Reaching New Heights:
Comparing Interpretation Bias Modification to
Exposure Therapy for Acrophobia
Shari Steinman &
Bethany Teachman
University of Virginia
Height Fear



Very common
3-5% of population
have acrophobia
Limitations of current
gold standard
treatment
(Antony, Craske, & Barlow, 1995)
Biased Interpretations



Overestimate Danger
Doubt ability to cope
Predicts Fear and
Avoidance on Heights
(Steinman & Teachman, 2011)
Theory
• Test causal
premise
Clinical
• Compare to
exposure
therapy
Participants





N = 101
77% female
Mean age: 24 (SD: 11.81, range 18-67)
> 45.45 on Acrophobia Questionnaire
Met sub-threshold or threshold SCID criteria for
acrophobia
Conditions
Interpretation
Only
• n = 25
Exposure
Only
• n = 28
Interpretation
+ Exposure
• n = 24
Control
• n = 24
Screening
S1: Baseline Measures
S2 & S3: Intervention/Control
S4: Outcome Measures
One Month Follow-up
Interpretation Training:
Scenario Training

You are standing on the edge of a balcony of a
ten-story building. You realize the railings are
shorter than they are on most balconies. The
m
chances of you falling are still mini_al.
Are you likely to fall off the balcony? NO
(modified from Mathews
& Mackintosh, 2000)
Interpretation Training:
Interpretation Modification Paradigm
Dangerous OR
Secure


“While standing on a
chair to reach a book
on a high shelf, you are
startled by a loud
noise.”
Are the word and the
sentence related?
(modified from Beard &
Amir, 2008)
Exposure Therapy

Half of the participants completed two sessions of
exposures with trained therapists
Control


You are reading one night when you come
across a word that you do not know. You
decide to look up the word. You go get your
i
dict_onary.
Do you look up a definition? YES
(modified from Mathews
& Mackintosh, 2000)
Hypotheses
Interpretation
Only
Interpretation
+ Exposures
• n = 25
• n = 24
Exposures
Only
• n = 28
improvement on all
“therapeutic synergies”
outcome measures
(beyond practice
Largest treatment gains
effects)
Control
• n = 24
Interpretations: Novel Scenarios
4.00
*
*
3.50
Endorsement
3.00
2.50
2.00
1.50
1.00
Positive
Negative
Positive
Heights
Negative
Foils
Disambiguated Interpretations
Interpretations: Heights Interpretation
Questionnaire
55
Heights Interpretation Questionnaire
50
45
40
35
30
25
Pre
Post
Time
Symptoms: AQ-Anxiety
75
Acrophobia Questionnaire-Anxiety
70
65
60
55
50
45
40
35
30
Pre
Post
Time
Height Fear Symptoms: AQ-Avoidance
20
Body
Sensations
Acrophobia Questionnaire-Avoidance
18
Anxious
Thoughts
Avoidance
16
14
12
10
8
6
Pre
Post
Time
Maintenance of Gains
60
Acrophobia Questionnaire-Anxiety
55
50
45
40
35
30
25
Post
Follow-Up
Time

Interpretations
Symptoms
Emotional Vulnerability

Differences?


 Novel
Scenarios
 Continued Improvement
Implications
Maladaptive
Interpretations




More palatable
Inexpensive
Done at home
Reach more people
Anxiety
Thank You

Supported by:
 NIA
R01AG033033
 NIH RO1MH075781

Research assistants, therapists, and graduate
students from the Program for Anxiety, Cognition,
and Treatment (PACT) Lab