Optimising exposure for adolescents with public speaking anxiety: Affect labelling or positive coping statements?

Cognitive Behavioural Therapy (CBT) is the first line treatment for anxiety disorders in youth however many adolescents do not benefit. Behavioural exposure is believed to be the critical ingredient of CBT and research with adults has shown that labelling affect, but not positive coping statements, enhances exposure outcomes. However, many CBT protocols for young people involve using positive coping statements alongside exposure. We compared the effects of exposure with positive coping statements, affect labelling, and neutral statements on fear responses in adolescents (age 13-14 years) with public speaking anxiety as they delivered a series of speeches in front of a pre-recorded classroom audience. Self-rated anxiety, heart rate, and observer ratings of expressed anxiety were assessed pre-test, immediate post-test and at 1-week follow-up. Neither affect labelling nor positive coping statements enhanced exposure on any measure from pre-test to 1-week follow-up. While there was an initial advantage of exposure with positive coping statements for post-speech self-reported anxiety, this effect was not maintained, and there was a significant increase in anxiety from immediate post-test to 1-week follow-up in this condition, compared to the other conditions. The short-term benefits from generating positive coping statements may explain why this is often employed in the treatment of anxiety problems in young people, but also indicate that it may not confer any advantage in the longer term. These intriguing findings highlight the urgent need for further attention to improve understanding of how to optimise exposure in young people and maximise treatment outcomes.