Jonathan D. Huppert

Background: Internet-based cognitive behavioral therapy (ICBT) has shown promise for the treatment of panic disorder (PD), but little is known about its feasibility and use across cultures and languages. Objective: This study examines the feasibility and preliminary outcomes of an Arabic-translated ICBT program for PD and describes how patients experienced the program. Methods: Six Arabic-speaking women (aged 21‐50 years, mean 35, SD 10 years) with a primary diagnosis of PD underwent a 16-week guided ICBT program using an Arabic-translated protocol. PD symptoms (Panic Disorder Severity Scale–Self-Report [PDSS-SR]), anxiety sensitivity (Anxiety Sensitivity Index-3 [ASI-3]), and agoraphobic avoidance (Mobility Inventory [MI]) were assessed pretreatment, posttreatment, and 3 months later. The outcomes were analyzed descriptively. Four patients also participated in individual, semistructured posttreatment interviews about their experience of the program, which are reported descriptively as the patient-perspective component of the case series. Results: The program was completed by 4 of the 6 (67%) patients. Among completers, PDSS-SR scores decreased from 11‐18 pretreatment to 0‐7 posttreatment, ASI-3 scores decreased from 18‐59 to 0‐4, and MI scores decreased from 1.44‐3.82 to 0.00‐1.60, indicating reduced agoraphobic avoidance. Follow-up data were available for 3 of the 4 (75%) completers: 2 maintained their gains, and 1 showed a partial return of symptoms. The fourth reported a recurrence of symptoms posttreatment but could not be reached for follow-up. During the interviews, all 4 patients expressed positive views of the program. Conclusions: Arabic-translated ICBT appeared feasible and was associated with reductions in panic symptoms and anxiety sensitivity among Arabic-speaking patients with mild-to-moderate PD. These preliminary findings support further investigation with larger samples.

In this study, we investigate mechanisms underlying transdiagnostic written-exposure therapy (WET), a novel, scalable, online intervention for pathological-anxiety symptoms. In a randomized controlled trial with 89 participants, WET produced significant anxiety reduction that continued through 2-month follow-up (standardized mean difference [SMD] = 0.85). We systematically evaluated multiple potential mechanisms across cognitive, emotional, and behavioral domains. From this broad assessment, two candidate mechanisms emerged as both significantly affected by treatment and correlated with symptom improvement: enhanced distress tolerance ( r = –.35) and decreased anxious responses to core threats ( r = .39). This suggests exposure therapy might operate through dual pathways: improving distress tolerance and reducing anxious responses. A neutral-imagery control condition showed immediate but nonsustained anxiety reduction and actually decreased distress tolerance, revealing distinct therapeutic trajectories between neutral-imagery-based versus exposure-based interventions. This research advances understanding of mechanisms of exposure while highlighting specific targets for enhancing interventions.

Social anxiety disorder (SAD) is characterized by disproportionate fear and anxiety of social performance and social situations. High socially anxious (SA) individuals exhibit heightened fear of ne...

This study utilized a single-session, randomized controlled analog design to investigate the mechanisms underlying cognitive-behavioral therapy (CBT) and psychodynamic therapy in treating anxiety sensitivity (AS). We hypothesized that changes in catastrophic interpretations of bodily sensations would predict reductions in AS in CBT, whereas improvements in panic-specific reflective functioning (pRF) would predict changes in the psychodynamic intervention (PDTp). Participants with elevated AS (N = 110; Mage = 43, 91 women) were randomized to CBT, PDTp, or a control group. Pre-to-post changes in mechanisms were examined as predictors of changes in AS at post-treatment and one-month follow-up. Results partially supported the hypotheses. Catastrophic interpretations changed significantly in the CBT condition. However, pRF did not change in any group. The relationship between changes in mechanisms and AS was more complex than predicted. In CBT, reductions in AS were closely tied to changes in interpretations. Within-session, distress declined in CBT but did not consistently predict AS change. pRF change was related to AS reductions only in CBT. These findings highlight the clinical relevance of targeting catastrophic thinking in brief CBT for AS, and suggest that pRF may play a secondary role. Future work should test these mechanisms in clinical settings and longer treatments.

Sudden gains in psychotherapy have been found to predict outcome, but the conditions under which this occurs remain understudied. In the present study, we experimentally examined the effects of processing sudden gains on treatment outcome. As part of a large randomized controlled trial of internet-delivered cognitive behavior therapy for social anxiety disorder (n = 182), we experimentally manipulated therapists' responses to sudden gains. Specifically, we randomized individuals who experienced a sudden gain (n = 52) to either receive (n = 26) or not receive (n = 26) processing of the gain. We found that processed sudden gains were significantly less likely to be reversed compared to unprocessed sudden gains. We also found that individuals with processed sudden gains had lower symptom levels at posttreatment/follow-up compared to individuals with unprocessed sudden gains (M_difference = 15.65, SE = 5.87, p = .023, Cohen's d = 0.84; M_difference = 16.68, SE = 6.36, p = .026, Cohen's d = 1.05; respectively). In addition, individuals with unprocessed sudden gains did not have significantly different symptom levels at posttreatment/follow-up compared to individuals who did not experience a sudden gain during treatment. Our findings suggest that in internet-delivered cognitive behavior therapy for social anxiety disorder, the processing of sudden gains (rather than the gains themselves) leads to upward spirals of improvement that affect long-term outcomes. Replication of these findings in additional studies is needed, and, if replicated, such findings could provide the basis for adding processing of sudden gains to existing therapeutic protocols. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

There is a growing interest in understanding insight or illness awareness in anxiety; however, most assessment instruments were designed for psychosis. The unique features of anxiety highlight the need for tailored measures to accurately evaluate insight. The aim of this study was to develop and validate the Schedule for the Assessment of Insight in Anxiety (SAI‐A), a clinician‐rated scale for assessing insight in anxiety disorders. We interviewed 46 participants diagnosed with anxiety disorders, conducted SAI‐A interviews, and administered self‐report measures. Using correlation and principal component analysis (PCA), we identified and assessed scale components, ensuring their reliability and consistency. The SAI‐A demonstrated acceptable psychometric properties, including convergent validity with an established self‐report measure ( r = −0.39, p = 0.008) and internal consistency (Cronbach’s α = 0.70). It showed moderate to strong agreement, interrater reliability (weighted kappa = 0.53, intraclass correlation coefficient [ICC] = 0.67), and test–retest reliability (ICC = 0.65). Two distinct insight components emerged: awareness of disorder and need for treatment. Higher overall SAI‐A scores correlated with symptom severity and impairment ( r = 0.56, r = 0.51, p < 0.001, respectively) and medication usage. The SAI‐A is a valid and reliable assessment tool, providing a comprehensive framework for understanding and addressing insight in the context of anxiety disorders.