An Experimental Comparison of Techniques: Cognitive Defusion, Cognitive Restructuring, and in-vivo Exposure for Social Anxiety

Abstract

Background: One of the primary differences between Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for anxiety is the approach to managing negative thoughts. CBT focuses on challenging the accuracy of dysfunctional thoughts through cognitive restructuring exercises, whereas ACT attempts to foster acceptance of such thoughts through cognitive defusion exercises. Previous research suggests that both techniques reduce the distress associated with negative thoughts, though questions remain regarding the benefit of these techniques above and beyond exposure to feared stimuli. Aims: In the present study, we conducted a brief experimental intervention to examine the utility of cognitive defusion + in-vivo exposure, cognitive restructuring + in-vivo exposure, and in-vivo exposure alone in reducing the impact of negative thoughts in patients with social anxiety disorder. Method: All participants completed a brief public speaking exposure and those in the cognitive conditions received training in the assigned cognitive technique. Participants returned a week later to complete a second exposure task and self-report measures. Results: All three conditions resulted in similar decreases in discomfort related to negative thoughts. ANOVA models failed to find an interaction between change in accuracy or importance and assignment to condition in predicting decreased distress of negative thoughts. Conclusions: These preliminary results suggest that changes in perceived importance and accuracy of negative thoughts may not be the mechanisms by which cognitive defusion and cognitive restructuring affect distress in the short-term.