Acceptance-based exposure therapy for public speaking anxiety

Public speaking anxiety (PSA), diagnosed at clinical levels as social anxiety disorder, nongeneralized type, is associated with significant distress and impairment in a substantial portion of the population (Aderka et al., 2012). Empirically supported behavioral treatments for PSA generally include in vivo and/or simulated exposure, usually presented with some form of rationale or context (e.g., habituation). Newer acceptance-based therapies frame exposure as an opportunity to increase one's willingness to experience anxiety, while engaging in valued behaviors. The present study examined the acceptability, feasibility, and preliminary effectiveness of acceptance-based exposure treatment for PSA compared to standard habituation-based exposure in a clinical population. Treatment was delivered in a group format over 6 weekly sessions. Participants receiving acceptance-based exposure (ABE) were significantly more likely than those receiving habituation-based exposure (HAB) to achieve diagnostic remission by 6-week follow-up. Those in the ABE condition rated this intervention equally acceptable and credible compared to participants receiving the habituation-based approach, and improvement on other outcome measures was comparable across conditions. Participants in both groups demonstrated significant and equivalent improvement on measures of public-speaking-related cognitions, confidence, and social skills. Baseline levels of mindful awareness moderated change in public-speaking-related cognitions across conditions, and baseline defusion moderated change in state anxiety for the ABE condition only.

► Comparison of acceptance-based and habituation-based exposure for public speaking anxiety.
► Acceptance-based exposure produced a higher remission rate than habituation-based exposure.
► Mindful awareness moderated change in public-speaking-related cognitions across conditions.
► Defusion moderated change in state anxiety for the acceptance-based condition only.