Comparing the Effectiveness of Paradoxical Timetable Therapy and Virtual Reality Technology Therapy on Anxiety Sensitivity in Patients with Social Anxiety Disorder

Babaie, Vajihe; Abolmaali Alhosseini, Khadijeh; Hobbi, Mohammad Bagher

Volume 13 - Articles-1402 MEJDS (2023) 13: 106 | Back to browse issues page

Ethics code: IR.IAU.TNB.REC.1401.024

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Babaie V, Abolmaali Alhosseini K, Hobbi M B. Comparing the Effectiveness of Paradoxical Timetable Therapy and Virtual Reality Technology Therapy on Anxiety Sensitivity in Patients with Social Anxiety Disorder. MEJDS 2023; 13 :106-106
URL: http://jdisabilstud.org/article-1-3218-en.html

Comparing the Effectiveness of Paradoxical Timetable Therapy and Virtual Reality Technology Therapy on Anxiety Sensitivity in Patients with Social Anxiety Disorder

Vajihe Babaie¹

, Khadijeh Abolmaali Alhosseini ^*²

, Mohammad Bagher Hobbi³

1- PhD Student, Department of Psychology, North Tehran Branch, Islamic Azad University, Tehran, Iran
2- Full Professor, Department of Psychology, North Tehran Branch, Islamic Azad University, Tehran, Iran
3- Assistant Professor, Department of Psychology, Faculty of Humanities, The Imam Hossein Comprehensive University, Tehran, Iran

Abstract: (749 Views)

Abstract
Background & Objective: Social anxiety disorder is the most common anxiety disorder whose main feature is fear or severe anxiety. Anxiety sensitivity as a cognitive and mediating variable plays an essential role in the occurrence of mental disorders, including social anxiety disorder. A growing body of research supports the role of anxiety sensitivity in social anxiety disorder. A high prevalence of social anxiety disorder has led to the development and expansion of new treatments for this disorder. Some previous studies have shown that paradoxical timetable therapy (rooted in psychodynamic and systemic theories) and virtual reality technology therapy (in which the basic techniques of psychotherapy are simulated with the help of modern technologies) can reduce the symptoms of social anxiety disorder. Considering the research gap in comparing these two types of treatments in reducing anxiety sensitivity, the present study was conducted to compare the effectiveness of paradoxical timetable therapy and virtual reality technology on the anxiety sensitivity of patients with social anxiety disorder.
Methods: This quasi–experimental research was conducted with a pretest–posttest and a one–month follow–up design with a control group. The statistical population included all people referred to counseling centers and psychotherapy clinics in Tehran City, Iran, from September 23, 2022, to March 20, 2023. The study sample consisted of 45 qualified volunteers diagnosed with social anxiety disorder based on the initial interview and social anxiety scale. They were selected by available sampling and randomly assigned to three groups of 15 people each (two experimental groups and one control group). The Anxiety Sensitive Questionnaire (Taylor & Cox, 1998) was used to collect data. The revised anxiety sensitivity index has a four–factor ordinal structure. These factors include fear of respiratory symptoms, fear of anxiety reactions, fear of cardiovascular symptoms, and cognitive dyscontrol. The reliability of this questionnaire in the present study was 0.92. The first experimental group undertook six 90–minute paradoxical timetable program therapy (Besharat, 2019), and the second group received eight 45–minute virtual reality technology therapy sessions (North, North & Coble, 2017). The control group did not receive any intervention. The obtained data were analyzed using repeated measure analysis of variance. The significance level of the tests was considered 0.05. The inclusion criteria were as follows: suffering from social anxiety disorder based on the diagnostic interview and the social anxiety scale questionnaire (with a score of at least 50), informed consent to participate in treatment and research sessions, aged 18 to 50 years, having minimum degree of diploma, no concomitant use of psychiatric drugs, and without other clinical or chronic physical disorders (such as cardiovascular diseases). The exclusion criteria were not participating in more than two treatment sessions, the occurrence of severe stressful events in life (such as divorce or death of first–degree relatives) during the research process, and unwillingness to continue the treatment.
Results: The results showed that both types of paradoxical timetable therapy and virtual reality technology reduced anxiety sensitivity in people with social anxiety disorder (p<0.001). The non–significance of the mean difference between the posttest and follow–up phase also shows the permanent effect of the two therapeutic methods of paradoxical timetable and virtual reality technology therapy on anxiety sensitivity and its components one month after the end of the implementation period. Based on this, the results of the present study showed that the two methods of treatment have reduced the average anxiety sensitivity and its components in a stable manner; however, the effectiveness of the paradoxical timetable therapy was higher.
Conclusion: Based on the research findings, the treatment of paradoxical timetable was more effective in reducing anxiety sensitivity than the virtual reality technology intervention. Therefore, therapists can use the mentioned treatment to reduce anxiety sensitivity in patients with social anxiety disorder.

Keywords: Anxiety sensitivity, Social anxiety disorder, Paradoxical timetable therapy, Virtual reality technology

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Type of Study: Original Research Article | Subject: Psychology

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM–V. 5th ed. Washington, DC: American Psychiatric Association; 2013.

2. Halldorsson B, Waite P, Harvey K, Pearcey S, Creswell C. In the moment social experiences and perceptions of children with social anxiety disorder: a qualitative study. Br J Clin Psychol. 2023;62(1):53–69. [DOI]

3. Beesdo K, Bittner A, Pine DS, Stein MB, Höfler M, Lieb R, et al. Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry. 2007;64(8):903–12. [DOI]

4. Crozier WR, Alden LE. The essential handbook of social anxiety for clinicians. 1st ed. West Sussex, England: Wiley; 2005.

5. Fink M, Akimova E, Spindelegger C, Hahn A, Lanzenberger R, Kasper S. Social anxiety disorder: epidemiology, biology and treatment. Psychiatr Danub. 2009;21(4):533–42.

6. Rose GM, Tadi P. Social anxiety disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023]. Available from: [Article]

7. Clark DM. A cognitive perspective on social phobia. In: The essential handbook of social anxiety for clinicians. Hoboken, NJ, US: John Wiley & Sons Ltd; 2005. pp: 193–218.

8. Eysenck MW. Anxiety: the cognitive perspective. Psychology Press; 2013.

9. Alkozei A, Cooper PJ, Creswell C. Emotional reasoning and anxiety sensitivity: associations with social anxiety disorder in childhood. J Affect Disord. 2014;152–154:219–28. [DOI]

10. Raines AM, Oglesby ME, Capron DW, Schmidt NB. Obsessive compulsive disorder and anxiety sensitivity: identification of specific relations among symptom dimensions. Journal of Obsessive–Compulsive and Related Disorders. 2014;3(2):71–6. [DOI]

11. Korte KJ, Brown MAS, Schmidt NB. Anxiety sensitivity and impairment: evidence for a direct association and partial mediation by subclinical anxiety symptoms. J Affect Disord. 2013;151(3):875–81. [DOI]

12. Olthuis JV, Thompson K, Watt MC, Stewart SH. Investigating pathways from anxiety sensitivity to impairment in a treatment–seeking sample. J Affect Disord. 2023;324:455–62. [DOI]

13. Baiano C, Raimo G, Zappullo I, Cecere R, Rauso B, Positano M, et al. Anxiety sensitivity domains are differently affected by social and non–social autistic traits. J Autism Dev Disord. 2022;52(8):3486–95. [DOI]

14. Brooke CM, Intrieri RC. The influence of anxiety sensitivity, & personality on social anxiety symptoms. Curr Psychol. 2023;42(11):9249–60. [DOI]

15. Ellison L, Witcraft SM, Dixon LJ. Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms. Arch Dermatol Res. 2021;313(7):531–7. [DOI]

16. Panayiotou G, Karekla M, Panayiotou M. Direct and indirect predictors of social anxiety: the role of anxiety sensitivity, behavioral inhibition, experiential avoidance and self–consciousness. Compr Psychiatry. 2014;55(8):1875–82. [DOI]

17. Scott EL, Heimberg RG, Jack MS. Anxiety sensitivity in social phobia: comparison between social phobics with and without panic attacks. Depress Anxiety. 2000;12(4):189–92. [DOI]

18. Blakey SM, Abramowitz JS, Reuman L, Leonard RC, Riemann BC. Anxiety sensitivity as a predictor of outcome in the treatment of obsessive–compulsive disorder. J Behav Ther Exp Psychiatry. 2017;57:113–7. [DOI]

19. Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12–year prospective study. Am J Psychiatry. 2005;162(6):1179–87. [DOI]

20. Khodabakhsh Pirkalani R, Rahim Jamarouni H. Effectiveness of mixed cognitive–behaviorial therapy and mindfulness based stressreduction in treating a case of generalized anxiety disorder. Clinical Psychology Studies. 2013;4(13):121–47. [Persian] [Article]

21. Ponniah K, Hollon SD. Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials. Psychol Med. 2008;38(1):3–14. [DOI]

22. Evans R, Clark DM, Leigh E. Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta–analysis. Behav Cogn Psychother. 2021;49(3):352–69. [DOI]

23. Hudson JL, Lester KJ, Lewis CM, Tropeano M, Creswell C, Collier DA, et al. Predicting outcomes following cognitive behaviour therapy in child anxiety disorders: the influence of genetic, demographic and clinical information. J Child Psychol Psychiatry. 2013;54(10):1086–94. [DOI]

24. Horigome T, Kurokawa S, Sawada K, Kudo S, Shiga K, Mimura M, et al. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta–analysis. Psychol Med. 2020;50(15):2487–97. [DOI]

25. Owens ME, Beidel DC. Can virtual reality effectively elicit distress associated with social anxiety disorder? J Psychopathol Behav Assess. 2015;37(2):296–305. [DOI]

26. Starcevic V. Representation of benzodiazepines in treatment guidelines: the paradox of undesirable objectivity. Psychother Psychosom. 2022;91(5):295–9. [DOI]

27. Besharat MA. Evaluating the effectiveness of paradox therapy for the treatment of social anxiety disorder: a case study. Journal of psychologicalscience. 2019;18(76):383–96. [Persian] [Article]

28. Nikan A, Lotfi Kashani F, Vaziri S, Mojtabaie M. Comparison of paradoxical timetable and cognitive behavioral therapy on worry and rumination of individuals with social anxiety. Rooyesh–e–Ravanshenasi Journal. 2021;10(1):1–14. [Persian] [Article]

29. Nason EE, Trahan M, Cash D. Evaluation of a mobile virtual reality intervention for social anxiety disorder: ethical and methodological lessons learned. J technol behav sci. 2023;8(1):79–86. [DOI]

30. Rubin M, Muller K, Hayhoe MM, Telch MJ. Attention guidance augmentation of virtual reality exposure therapy for social anxiety disorder: a pilot randomized controlled trial. Cogn Behav Ther. 2022;51(5):371–87. [DOI]

31. Chard I, Van Zalk N, Picinali L. Virtual reality exposure therapy for reducing social anxiety in stuttering: a randomized controlled pilot trial. Front Digit Health. 2023;5:1061323. [DOI]

32. Emmelkamp PMG, Meyerbröker K, Morina N. Virtual reality therapy in social anxiety disorder. Curr Psychiatry Rep. 2020;22(7):32. [DOI]

33. Price M, Anderson P. The role of presence in virtual reality exposure therapy. J Anxiety Disord. 2007;21(5):742–51. [DOI]

34. Anderson PL, Price M, Edwards SM, Obasaju MA, Schmertz SK, Zimand E, et al. Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. J Consult Clin Psychol. 2013;81(5):751–60. [DOI]

35. Bouchard S, Dumoulin S, Robillard G, Guitard T, Klinger É, Forget H, et al. Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three–arm randomised controlled trial. Br J Psychiatry. 2017;210(4):276–83. [DOI]

36. Azimisefat P, de Jongh A, Rajabi S, Kanske P, Jamshidi F. Efficacy of virtual reality exposure therapy and eye movement desensitization and reprocessing therapy on symptoms of acrophobia and anxiety sensitivity in adolescent girls: a randomized controlled trial. Frontiers in Psychology. 2022;13: 919148. [DOI]

37. Bakhshipour Roodsari A, Mahmood Aliloo M, Farnam A, Abdi R. Efficacy evaluation of unified transdiagnostic treatment in symptoms reduction of patients with generalized anxiety disorder and a comorbid emotional disorder. Journal of Modern Psychological Researches. 2014;8(32):41–74. [Persian] [Article]

38. Lee H, Choi J, Jung D, Hur JW, Cho CH. The effects of virtual reality treatment on prefrontal cortex activity in patients with social anxiety disorder: participatory and interactive virtual reality treatment study. J Med Internet Res. 2021;23(12):e31844. [DOI]

39. Taylor S, Cox BJ. An expanded anxiety sensitivity index: evidence for a hierarchic structure in a clinical sample. J Anxiety Disord. 1998;12(5):463–83. [DOI]

40. Moradimanesh F, Mirjafari SA, Goodarzi MA, Mohammadi N. Psychometric properties of the anxiety sensitivity index–revised (ASI–R). Journal of Psychology. 2007;11(4):426–46. [Persian]

41. North MM, North SM, Coble JR. Virtual reality therapy: an effective treatment for psychological disorders. Stud Health Technol Inform. 1997;44:59–70.

42. Botella C, Villa H, Baños R, Perpiñá C, García–Palacios A. The treatment of claustrophobia with virtual reality: changes in other phobic behaviors not specifically treated. Cyberpsychol Behav. 1999;2(2):135–41. [DOI]

43. Hawajri O, Lindberg J, Suominen S. Virtual reality exposure therapy as a treatment method against anxiety disorders and depression-a structured literature review. Issues Ment Health Nurs. 2023;44(4):245–69. [DOI]

44. Hoorn JF, Konijn E, Veer G. Virtual reality: do not augment realism, augment relevance. In: 3rd International Conference on Human–Computer Interaction. Leganes, Spain: APIO; 2003. p. 154–63.

45. Reid DT. Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self–efficacy: a pilot study. Pediatr Rehabil. 2002;5(3):141–8. [DOI]

46. Besharat MA, Naghipoor M. The application of a new model of paradox therapy for the treatment of illness anxiety disorder: a case report. Clin Case Rep Int. 2019;3(1):1100.