Lindsey Stevens

22 March 2016
Annotated Bibliography
Alcaiz M, Baos R, Botella C, Guilln V, Perpia C, Pons A (2000). Telepsychology:
Public Speaking Fear Treatment on the Internet. CyberPsychology & Behavior. 3(6): 959968. Retrieved from http://digitalcommons.trinity.edu/cgi/viewcontent. cgi?
article=1006&context=psych_faculty

New technology has been developed to help individuals with an array of disorders. The
authors of this article discuss telepsychology and its effect on public speaking fear. The process
of this treatment includes an evaluation on individuals fear level, a structured program, and
assessments on the treatments effectiveness. In comparison to other common fear treatments,
benefits of telepsychology include that it is less threatening, individualized, accessible, etc. The
specific system that the authors discuss is Talk to me, a treatment that combines
psychoeducation, exposure, attentional focus, and cognitive restructuring. It provides various
scenarios in which individuals might experience anxiety: in a classroom, oral exam,
congratulatory speech, and more. The treatment constantly questions the subject on his or her
level of fear. Telepsychology can be more effective than exposure therapy due to its
individualized approach and accessibility, among other benefits. This article provides another
potential treatment to fear.

Anderson E, Becker CB, Zayfert C (2004). A Survey of Psychologists Attitudes towards and

Utilization of Exposure Therapy for PTSD. Behavior Research and Therapy. 42(3). 277292. Retrieved from
http://www.sciencedirect.com/science/article/pii/S0005796703001384

The extensive survey administered to psychologists and clinicians goes beyond stating
that professionals under-utilize exposure therapy and goes into the why. The study concentrates
on PTSD, but the authors discuss other anxiety disorders as well. The findings included that even
when psychologists are trained with and have a strong interest in behavioral treatment, exposure
is still not completely accepted or widely used due to its significant barriers. Many of the
participants responded that potential complications of the therapy include drop out,
overwhelming anxiety, avoidance, etc. The three main concerns that limit the professional use
are limited training, preference for individualized treatment (over manualized), and concerns of
patient decompensation. These concerns along with the ones listed before are helpful to know for
research. It provides insight into why professionals are using exposure therapy at an alarming
low rate, which could support the claim that it is not the best fit for adolescents trying to combat
their everyday fears.
Interestingly, the experimenters note that instead of testing new interventions to combat
PTSD (and other disorders), cognitive behavioral therapies have turned to the task of solely
trying to disseminate the current treatments to the mental health community. The survey also
produced evidence that psychologists are trained in exposure therapy use on exclusively PTSD
and not for other anxiety disorders. This is alarming as countless studies promote this treatment
on a variety of these conditions. Lastly, it is notable that many concerns did not vary with the
professionals differing levels of training, comfort, or theoretical orientation. Overall, this

survey study helps get a broader view of why exposure is potentially uncomfortable for
clinicians and harmful to patients.

Brooks AW (2013). Get Excited: Reappraising Pre-Performance Anxiety as Excitement. Journal

of Experimental Psychology: General. 143(3): 1144-1158. Retrieved from
http://www.apa.org/news/press/releases/2013/12/performance-anxiety.aspx

This article provides a solution to pre-performance anxiety using emotional reappraisal.

Reappraisal is a form of cognitive change that involves construing an emotion-eliciting situation
in a way that changes its emotional impact. Instead of trying to replace anxiety with calmness,
the experimenter suggests replacing it with excitement. Suppressing anxiety is ineffective as the
mind is attempting to change from a high-arousal state to a low-arousal state. By converting
anxiety to excitement, the subject simply changes from one high-arousal state to another, which
requires much less effort and physiological, cognitive, and interpersonal costs. Although
anxiety and excitement produce adverse effects on performance, they are beneficially similar
being arousal congruent. Reappraisal does not require the decrease in anxiety for the increased
excitement to improve performance. The experimenter finds that this self-talk (such as Im
excited or Get excited) will produce self-fulfillment.
The author also looks at the effect of reappraisal on math performance. When she
compares reappraisal to calmness, no reappraisal, and reappraisal to excitement, the results
provide that excitement improves math performance. Once the subjects are anxious about the
math assessment, the fearful state is hard to control. Even when attempting to remain calm, the

heart rates of individuals remain high throughout the entire assessment. These findings may be
paralleled to performance anxiety in singing, public speaking, etc.
This technique works because anxiety creates a threat mindset and excitement creates
an opportunity mindset. Once the person converts their anxiety into excitement with self-talk,
then one can convert the situation into something more positive. This article provides a real
potential solution instead of studying what does not work.

Cahill SP, Foa EB, Hembree EA, Marshall RD, Nacash N (2006 Oct). Dissemination of
Exposure Therapy in the Treatment of Posttraumatic Stress Disorder. Journal of
Traumatic Stress. 19(5): 597-610. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/jts.20173/abstract;jsessionid=B23B6F7E3140
F40D5E63E435F0AB2079.f02t01

This article does a good job of explaining it in a way that is professional but
understandable. The authors describe the therapy as a way to reduce unrealistic anxiety by
confronting the very situation that provokes the anxiety, either in imagination (imaginal) or real
life (vivo).
The main purpose of the article is to address why clinicians rarely utilize exposure therapy
even when its efficacy has been supported in many cases. The concerns that therapists hold on
administering the treatment is their lack of training on it and the preference for individualized
treatment as well as the patients tolerability, safety, and decompensation. In the provided
cases that support the inadequacy of the therapy, the article pokes holes in their accountability.

Thus, the authors do not incriminate or support exposure but rather provide both sides for the
reader to create their own view.

Cho M (2013 April 30). What Happens to Our Brains When We Have Stage Fright: The Science
of Public Speaking. Life Hacking. Retrieved from https://blog.bufferapp.com/whathappens-to-our-brains-when-we-have-stage-fright-the-science-of-public-speaking

This blog post by the co-founder of Ooomf takes a more casual look at fears effects. The
article is easy to understand yet adequately goes into the complex brain and body. The author,
Mikael Cho, explains that he had a fear of public speaking and that he thought the best way to
get over the fear was to figure out why he had it in the first place. Now no longer afraid of public
speaking, Cho explains his research and how he overcame stage fright. Humans are hardwired
to put our reputation first, so when one perceives something that could possibly interfere with it,
one instinctively experiences fear with a fight or flight response. When people get nervous or
scared, the hypothalamus activates the pituitary gland and the hormone ACTH is released. ACTH
then triggers the adrenal glands which releases adrenaline into the body.
This process creates a change in appearance: the body moves into a low-power position
of slouching as a pseudo-fetal position. However, if one tries to straighten the posture, muscles
of the limbs start to shake in preparation for an impending attack. Cho also lists many others
side effects of fear that are helpful in research. It is beneficial to know exactly what processes are
going on inside of the body in order to get focus on controlling certain areas.
The author gives credit for causing fear to genes, level of task mastery, and stakes. His
four step solution to cure the fear of public speaking includes: prepare, practice like its the real

thing, use his unusual breathing method, and book another speaking engagement immediately
after. This research and steps helped him, so it may be beneficial to research.

Hofmann SG, Meuret AE, Smits JJ, et al. (2006 Mar). Augmentation of Exposure Therapy With
D-Cycloserine for Social Anxiety Disorder. Arch Gen Psychiatry. 63(3):298304. Retrieved from http://archpsyc.jamanetwork.com/article.aspx?articleid=
209432&resultClick=3

This source analyzes SAD (social anxiety disorder) and a potential treatment. According
to the study, SAD is the third most common psychiatric condition in America. This research
not only provides a possible solution to this fear, but it goes the medical route. The scientists
explain that exposure therapy is used often for this disorder, but individuals often live with
symptoms. It was hypothesized that the agonist D-Cycloserine (DCS) would enhance the effects
of exposure therapy. This source is important in that the participants had significant public
speaking anxiety. Although teenagers are sometimes highly fearful presenting or performing,
they are constantly placed in the very situation the situation they dread the most.
The results supported the hypothesis: the subjects receiving exposure therapy and DCS
reported considerably less anxiety than the individuals receiving exposure therapy and a placebo.
It is helpful to see that there are other options.

Kendler KS, Gardner CO, Annas P, Neale MC, Eaves LJ, Lichtenstein P (2008). A Longitudinal

Twin Study of Fears from Middle Childhood to Early Adulthood: Evidence for a
Developmentally Dynamic Genome. Arch Gen Psychiatry. 65(4):421-429. Retrieved
from http://archpsyc.jamanetwork.com/article.aspx?articleid=482663&resultClick=3

The experimenters analyze the fears among twins to discern the inherent and learned
senses of fear. They studied the subjects as they aged and grouped their fears into three
categories: situational, animal, and blood/injury. Interestingly, they found that most of the fears
declined with age and that females had a higher scare intensity than the males. They found that
the self-reported fear intensities were higher than the intensities reported by the parents on behalf
of the subjects. This information could be used to support that adults are not aware of, or even
undermine, the fears of their children and push them to get over the minor distress.
In regards to genes, the scientists found seven noteworthy results. First, genetics
strongly play into situational fears, at least 50% in each age group. They also concluded that
there was no genetic influences that emerged in the last three age groups. Other significant
findings were that genetic factors that accounted for 50% of the intensity declined with age until
it was less than 5% responsible at age 20.
Overall, the experimenters wanted to discriminate between the hypotheses of whether
fear-causing genetic factors are developmentally stable or developmentally dynamic. By
stable, the experimenters meant that the set of genetic risk factors that are present at age 8 (the
starting age group for the experiment) remain with age. Conversely, the dynamic hypothesis
predicts that genetic effects on fear range with age. All three categories of fear supported the
developmentally dynamic hypothesis. Both attenuation and innovation was found in the genetics
risks from childhood to early adulthood. To clarify, there was a set of risk factors identified at

age 8 which decreased over time, but the study also found that there was an increase in another
set over the ages.
In regards to the twins, the scientists expectedly found that with age, shared environment
decreased and unique environment increased. This corresponds with adolescence in that
teenagers begin to experiment with different relationships and social groups. This explains how
nature vs. nurture impacts fear. The study provides valuable insight into how and why the twins
had some lasting fear and some diminishing fears. Additionally, this study doesnt assume that
genetic risks are stable through life and how it studies subjects from age eight until they turn
twenty, so it captures the pivotal changes of puberty on adolescents fear.

Kowan, J. (2013 Nov). Joe Kowan: How I Beat Stage Fright [Video File]. Retrieved from
https://www.ted.com/talks/joe_kowan_how_i_beat_stage_fright

In this relatable and informative presentation, Kowan explains his crippling fear of
performing in front of a crowd and how he beat it. His story supports initial thoughts of exposure
therapys setbacks/ineffectiveness. He discusses how he tried to combat his stage fright by going
to an open-mic night every single week. But this repeated exposure was no use, and every
weekend he would experience the same physical and mental effects from his phobia. Kowan
realized that going on stage every week would never solve his problem, so instead, he wrote a
song about his stage fright. By addressing his fear, he said that it let the crowd relate to him
instead of pitying his shaky performance. Instead of placing himself alone in an uncomfortable
situation over and over again in the hopes of overcoming the fear, he let the audience relate to
him so he wouldnt feel alone.

MacDonald K (2015 July 8). This Is Your Brain on Fear. The Confident Mind with
Psychotherapist Kyle MacDonald. Podcast retrieved from
http://overcomingsocialanxiety.com/the-confident-mind-podcast/this-is-your-brain-onfear/

The twenty minute podcast is led by Psychotherapist Kyle MacDonald. He claims that
among other parts in the brain where fear occurs, it is concentrated in the amygdala, where fear
is used as a survival mechanism through our flight or fight response. The density of the neurons
in the amygdala can predict the thickness of the connections between different nerve cells. The
more dense the neurons, the stronger the connections, and the more anxiety or fear the person
experiences. But the brain can adapt and be molded by experience due to its plasticity.
MacDonald suggests meditation as a treatment for anxiety. He explains that after an eightweek course on mindfulness, the neural connections in the subjects amygdala physically shrink.
In addition, the prefrontal cortex increases in density, making it easier to concentrate and
manage our impulses. Overall, the psychotherapist argues that meditation weakens the fear
centers control on our behavior. The more one practices mindfulness over time, the less anxiety
that grips the brain. Lastly, the speaker provides a short meditation practice. This podcast is very
interesting and opens a new topic of research. Although meditation is not the most highly
esteemed in terms of science and medicine, but its potential effects on the brain can be respected.

Ressler KJ, Rothbaum BO, Tannenbaum L, et al. (2004 Nov). Cognitive Enhancers as Adjuncts

to Psychotherapy: Use of D-Cycloserine in Phobic Individuals to Facilitate Extinction of

Fear. Arch Gen Psychiatry. 61(11):1136-1144. Retrieved from
http://archpsyc.jamanetwork.com/article.aspx?articleid=482089&resultClick=3

The article is similar to Artifact 3; both sources explore the effects of D-Cycloserine and
exposure therapy on fear. DCS has shown to decrease fear in rodents, so the experimenters
predicted to same would apply to humans on some level. It differs from the last artifact as this
source exposes the subjects to heights in a virtual glass elevator. The results indicated that the
combination of exposure therapy and DCS caused a significantly larger reduction of
acrophobia. Post-assessments after three months maintained the data. This shows that DCycloserine isnt just a temporary fix but can be a long-term solution.