Internet-based extinction therapy for worry: A randomized controlled trial

Internet-based extinction therapy for worry: A randomized controlled trial
June 16, 2017 by
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Internet-based extinction therapy for worry: A randomized controlled trial

Worry is a key feature of many anxiety disorders as well as being something that the general population deal with constantly. Worry serves as a way of avoiding negative emotional experiences- if we “prepare for the worst” by worrying about some feared future event we hope to prepare ourselves for it and save ourselves from some of the harm that may result.

Worry can also be seen as a conditioned behaviour in that it is learned through a process of reinforcement. Worry consists of both imagining the catastrophic consequences of some future action (such as imagining a public speaking task going terribly) and comforting thoughts (eg telling yourself that the task won’t be as bad as you’re imagining). Catastrophic thoughts are therefore conditioned because they allow you to feel the comfort of the subsequent reassuring thoughts.

Based on this idea of worry as a learned behaviour, it can be extinguished by stopping the worrier from thinking comforting thoughts. Doing so removes their reason to think the catastrophic thoughts and so eventually they will stop having them. The current study describes a treatment method known as Internet based Extinction Therapy (IbET) in which patients are taught to block out their comforting thoughts with a competing thought process in order to eliminate the cycle of worry.

140 participants who rated highly on scales of worry completed an online program lasting 10 weeks. Participants were trained to block the comforting thoughts that resulted from worry using three techniques: a mindfulness-based acceptance of catastrophic thoughts (not evaluating the catastrophic thought as bad, and so having no reason to remove it), forcing yourself to think the worst thought instead of comforting thoughts, and accepting the fact that the catastrophic thought may very well come true and learning to accept this uncertainty.

Participants practiced each of these three thought processes for several weeks. This treatment approach was found to create a significant long-term reduction in symptoms of worry compared to a control group of patients placed on a waiting list. This anxiety treatment also produced significant reductions in depressive symptoms, cognitive avoidance and intolerance of uncertainty and a significant improvement in quality of life. By removing the comforting thoughts, participants lost the benefits of worry and so no longer had any reason to engage in it. While the treatment did produce some adverse effects in some patients, in the form of increased anxiety during the treatment, these effects were gone when assessed at a 4-month follow-up.

This research highlights an interesting new form of anxiety treatment which targets worry along a simple and effective behavioural process which can be successfully delivered online. Since worry is such a key feature of many anxiety disorders, particularly generalised anxiety disorder (GAD), this form of treatment could be especially effective in tackling GAD symptoms. Moreover, unlike other forms of GAD treatment, IbET does not require clients to expose themselves to high levels of anxiety for long periods of time, making it easier and less distressing for people to use. The next step in testing this exciting new GAD treatment would be to test it against other established forms of treatment.

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Authors: Erik Andersson, Erik Hedman, Olle Wadstro¨m, Julia Boberg, Emil Yaroslav Andersson, Erland Axelsson, Johan Bjureberg, Timo Hursti, Brja´nn Ljo´tsson
Journal: Behavior Therapy
Source Title:Internet-based extinction therapy for worry: A randomized controlled trial
Publish Date: July, 2016