Anu Asnaani1, Jeremy Tyler2, Jesse McCann2, Lily Brown2, Yinyin Zang3. 1. University of Utah, Department of Psychology, 380 S 1530 E Behavioral Sciences Building, Salt Lake City, UT, United States 84112. Electronic address: anu.asnaani@psych.utah.edu. 2. University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, United States 19104. 3. Peking University, School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, No. 5 Yiheyuan Road, Haidian District, Beijing, China 100871. Electronic address: yinyin.zang@pku.edu.cn.
Abstract
BACKGROUND: Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction. METHODS: Participants were treatment-seeking patients (N = 247) at an outpatient anxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses. RESULTS: Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081). LIMITATIONS: This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group. CONCLUSIONS: These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples.
BACKGROUND: Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction. METHODS:Participants were treatment-seeking patients (N = 247) at an outpatientanxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses. RESULTS: Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081). LIMITATIONS: This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group. CONCLUSIONS: These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples.
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