UCLA

ABSTRACT OF THE DISSERTATION

Anxiety and Avoidance: The Relationship, Function, and Measurement

by

Natalie Nicole Castriotta

Doctor of Philosophy in Psychology

University of California, Los Angeles, 2013

Professor Michelle G. Craske, Chair

Study 1 aimed to differentiate fear and avoidance as separate predictors of treatment outcome and examine whether avoidance behavior is a stronger predictor of treatment outcome and future relapse than fear level. Participants were treatment seeking adults (N=75) who met diagnostic criteria for social anxiety disorder (SAD) using the Anxiety Disorders Inventory Schedule-IV (ADIS). Eligible participants were randomly assigned to one of two treatment groups to complete 12 weeks of manualized Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT) treatment. Fear, avoidance, and clinical severity ratings (CSR) were measured via the ADIS and participant self-report using the Mood and Anxiety Symptom Questionnaire at pre and post-treatment and six month follow-up. Results indicate that pre-treatment avoidance level predicted post-treatment fear level over and above pre-treatment fear level, but pre-treatment fear level did not predict post-treatment avoidance Level. Pre-treatment avoidance level significantly predicted post-treatment CSR and MASQ scores, over and above pre-treatment fear levels. Post-treatment avoidance level significantly predicted CSR and MASQ scores at six-month follow-up, over and above post-treatment fear levels. These results suggest that fear and avoidance are separate predictors of outcome, that avoidance may predict changes in fear, and avoidance may be a stronger and more stable predictor of treatment outcome and future functioning than fear level.

Study 2 aimed to create a new objective and ecologically valid measure of behavioral avoidance that recreates the approach-avoidance conflict that anxious individuals face when confronted with feared stimuli that incorporates risk and reward. Participants were recruited from an undergraduate student sample based on their level of Blood Injection Injury (BII) Phobia related symptoms using the Blood Injection Symptom Scale and placed into Low and High Anxiety groups. The Behavioral Avoidance and Reward Sensitivity Task (BARST) consisted of six levels and asked participants to choose to view one of two groups of BII related images, where one set was more difficult but yielded a higher reward. Each level increased in difficulty and incentive and measured participants' willingness to approach feared stimuli in exchange for reward. The results indicated that the high and low anxiety groups differed as a function of the difficulty level and the reward incentive associated with the images. Reward incentive was also found to be a more consistent predictor of the decision to approach feared stimuli than anxiety level. The results indicate that in general, anxious individuals become more risk averse and less sensitive to reward as difficulty level increases as compared to non-anxious individuals. Also, anxious individuals vary in both their sensitivity to reward and their willingness to approach fear provoking stimuli in exchange for reward.