Testing a procedural variant of written imaginal exposure for generalized anxiety disorder

J Anxiety Disord. 2014 Aug;28(6):559-69. doi: 10.1016/j.janxdis.2014.05.011. Epub 2014 Jun 14.


This experiment examined the degree to which it is more beneficial for individuals with generalized anxiety disorder (GAD) to engage in repeated exposure to mental imagery of the same feared scenario versus varying the exposure content. On three consecutive days, individuals with GAD (N=57) spent 20min writing about: (1) the same worst case scenario (consistent exposure; CE), (2) variations of their worst case scenario (varied exposure; VE), or (3) a neutral topic (neutral control; NC). Participants in the CE condition displayed significant decreases in worry, acute cognitive avoidance, and intolerance of uncertainty from baseline to 1-week follow-up; participants in the VE and NC conditions did not. Initial activation of self-reported anxiety (observed in the CE and VE conditions) and between-session reduction in anxiety (observed in the CE condition only) were associated with improvement in worry. Including more references to negative emotion and writing in the present tense were also associated with greater improvement in worry in the CE condition. These findings suggest that writing repeatedly about the same worst case scenario may benefit people with GAD. The study also provides information on potential mechanisms of change.

Keywords: Cognitive processes; Cognitive-behavioral therapy; Emotional processing theory; Exposure; Generalized anxiety disorder; Mental imagery.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Arousal / physiology
  • Avoidance Learning / physiology
  • Combined Modality Therapy / methods
  • Fear
  • Female
  • Humans
  • Imagery, Psychotherapy / methods*
  • Implosive Therapy / methods*
  • Male
  • Mental Processes / physiology
  • Psychiatric Status Rating Scales
  • Self Report
  • Surveys and Questionnaires
  • Uncertainty