Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Anxiety is a disabling mental disorder that affects 1 in 4 people during their lifetime. Effective strategies for treating anxiety include cognitive restructuring (CR; evaluating and challenging negative beliefs that maintain anxiety) and exposure (gradually facing fears). Exposure is thought effective because it reveals that expected feared outcomes do not occur when facing one's fear. In other words, the element of surprise during exposure changes negative beliefs and teaches the individual that there is nothing to fear. However, it has recently been proposed that CR should only happen after exposure, as introducing it before exposure would reduce the element of surprise and therefore make exposure less effective. Considering that CR is usually introduced in therapy before exposure, it is necessary to test this recommendation. My PhD research will explore whether examining one's beliefs using CR before vs. after exposure reduces the element of surprise, therefore reducing overall improvement in therapy. I predict that those who receive CR before exposure will be more surprised and, as a result, have better treatment outcomes than those who receive CR after exposure or no CR at all. 60 people with agoraphobia, a disorder where individuals experience extreme anxiety in public situations for fear that they will not be able to cope or escape from the situation if they experience panic-like symptoms, will receive 4 sessions of individual therapy tailored to their feared situations. 1/3 will receive CR after exposure, 1/3 will receive CR before exposure, and 1/3 will receive exposure without CR. During exposure, participants will identify decreases in fear and level of surprise. They will also complete outcome measures of agoraphobia at each of the 4 sessions and after 1 month has passed. A clearer understanding of how CT and exposure interact in therapy to influence outcome is integral to providing more effective health services to improve mental health in Canadians.