The effects of emotional acceptance and suppression upon emotional processing in exposure treatment of claustrophobia
MetadataShow full item record
Recent investigations have suggested that the use of emotion-avoidance or emotion- suppression strategies to cope with anxiety contributes to the development and maintenance of anxiety disorders, and that substituting these strategies with emotional acceptance can lead to effective symptom reduction. We wished to consider whether attempts to suppress the negative emotions associated with exposure therapy would serve to impede emotional processing and symptom reduction, and conversely, whether acceptance of these emotions would augment treatment efficacy. Fifty-nine participants displaying marked claustrophobic fear were assigned to receive 30 minutes of exposure (enclosure in a small chamber) while receiving, A) instructions to accept and allow the experience of unpleasant emotions (ACC), B) instructions to control and suppress the experience of unpleasant emotions (SUP), or C) no instructions regarding emotion regulation (exposure only; EO). Outcome assessments were conducted prior to treatment, immediately following treatment, and at one-month follow-up, and included fear and heart rate reactivity in response to a behavioral approach test. We predicted that ACC participants would display greater reductions in claustrophobic fear than EO participants, and that EO participants would in turn display greater reductions in claustrophobic fear than SUP participants. These hypotheses were not supported. In addition, a detailed analysis of treatment process data was conducted. Peak fear ratings, claustrophobic threat expectancies, self-efficacy, and acceptance of anxiety were collected over the course of the treatment session, and hierarchical linear modeling (HLM) was used to produce individual growth curves for these variables. Three hypotheses were formulated: 1) ACC participants would display a more rapid improvement in these measures than SUP and EO participants, 2) threat expectancies, self-efficacy and anxiety would mediate reductions in fear over the course of treatment, and 3) mediational pathways would be moderated by treatment condition. Though no support was found for our first process hypothesis, treatment specific mediation was found. Among ACC participants, self-efficacy and suffocation expectancies mediated the session-fear relationship, and among EO participants, entrapment expectancies mediated this relationship. Among SUP participants, no significant mediators were identified.