assigned to an active condition (implicit training to approach smiling faces) or control condition (equal approach and avoidance of smiling faces) of the Approach and Avoidance Task (a computerized joystick task) in three sessions over the span of a week. Pre- to post-assessment changes were assessed on the following outcome measures: social anxiety (Liebowitz Social Anxiety Scale and Social Phobia Inventory), depression (Beck Depression Inventory-II), other self-report (State-Trait Anxiety Inventory - State version and Social Interaction Self-Statement Test), implicit measures of attention (dot probe) and rejection (implicit association task), and behavioral approach tasks (a conversation with a stranger and an impromptu speech). There were no differences between the groups on the basis of baseline approach tendency or experimental condition, except for a strong interaction effect between baseline approach tendency and condition on latency to engage in the conversation task. Specifically, individuals with a baseline avoidance tendency in the active training condition took longer to engage in this interaction at post-test. In addition, analyses revealed that the whole sample significantly improved on both social anxiety measures, and indicated reduced subjective distress on the speech task and reduced number of negative self-statements made after both behavioral tasks. There were no changes in level of depression or in performance on the other implicit measures (i.e., dot probe and implicit association task). Finally, participants' own beliefs that they were in the active condition of the study significantly predicted lower objectively-rated anxiety during the speech at post-test, regardless of baseline social anxiety severity or actual condition. In sum, a multi-session approach-avoidance modification that trains approach towards smiling faces appears to be limited in its effectiveness for treatment of social anxiety disorder.
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