Values- Versus Monetary Reward-Enhanced Exposure Therapy For The Treatment of Social Anxiety In Emerging Adulthood

Schneider, Rebecca Lynn

Graduate Thesis Or Dissertation

Values- Versus Monetary Reward-Enhanced Exposure Therapy For The Treatment of Social Anxiety In Emerging Adulthood Public Deposited

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Citeable URL: https://scholar.colorado.edu/concern/graduate_thesis_or_dissertations/5m60qt050

Abstract

Exposure therapy represents the gold-standard treatment for social anxiety disorder, yet significant improvement is still needed. One promising avenue involves explicitly linking the exposures to a source of motivation. Specifically, personal values represents an intrinsic source of motivation drawn from acceptance and commitment therapy, whereas money represents an extrinsic source of motivation commonly used to motivate behavior change. The current study examined the impact of values-enhanced versus monetary reward-enhanced exposures on social anxiety fear and avoidance outcomes, and directly compared the role of intrinsic and extrinsic rewards in motivating treatment engagement and willingness. Secondarily, the study explored the impact of personal values linked to exposures on exposure learning and generalization from an inhibitory learning framework. Finally, potential mediators and moderators of fear, avoidance, and engagement outcomes were explored. Methods: Participants were 60 emerging adults ages 17-26 who self-reported high levels of social and public speaking anxiety. Participants were randomized to one of three conditions: values-enhanced exposure, monetary reward-enhanced exposure, or exposure alone. They completed three sessions: a baseline laboratory session with the condition-specific intervention and public speaking exposure, a laboratory-based follow-up one week later, and an online follow-up two weeks later. Subjective, behavioral, and physiological measures of anxiety were collected. Results: Linking exposures to one’s values decreased self-reported anxiety following a speech task, and this anxiety reduction generalized to anticipatory anxiety prior to a novel speech task. Linking exposures to money temporarily increased speech length, particularly for those who expressed less readiness to change, but this difference did not remain during the novel speech task. Neither positive affect nor spontaneous homework completion mediated this result. Conclusion: Extrinsic motivators may be useful to initiate behavior change in individuals who lack internal motivation, while a brief values intervention can be used to enhance exposure learning and subsequently decrease subjective anxiety across feared situations. If replicated, this has important implications for exposure framing and anxiety treatment more broadly. Continued exploration of the role of values in exposure therapy, and the role of motivators in treatment engagement more generally, will be important.

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