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Exposure With Acceptance-Based Versus Habituation-Based Rationale for Public Speaking Anxiety

This study has been completed.
Information provided by (Responsible Party):
James Herbert, Drexel University Identifier:
First received: February 11, 2009
Last updated: May 1, 2014
Last verified: May 2014
The purpose of this study is to compare two exposure-based behavioral group treatments for public speaking anxiety. Specifically, exposure within the context of psychological acceptance will be compared to exposure within a standard habituation context. It is hypothesized that participants receiving exposure within the context of psychological acceptance will experience a greater decrease in anxiety and greater improvement in quality of life compared to the habituation-based group.

Condition Intervention
Public Speaking Social Fear Behavioral: Exposure w/ Acceptance-Based Rationale Behavioral: Exposure w/ Habituation-Based Rationale

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Exposure With Acceptance-Based Versus Habituation-Based Rationale for Public Speaking Anxiety

Resource links provided by NLM:

Further study details as provided by James Herbert, Drexel University:

Primary Outcome Measures:
  • Number of Participants in Remission (Per Structured Clinical Interview for DSM-IV Axis I Disorders (SCID)) [ Time Frame: 6-weeks post-treatment ]

    The SCID (First, Spitzer, Gibbon, & Williams, 1996) is an extensively utilized structured diagnostic interview based on DSM-IV criteria. Estimates of interrater reliability range from moderate to high for most Axis I disorders (e.g., Williams et al., 1992; Zanarini

    & Frankenburg, 2001).

Enrollment: 45
Study Start Date: February 2009
Study Completion Date: November 2009
Primary Completion Date: November 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Exposure w/ Acceptance-Based Rationale
Behavioral exposure within the context of psychological acceptance.
Behavioral: Exposure w/ Acceptance-Based Rationale
Treatment focuses on the ineffectiveness of participants' past attempts to control or reduce their anxiety in public speaking situations. Acceptance of one's private experiences (thoughts, feelings, sensations) will be introduced. "Willingness" to experience unwanted thoughts and feelings while simultaneously engaging in valued activities, especially those related to public speaking, is stressed. Techniques designed to foster psychological acceptance are practiced prior to and during exposure exercises, as well as assigned for homework between sessions.
Active Comparator: Exposure w/ Habituation-Based Rationale
Behavioral exposure within the context of habituation.
Behavioral: Exposure w/ Habituation-Based Rationale
Exposure to feared public speaking situations are accompanied by explanations of behavioral principles, including classical/operant conditioning and habituation. The process of associating public speaking situations with unwanted feelings of anxiety will be discussed, as well as negative reinforcement of escape and avoidance behaviors. The underlying principle of habituation is reviewed. When engaging in exposure exercises (both in session and assigned homework exercises), participants will be encouraged to remain in the feared speaking situation until their subjective ratings of anxiety decrease.

Detailed Description:

Social Anxiety Disorder (SAD) is a potentially debilitating condition affecting approximately 12% of the population at some point in their life (Ruscio et al., 2008). Nongeneralized SAD refers to individuals whose fears are limited to one or two social situations, most commonly public speaking. Empirically supported treatments for public speaking anxiety generally include an exposure component involving participation in anxiety-provoking public speaking situations (usually simulated situations using an audience of confederates and/or fellow participants, as well as actual public speaking situations in the community). Exposure is often presented within the context of habituation, but cognitively- based therapies utilize a rationale for exposure based on cognitive restructuring and belief modification. Research investigating the incremental benefit of adding other treatment components to exposure has yielded mixed results; however, there is preliminary evidence that the context in which exposure is presented can have an impact on treatment outcome. Recently, acceptance-based therapies have begun to frame exposure as an opportunity to increase one's willingness to experience anxiety while engaging in valued behaviors, rather than as a vehicle for modifying maladaptive cognitions and reducing anxiety. However, little research has been conducted on the efficacy of acceptance-based therapies for public speaking anxiety, and no component control studies have examined the utility of an acceptance/cognitive defusion rationale and context for exposure for public speaking anxiety. The present study will compare two exposure-based treatments for public speaking anxiety in a clinical sample. Specifically, exposure within an acceptance/defusion context will be compared to exposure with a habituation-based rationale.


  1. Participants receiving exposure within an acceptance/defusion context will experience a greater reduction in anxiety and behavioral avoidance, and greater improvement in measures of quality of life, compared to participants receiving exposure within a habituation rationale, at post-treatment.
  2. Acceptance, defusion, and mindfulness will mediate treatment outcome. Specifically, greater changes on measures of these three constructs will account for a significant portion of the effect of treatment condition on the dependent variables.
  3. Lower baseline levels of public speaking anxiety and overall anxiety will be associated with higher baseline quality of life, mindfulness, acceptance, defusion, and social skills.
  4. Baseline levels of acceptance, defusion, and mindfulness will predict overall treatment response, regardless of intervention condition.

Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Clinically diagnosable public speaking anxiety (per DSM-IV-TR criteria for nongeneralized social anxiety disorder)
  • Aged 18-65
  • Residence in the greater Philadelphia area

Exclusion Criteria:

  • Pervasive developmental disability
  • Acute suicide potential
  • Inability to travel to the treatment site
  • Certain comorbid Axis I diagnoses, namely:

    • generalized SAD
    • schizophrenia or other psychotic disorder
    • current substance dependence
  • Comorbid diagnoses of Major Depressive or other mood or anxiety disorders are acceptable ONLY if clearly secondary to the diagnosis of public speaking anxiety
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00842946

United States, Pennsylvania
Drexel University
Philadelphia, Pennsylvania, United States, 19102
Sponsors and Collaborators
Drexel University
Study Director: James D Herbert, Ph.D. Drexel University
Study Director: Evan M Forman, Ph.D. Drexel University
  More Information

England, E.L., Herbert, J.D., Forman, E.M., Rabin, S.J., Juarascio, A., & Goldstein, S. (2012). Acceptance-based exposure therapy for public speaking anxiety. Journal of Contextual Behavioral Science, 1(1), 66-72.

Responsible Party: James Herbert, Professor of Psychology, Drexel University Identifier: NCT00842946     History of Changes
Other Study ID Numbers: DRX-17819
Study First Received: February 11, 2009
Results First Received: May 1, 2014
Last Updated: May 1, 2014 processed this record on August 21, 2017