The Effectiveness of Unified Transdiagnostic Treatment on Brain-Behavioral Systems and Anxiety Sensitivity in Female Students with Social Anxiety Symptoms

Document Type: Original Article

Authors

1 Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran

2 Department of Psychiatric, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Abstract

The present research was conducted to study effectiveness of unified trans diagnostic treatment on brain-behavioral systems and anxiety sensitivity in female students with social anxiety symptoms. The statistical population of this study included all undergraduate female students of Ahvaz Jundishapur University of medical sciences. In a pre-posttest experimental design with control group, 32 female students with the diagnosis of social anxiety disorder were selected by cluster random sampling. Then, all of the subjects were randomly allocated  into two groups: experimental and control groups (16 students each). Research tools used in this study were Social Phobia Inventory (SPIN), Behavioral Activation/Behavioral Inhibition Scales (BIS/BIS) and Anxiety Sensitivity Inventory (ASI-R). Prior to commencement of the intervention, a pretest was performed on each group; then, the experimental group was exposed to transdiagnostic intervention, while the control group received no intervention. At the end of the intervention, a post-test was administrated to each group. The result of covariance analysis showed that the unified transdiagnostic intervention decreased behavioral inhibition and anxiety sensitivity, and increased behavioral activity. With regards to effectiveness of unified transdiagnostic intervention on social anxiety symptoms, utilization of this therapeutic method is suggested to psychologists and advisors.

Keywords


Abdi, R., Bakhshi, A., & Mahmoud Alilou, M. (2013). Efficacy of unified transdiagnostic treatment on reduction of transdiagnostic factors and symptoms severity in emotional disorders. Journal of Psychological Models and Methods, 3(13), 1-27. [Persian].

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th Ed). Arlington, VA: American Psychiatric Publishing.

Anderson, R. E., & Hope, D. A. (2009). The relationship among social phobia, physiological reactivity, and anxiety sensitivity in an adolescent population. Journal of Anxiety Disorders, 23, 18-26.

Asghari, P., Mashhadi, A., & Sepehri Shamloo, Z. (2015). Effect of group cognitive behavioral therapy based on Hofmann model on anxiety symptoms and brain behavioral systems in adults  suffering from social anxiety disorder. Fundamentals of Mental Health, 17(1), 38-45.

Barlow, D. H. (2008). Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: The Guilford press.

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L. Allen, L. B., & Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Therapist Guide. New York: Oxford university press.

Bella, T. T., & Omigbodun, O. O. (2009). Social phobia in Nigerian university students: Prevalence, correlates and co-morbidity. Social Psychiatry and Psychiatric Epidemiology, 44(6), 458-63.

Boswell, J. F., Farchione, T. J., Sauer-Zavala, S. H., Murray, H. W., Fortune, M. R., & Barlow, D. H. (2013). Anxiety sensitivity and interceptive exposure: A transdiagnostic construct and change strategy. Behavior Therapy, 44(3), 417–431.

Bullis, J. R., Fortune, M. R., Farchione, T. J., & Barlow, D. H. (2014). A preliminary investigation of the long-term outcome of the unified protocol for transdiagnostic treatment of emotional disorders. Comprehensive Psychiatry, 55(8), 1920-1927.

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.

Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation and affective responses to impending reward and punishment: The BIS/BAS scales. Journal of Personality and Social Psychology, 67, 319-333.

Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. in R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social Phobia: Diagnosis, Assessment and Treatment. New York: Guilford Press.

Craske, M. G., & Barlow, D. H. (2007). Mastery of your anxiety and panic: Therapist Guide. New York: Oxford University Press.

Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Foa, E., &Weisler, R. H. (2000). Psychometric properties of the social phobia inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176, 379-86.

Cui, W., & Cui, J. F. (2011).Theoretical discussion of applying grey system theory in neuropsychological studies. Grey systems: Theory and Application, 1(3), 268 –273.

Damercheli1, N., Kakavand, A. R., & Jalali, M. R. (2017). Proposing a model for analysing relationship between social anxiety and body dysmorphic disorder: Mediating role of fear of positive and negative evaluation. International Journal of Medical Research & Health Sciences, 6(2) 91-103.

Davison, G. C., Neale, J. M., & Kring, A. M. (2004). Abnormal psychology  (9th Ed.). New York: John Wiley and Sons.

Deacon, B., & Abramowitz, G. (2006). Anxiety sensitivity and its dimensions across the anxiety disorders. Journal of Anxiety Disorders, 20, 837–857.

Fardaeni Sofla, H., Karsazi, H., Imami Ezzat, A., & Bakhsipour Roudsari, A. (2015). The structural relationship of anxiety sensitivity, worry and difficulty in regulating emotions with generalized anxiety disorder, social anxiety disorder and panic disorder. Journal of Thought & Behavior in Clinical Psychology, 9(36), 77-92. [Persian].

Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Salmaso, L., & Mangelli, L. (2005). Well-being therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics, 74, 26-30.

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV axis I disorders (SCID-I), Clinician version. Washington DC: American Psychiatric Association.

Fowles, D. C. (1993). Biological variables in psychopathology: A psychobiological perspective. In H. E. Adams & P. B. Sutker (Eds.), Comprehensive Handbook of Psychopathology. New York:Plenum Press.

Gray, J. A., & McNaughton, N. (2000). The neuropsychology of anxiety: An enquiry into the functions of the septohippocampal system. New York: Oxford University Press.

Haller, S. P. W., Kadosh, K. C., Scerif, G., & Lau, J. Y. F. (2015). Social anxiety disorder in adolescence: How developmental cognitive neuroscience findings may shape understanding and interventions for psychopathology. Developmental Cognitive Neuroscience, 28(13), 11-20.

Hasanvand Amouzadeh, M. (2014). The standardization of social phobia inventory (SPIN) in nonclinical Iranian samples. The journal of Uremia University of Medical Sciences, 26(1), 17-30. [Persian].

Hasanvand Amouzadeh, M., & Roshan Chesly. R. (2013). Association of brain-behavioral systems and gender with social anxiety. Pejouhandeh, 18(3), 114-121. [Persian].

Himle, J. A., Bybee, D., Steinberger, E., Laviolette, W. T., Weaver, A., & Vlnka, S., et al. (2014). Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot Trial. Behaviour Research and Therapy, 63, 169-176.

Hofmann, S., & Otto, M. (2008). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder-specific treatment techniques. New York: Routledge Taylor & Francis Group.

Howells, F. M., Hattingh, C. J., Syal, S., Stein, D. J., Lochner, C., & Breet, E. (2015). H-magnetic resonance spectroscopy in social anxiety disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 58, 97–104.

Klumpp, H., Fitzgerald, D. A., & Phan, K. L. (2013). Neural predictors and mechanisms of cognitive behavioral therapy on threat processing in social anxiety disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 45, 83-91.

Krejcie, R. V., & Morgan, D. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30, 607-610.

Laposa, J. M., Mancuso, E., Abraham, G., & Loli-Dano, L. (2016). Unified protocol transdiagnostic treatment in group format a preliminary investigation with anxious individuals. Behavior Modification. Retrived from: http://bmo.sagepub.com/content/early/2016/ 09.2.145445516667664 .abstract

Martin, L., Kidd, M., & Seedat, S. (2016). Anxiety sensitivity in school attending youth: Exploratory and confirmatory factor analysis of the 18-item CASI in a multicultural South African sample. Frontiers in Psychology, 6, 1-10.

Mekuria, K., Mulat, H., Derajew, H., Mekonen, T., Fekadu, W., & Belete, A., et al. (2017). High magnitude of social anxiety disorder in school adolescents. Hindawi Psychiatry Journal, 2017, 1-5.

Meyer, B., Johnson, S. L., & Winters, R. (2001). Responsiveness to threat and incentive in bipolar disorder: Relations of the BIS/BAS scales with symptoms. Journal of Psychopathology and Behavioral Assessment, 23, 133–143.

Mohammadi, N. (2008). Psychometric characteristics of BIS/BAS scales in Shiraz students. Daneshvar (Raftar), 28, 61-69. [Persian].

Mohammadi, M. R., Alavi, A., Mahmoodi, J., Shahrivar, Z., Tehranidoost, M., & Saadat, S. (2008(. Prevalence of psychiatric disorders amongst adolescents in Tehran. Iranian Journal of Psychiatry, 3(3), 100-4.

Moradimanesh, F., Mirjafari, A., Goodarzi, M. A., & Mohammadi, N. (2007). Psychometric properties of the anxiety sensitivity index-revised (ASI-R). Journal of Psychology, 11(4), 426-446.  [Persian].

Nathan, P., & Gorman, J. M. (2015). A guide to treatments that work. 4th edition. Oxford University Press.

Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for Anxiety disorders: A preliminary randomized controlled non-inferiority trial. Depression and Anxiety, 29(10), 874–882.

Ornelas Maia, A. C. C., Nardi, A. E., & Cardoso, A. (2015). The utilization of unified protocols in behavioral cognitive therapy in transdiagnostic group subjects: A clinical trial. Journal of Affective Disorders, 172, 179–183.

Panayiotou, G., Karekla, M., & Panayiotou, M. (2014). Direct and indirect predictors of social anxiety: The role of anxiety sensitivity, behavioral inhibition, experiential avoidance and self-consciousness. Comprehensive Psychiatry, 55(8), 1875-82.

Reese, E. D., Zielinski, M. J., & Veilleux, J. C. (2015). Facets of mindfulness mediate behavioral inhibition systems and emotion dysregulation .Personality and Individual Differences, 72, 41–46.

Reiss, S. (1991). Expectancy model of fear, anxiety and panic. Clinical Psychology Review, 11, 141–153.

Reiss, S., & McNally, R. J. (1985). The expectancy model of fear, in theoretical issues in behavior therapy, Eds S. Reiss and R. R. Bootzin (NewYork, NY: Academic Press), 107–121.

Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the predictions of fearfulness. Behaviour Research and Therapy, 24, 1–8.

Riccardi, C. J. (2012). A randomized pilot study of a brief transdiagnostic treatment for anxiety disorders. Doctoral thesis, Florida State university, Tallahassee, Florida, United States.

Roushani, Kh., Bassak Nejad, S., Arshadi, N., Mehrabizadeh Honarmand, M., & Fakhri, A. (2016). Examining the efficacy of the unified transdiagnostic treatment on social anxiety and positive and negative affect in students. Razavi International Journal of Medicine, 4(4):e41233.

Salina, M., Ng, C. G., Gill, J. S., Chin, J. M., Chin, C. J., & Yap, W. F. (2008). Social anxiety problem among medical students in university Malaya medical center (UMMC)-A cross-sectional study. Malaysian Journal of Psychiatry, 17(2), 17-22.

Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Bentley, K. H., Ametaj, A., & Barlow, D. H. (2012). The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders. Behavior Research and Therapy, 50, 551-557.

Sharifi, V., Asadi, S. M., Mohammadi, M. R., Amini, H.,  Kaviani H., & Semnani, Y., et al. (2004). Reliability and feasibility of the Persian translation of the structured clinical interview for DSM-IV (SCID). Advances in Cognitive Science, 6, 10-22. [Persian].

Talepasand, S., & Nokani, M. (2010). Social phobia symptoms: Prevalence and socio demographic correlates. Archives of Iranian Medicine, 13(6), 522-7.

Taylor, S., & Cox, B. J. (1998). An expanded anxiety sensitivity index: Evidence for a hierarchic structure in a clinical sample. Journal of Anxiety Disorders, 12, 463-484.

Tillfors, M., Furmark, T., Marteinsdottir, I., & Fredrikson, M. (2002). Cerebral blood flow during anticipation of public speaking in social phobia: A PET Study. Biological Psychiatry, 52, 1113–1119.

Zargar, F., Asgharnejad Farid, A. S., Atef-Vahid, M. K., Afshar, H., Maroofi, M., & Omranifard, V. (2012). Effect of acceptance-based behavior therapy on severity of symptoms, worry and quality of life in women with generalized anxiety disorder. Iranian Journal of Psychiatry and Behavioral Sciences, 6(2), 23-32.