RESUMEN
BACKGROUND AND OBJECTIVES: Emotion can be seen as the organizing process that coordinates response systems to deal effectively with challenges and opportunities. Synchronous change in subjective and physiological reactivity is regarded as an indication of this organizing process. Synchrony is expected to increase with the intensity of emotional stimuli. Conversely, adaptive emotional functioning could be indicated by progressive synchrony upon increasing demands, and the magnitude of synchrony could be an indication of progress during therapy. METHODS: We examined whether synchronous change in subjective and physiological reactivity over repeated exposures increased from watching a flight video through simulated flight to actual flight, and whether the magnitude of synchronous change predicted favourable short- and long-term treatment outcome within a group of 77 aviophobic participants during CBT. RESULTS: Results did not show a relationship between the intensity of the phobic stimuli and the magnitude of synchronous change in subjective and physiological reactivity. Moreover, synchronous change across both response systems did not predict treatment outcome. LIMITATIONS: By design this study had no control group. Additional treatment or life events between end of treatment and 3-year follow-up were not assessed. CONCLUSION: The results provide only weak support for the functionalistic view that successful treatment of anxiety disorders is indicated by synchronous change in reactivity across emotional response systems. The relationship between these systems is likely to be affected by many intervening variables including higher order cognitive processes.
Asunto(s)
Aeronaves , Trastornos Fóbicos/terapia , Adulto , Terapia Cognitivo-Conductual , Emociones , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Trastornos Fóbicos/fisiopatología , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To examine the predictive value of cognitive coping strategies at pretreatment and the value of changes in these strategies during cognitive-behavioral treatment for aviophobia for long-term therapy results. METHOD: Data from baseline, after therapy at 2 months, short-term follow-up at 5 months, and long-term follow-up at 41 months were analyzed (N = 59). RESULTS: Participants were in a long-term process of change, which continued positively after therapy for maladaptive cognitive coping strategies. The use of cognitive coping strategies at baseline was not predictive of long-term outcome. However, a greater increase in the use of adaptive coping strategies, and more importantly, a greater decrease in the use of maladaptive coping strategies were predictive of improvements indicated in self-report of flight anxiety and actual flight behavior at long-term follow-up. CONCLUSION: Improvement of maladaptive cognitive coping strategies is possibly a key mechanism of change in cognitive-behavioral therapy for aviophobia.
Asunto(s)
Adaptación Psicológica , Terapia Cognitivo-Conductual/métodos , Evaluación de Resultado en la Atención de Salud , Trastornos Fóbicos/terapia , Adulto , Aeronaves , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVES: Exposure is regarded to be a crucial component of therapies for phobias. According to emotional processing theory, the success of exposure therapy is predicted by activation of subjective and physiological fear responses and their within-session habituation and between-session adaptation. This study tested this prediction for aviophobia. METHODS: Seventy-nine participants following a highly standardized treatment program for aviophobia provided self-reported and physiological (heart rate, respiratory sinus arrhythmia and pre-ejection period) measurements of fear activation, within-session habituation, and between-session adaptation during exposure to flight-related stimuli, a flight simulator, and during two real flights. Multiple regression analyses were conducted to examine whether these measurements predicted therapy outcome up to 3 years after finishing therapy, including number of flights flown in this period. RESULTS: Both subjective and physiological arousal measurements indicated strong fear activation and large within-session habituation and between-session adaptation during exposure. Flight anxiety measures showed large improvements up to 3 years after treatment (η between 0.72 and 0.91). Lower self-reported anxiety during flight exposure was associated with lower flight anxiety after exposure (R = 0.15) and more flights flown (R = 0.14). Within-flight habituation or between-session adaptation of self-reported anxiety had no relationship with treatment outcome. Within-flight habituation of HR reactivity (R = 0.10) and respiratory sinus arrhythmia reactivity (R = 0.11) was associated with lower flight anxiety directly after the flight, but not on flight anxiety 3 years after finishing therapy or on long-term flying behavior. CONCLUSIONS: The results provide only weak support for emotional processing theory. Low self-reported anxiety during in vivo flight exposure was the best predictor of successful long-term therapy outcome.
Asunto(s)
Aeronaves , Nivel de Alerta/fisiología , Frecuencia Cardíaca/fisiología , Terapia Implosiva/métodos , Evaluación de Resultado en la Atención de Salud , Trastornos Fóbicos/fisiopatología , Estrés Psicológico/fisiopatología , Adulto , Femenino , Habituación Psicofisiológica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Arritmia Sinusal Respiratoria/fisiología , Autoinforme , Adulto JovenRESUMEN
Physiological sensations and discomfort constitute the major symptoms reported by aviophobics. Anxiety sensitivity (AS) seems to moderate the relationship between self-reported somatic sensations and flight anxiety, and AS has been identified as a vulnerability factor for flight phobia. In this study we examined whether AS moderates the effects of somatic sensations and autonomic nervous system reactivity on flight anxiety induced by real flight. In fifty aviophobics participating in Cognitive Behaviour Group Therapy (CBGT), flight anxiety, somatic sensations and autonomic nervous system reactivity were assessed during a guided return flight. Results indicate that physiological reactivity interacted with AS. Changes in heart rate and parasympathetic activity were more strongly associated with changes in reported flight anxiety for high AS participants, and less for participants low on AS. Results did not indicate a moderating effect of AS on the relationship between self-reported somatic sensations and flight anxiety. Our results suggest that therapy for flight phobia might benefit from addressing the physical effect of anxiety, by means of cognitive restructuring and exposure to interoceptive stimuli, particularly in aviophobics high in AS.
Asunto(s)
Medicina Aeroespacial/métodos , Ansiedad/terapia , Nivel de Alerta , Terapia Implosiva/métodos , Trastornos Fóbicos/terapia , Viaje/psicología , Adulto , Aeronaves , Terapia Cognitivo-Conductual/métodos , Miedo , Femenino , Humanos , Masculino , Trastornos Fóbicos/psicología , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The nature of the relationship between physiological and subjective responses in phobic subjects remains unclear. Phobics have been thought to be characterized by a heightened physiological response (physiological perspective) or by a heightened perception of a normal physiological response (psychological perspective). METHOD: In this study, we examined subjective measures of anxiety, heart rate (HR), and cardiac autonomic responses to flight-related stimuli in 127 people who applied for fear-of-flying therapy at a specialized treatment center and in 36 controls without aviophobia. RESULTS: In keeping with the psychological perspective, we found a large increase in subjective distress (eta(2)=.43) during exposure to flight-related stimuli in the phobics and no change in subjective distress in the controls, whereas the physiological responses of both groups were indiscriminate. However, in keeping with the physiological perspective, we found that, within the group of phobics, increases in subjective fear during exposure were moderately strong coupled to HR (r =.208, P=.022) and cardiac vagal (r =.199, P=.028) reactivity. In contrast to predictions by the psychological perspective, anxiety sensitivity did not modulate this coupling. CONCLUSION: We conclude that subjective fear responses and autonomic responses are only loosely coupled during mildly threatening exposure to flight-related stimuli. More ecologically valid exposure to phobic stimuli may be needed to test the predictions from the physiological and psychological perspectives.