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Comparison Between Brief Acceptance and Cognitive
Comparison Between Brief Acceptance and Cognitive
Interventions: Assessing Public Speaking Performance in Socially-
Interventions: Assessing Public Speaking Performance in Socially-
Anxious Individuals
Anxious Individuals
Soultana Mpoulkoura
Minnesota State University, Mankato
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public speaking performance in socially-anxious individuals [Master’s thesis, Minnesota State University,
Mankato]. Cornerstone: A Collection of Scholarly and Creative Works for Minnesota State University,
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Comparison Between Brief Acceptance and Cognitive Interventions: Assessing Public Speaking
Performance in Socially-Anxious Individuals
by
Soultana Mpoulkoura
A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of
Master of Arts
In
Clinical Psychology
Minnesota State University, Mankato
Mankato, Minnesota
May 8th, 2019
May 8th, 2019
Comparison Between Brief Acceptance and Cognitive Interventions: Assessing Public Speaking
Performance in Socially-Anxious Individuals
Soultana Mpoulkoura
This thesis has been examined and approved by the following members of the student’s thesis
committee.
____________________________________
Advisor Jeffrey Buchanan, Ph.D.
____________________________________
Committee Member Kari Much, Psy.D.
____________________________________
Committee Member Bradley Arsznov, Ph.D.
I
Dedication
Creating this thesis have a been a delightful and rewarding experience. From the first
part until the last has been an enjoyable and informative endeavor. All of this project would not
have been possible without the people who inspired me and guided me along the way. First, I
would like to thank my advisor, Dr. Jeffrey Buchanan, who with his guidance and knowledge
created an easy path for me to follow and made every step in the process incredibly clear. I
would also like to thank Mr. Samuel Spencer, who helped and guided me in extending his study,
with his endless guidance, feedback, and insightful comments, in the stages of experimental
design and data analysis. The study would have not been as well-created without the help and
understanding of my entire committee.
I would also like to thank all the students who participated in this study, both, as research
assistants and as participants. This project would not have been possible without the tireless
efforts of faculty and without the undergraduate students on our research team.
On a personal note, I would like to take a moment to thank my dear husband Louis for his
endless support, patience, and love throughout my academic career. I would not have been here
if not for his efforts. I would like to dedicate this thesis to my kids, Fotini and Andreas, who
with their support and understanding made me to strive achieve excellence in academia and
beyond. I only hope I am and I will be the role model they always wanted to have.
II
Abstract
Social anxiety disorder is one of the most prevalent psychological disorder to date and it
is associated with impairments in multiple domains, such as in occupational and academic
settings. Although, traditional Cognitive Behavioral Therapy (CBT), aims to reduce distress by
altering maladaptive schemas, this approach is not always successful. Recent research has
shown ambiguous support for cognitive restructuring as a mechanism of change. Therefore,
further research is needed to discover effective treatments. Acceptance and Commitment
Therapy (ACT), emphasizes psychological flexibility and values rather controlling negative
thoughts. The current study compared brief acceptance and cognitive control based interventions
for increasing performance on a public speaking task. It was hypothesized that participants in
CBT and ACT conditions will exhibit greater reduction of anxiety following the speech task
compared to the psychoeducational control group. It was also hypothesized that the acceptance
based intervention will lead to greater increases in performance compared to other two protocols.
Participants were college students at a Midwestern public university and were then randomized
to receive an acceptance, cognitive-control, or psychoeducational-based protocol. Participants
then prepared and gave 5-minute autobiographical speech in front of an audience of two research
assistants. Results indicated that participants in either ACT, CBT, or Control conditions did not
significantly differ in public speaking performance, nor did differ on physiological anxiety,
subjective distress and experiential avoidance. These findings promote the utility of brief
interventions and promote the importance of continuing to develop techniques that increase
public speaking performance.
Keywords: Acceptance-based interventions, Cognitive-based interventions, ACT, CBT, public
speaking anxiety, social anxiety.
III
Table of Contents
Table of Contents
Introduction ……………………………………………………………………………………………………………..6
Method ………………………………………………………………………………………………………………….12
Results …………………………………………………………………………………………………………………..19
Discussion ……………………………………………………………………………………………………………..22
References ……………………………………………………………………………………………………………..28
Tables
1. Overall Means for Dependent Variables…………………………………………………………………..35
2. Means by Dependent Variables by Condition…………………………………………………….36
3. Participant Ratings of Intervention……………………………………………………………..36
4. Participant Ratings of Public Speaking Task……………………………………………………………..36
Figures
1. Experiment flow chart……………………………………………………………………………………………37
2. Participant AAQII ratings……………………………………………………………………………………….38
3. Participant SUDS ratings…………………………………………………………………………………………38
4. Participant BPM ratings…………………………………………………………………….39
Appendices
A. Participant recruitment email………………………………………………………………………………….40
B. Participant Demographics………………………………………………………………………………………41
C. Spielberger State-Trait Anxiety Inventory………………………………………………………………..42
D. Acceptance and Action Questionnaire-II………………………………………………………………….43
E. Speech Performance Scale………………………………………………………………………………….44
F. CBT intervention protocol………………………………………………………………………………………45
G. ACT intervention protocol……………………………………………………………………………………..49
H. Psychoeducational intervention protocol………………………………………………………………….53
I. Participant speech instructions………………………………………………………………………………..56
J. Confederate instructions………………………………………………………………………………………..57
K. Informed consent form…………………………………………………………………………………………..58
L. Post-speech survey………………………………………………………………………………………………..60
M. Debriefing form……………………………………………………………………………………………………61
1
Comparison Between Brief Acceptance and Cognitive Interventions: Assessing Public Speaking
Performance in Socially-Anxious Individuals
Fear of public speaking is prevalent in American society. The prevalence of public
speaking anxiety (PSA) in the general population ranges from 25% to 85% (Glassman &
Foreman, 2016; Russio et al., 2008). Public speaking is the most common lifetime social fear and
at clinical levels, PSA is diagnosed as social phobia (England et al., 2012; Glassman & Foreman,
2016). Social phobia, also known as social anxiety disorder, is a condition marked involving
marked anxiety about social or performance situations in which there is a fear of embarrassing
oneself under scrutiny by other (Ruscio, Brown, Chiu, Sareen, Stein, & Kessler, 2008). Socially
anxious individuals tend to avoid situations where they assume they will be perceived by others
unfavorably (Craske et al., 2014; Eifert & Forsyth, 2005).
Public speaking anxiety is connected with higher rates of unemployment, lower income,
and reduced likelihood of completing a college education compared to the general population of
the United States (Cunningham, Lefkoe, & Sechrest, 2006; England et al, 2012). Public speaking
anxiety is often the primary reason of non-advancement in someone’s career (Cunningham et al.,
2006). Individuals with public speaking anxiety also experience significant distress and
impairment in their education, work, and social life (England, Herbert, Forman, Rabin, Juarascio,
& Goldstein, 2012).
Cognitive Behavioral Approaches
To date, a growing body of literature has focused on theoretical implications for
intervention and prevention of disorders (Block, 2003). Cognitive theory asserts that information
processing is vital for human adaptation and survival. The cognitive system is tied to other
affective, behavioral, and motivational repertoires (Beck, & Dozois, 2011). Each of these
repertories serves as a single function and operates in synchrony toward goal-oriented strategies.
2
Cognitive-behavioral therapists have developed an information-processing model, whereby
hypothesized cognitive structures, or schemas, are causally involved in the development of
psychopathology (Block & Wulfret, 2000). Cognitive behavioral therapy, therefore, focuses on
identifying, modifying, and ultimately replacing these maladaptive cognitive structures
(Glassman et al., 2016; Block & Wulfret, 2000).
Cognitive behavioral therapy is described as an active, collaborative, current-problem
oriented treatment that combines both, cognitive and behavioral principles to lessen distress and
reduce clinical symptoms (Herbert & Foreman, 2009). With regard to PSA, cognitive theories
suggest that anxiety may be maintained because of the importance the individual places on being
positively received by others and fears that one will be negatively judged and scrutinized by
others (Rapee & Heimberg, 1997). Action theory is a part of the comprehensive model of
cognitive theory concerning social anxiety. The action theory gives an emphasizes cognitive
processes that are relevant to a goal attainment. The goal achieved by an individual defines the
demands of an event and also cognition and behavior in a certain way (Hoffman, 2007). When
individuals with this disorder attend a social event they monitor and observe themselves
constantly (Hoffman, 2007).
Outcome research suggests that 50% of persons with social anxiety can benefit from CBT
(Craske et al., 2014; Hoffman, 2007). However, although CBT is quite effective, many patients
do not show benefits (Craske et al., 2014; Gould, 1997). Little and Simson (2000) argue that
CBT works because clients learn to alter the form and/or frequency of negative thinking patterns.
However, recently some have argued that there is limited evidence that changes in the form or
frequency of negative cognitions accounts for the positive treatment effects associated with CBT
(Hayes, 2004; Craske et al., 2014), which calls into question the proposed mechanisms of change
3
postulated by cognitive-behavioral theorists. Consequently, acceptance-based approaches rooted
in behavior analytic theories of language and cognition have been developed to address these
shortcomings associated with traditional CBT (Hayes, 2004; Craske et al., 2014).
Acceptance and Commitment Therapy
One of these acceptance-based treatment approaches is Acceptance and Commitment
Therapy (ACT). ACT includes a number of methods that are designed to help individuals
experience aversive private events (e.g., anxiety, self-defeating thoughts) without engaging in
ineffective behaviors intended to terminate these aversive private events (e.g., drinking, avoiding
social situations; Hofmann, 2007; Rapee & Heimberg, 1997). One of these methods is called
cognitive defusion, and is designed to address the harmful effect of cognitive fusion, which
refers to the connection between language and behavioral domination. An individual with PSA
might have a self-evaluation and have thoughts that one is bad or is unlovable (Hayes, Levin,
Plumb-Viladarga, Villate, & Pistorello, 2013). Fusion might not be harmful in a general sense,
but it can be harmful when individuals take their thoughts literally without considering the
process of thinking by itself (Hayes et al., 2013). ACT also address the role of that experiential
avoidance, which is an attempt to change or avoid internal experiences, such as thoughts,
feelings, or bodily sensations even when this avoidance is very costly (Heyes et al., 2013). ACT
contends that experiential avoidance is important in maintaining psychological disorders such as
social phobia (Block & Wulfert, 2000). For example, socially anxious individuals may focus on
unpleasant internal events such as thoughts and feelings and try to change them using strategies
similar to those they use when attempting to change external events (e.g., try to control negative
thoughts by ignoring them or changing the way one thinks; avoid social situations). Avoidance
of unpleasant situations, emotions, and thoughts can restrict one’s life in important ways, which
4
in turn can lead to loss of social or occupational opportunities and ultimately, result in emotional
isolation (Hayes, Wilson, & Strosahl, 1999).
Ultimately, the goal of ACT is to discourage avoidance and foster psychological
flexibility such that an individual is able to make decisions and engage in actions according to
one’s values as opposed to behavior being motivated primarily by avoidance of aversive
situations and private events (Hayes, 2008). Acceptance and Commitment Therapy, therefore,
emphasizes psychological acceptance and the reduction of emotional avoidance as the primary
mechanisms of change rather than altering cognitive content.
Literature Review
In terms of treating social anxiety, and in particular PSA, both CBT and ACT have
produced beneficial results (Ruiz, 2012; Craske et al., 2014). However, only a small literature
has directly compared change-oriented therapies such as CBT and acceptance-oriented therapies
such as ACT for reducing social anxiety. Glassman, Foreman, Herbert, Bradley, Foster,
Izzetoglou, & Ruocco (2016) completed one such study designed to increase public speaking
performance. This study also investigated neurophysiological changes associated with each
treatment. Results indicated that the differences between these two interventions in terms of
reducing public speaking anxiety and improving performance were marginal. In addition,
individuals who received a 90-minute ACT intervention had significantly lower levels of blood
volume in their left dorsolateral prefrontal cortex, compared to those who received a CBT
intervention of similar length and structure (Glassman et al., 2016). These results suggest that
trying to control thoughts may negatively affect public speaking performance because cognitive
resources are devoted to controlling negative thoughts, feelings, and bodily sensations while
trying to perform a behavior such as giving a speech (Glassman et al., 2016).
5
Spencer (2017) compared CBT and ACT in relation to public speaking anxiety in a
sample of 42 socially anxious college students. The study implemented brief, 15-20 minute
acceptance and cognitive-based interventions. The interventions were designed to prepare
participants for a public speaking task. Results of this study indicated that although there were
no significant differences between the CBT and ACT conditions, participants in ACT condition
exhibited less distress during the public speaking task (Spencer 2017, unpublished thesis). In
addition, individuals in the ACT condition exhibited significantly lower experiential avoidance
compared to participants in the CBT condition (Spencer 2017, unpublished thesis), which
provided some evidence that ACT produced benefits consistent with its proposed mechanism of
change.
Purpose of Current Study
This study contributes to the extant literature by investigating the use of brief acceptance,
cognitive, and psychoeducational-control based interventions for increasing public speaking
performance. Both control-based and acceptance-based interventions have been shown to
decrease PSA, but it is unclear which treatment may produce greater benefits with regard to
public speaking performance. The effects of treatment on public speaking performance may be a
key differentiator of these two treatments because although reducing anxiety is an important
outcome, improving public speaking performance is arguably more important. Therefore, it is
important to investigate the differential effects of acceptance- and cognitive-based interventions
for increasing performance as well as decreasing anxiety associated with public speaking.
Therefore, the primary goal of this study was to compare brief acceptance- and cognitive-based,
interventions for increasing public speaking performance in social anxious individuals. This
study expanded Spencer’s (2017) study described previously. The current study compares the
6
differential effects these interventions have on anxiety and it evaluates the differential effects of
the interventions on public speaking performance. The current study expands upon previous
research by including: 1) a psychoeducational control group, and 2) physiological measurement
to investigate how the different interventions impact physiological responses consistent with
anxiety (i.e., heart rate).
Given previous literature and the purposes of the current study, several hypotheses were
proposed. The current study hypothesized that participants in CBT and ACT conditions will
exhibit greater reduction in anxiety following the speech task in comparison to no treatment,
control group. This hypothesis is based on existing research that has shown that both treatments
are equally effective for reducing anxiety (Craske et al., 2014; Forman et al., 2007). A second
hypothesis is that participants receiving either an ACT or CBT protocol will have greater public
speaking performance than the Control group. This hypothesis is based on Goldfarb (2009),
which found that individuals in both conditions had greater public speaking performance than the
control group. Third, it is hypothesized that participants in the ACT protocol will show less
avoidance post-intervention than participants in the CBT group, or participants in the control
group. This hypothesis is based on Glassman et al. (2016), which found that individuals in the
ACT condition had more available cognitive resources than individuals in CBT condition, which
lead to superior public speaking performance. The fourth hypothesis is that Participants in the
control condition will have higher subjective distress during and after the task compared to other
two groups. This hypothesis is intended to be a process measure of mechanism of action in ACT
which provides that reductions in distressing thoughts is not the main focus of change (Hayes,
2004). The fifth hypothesis is that participants in the control condition will have higher
physiological anxiety (Fitbit) levels during and after the task compared to other two groups. This
7
hypothesis also investigates the mechanism of action proposed by ACT in that instructions to
accept one’s distress and negative feelings may lead to greater distress because less effort will be
devoted to decrease anxiety while more effort will be devoted to attending to the immediate
experience of anxiety (Hayes et al., 2013). Furthermore, it is expected that participants in the
control condition will have higher anxiety during and after the public speaking task compared to
other two groups given that no specific coping mechanisms will be provided to those in the
control group.
Method
The experimental design utilized in this current study involved random assignment of
participants to receive either an acceptance-based, cognitive-control-based, or psychoeducational
control intervention. Following completion of the assigned intervention, participants prepared,
and then delivered, a five-minute autobiographical speech. Speeches were videotaped for and
were later analyzed to determine level of performance. The experimental design was a partial
replication of a studies completed by Spencer (2017) and Goldfarb (2009).
Participants
Participants in this study were undergraduate college students from a Midwestern public
university. Three hundred forty-nine students completed prescreening measures to determine the
severity of public speaking anxiety. Ninety of these individuals (26%) met the inclusion criteria
and were subsequently contacted via email to participate to the in-person part of the study. In
total, 38 individuals (42%) participated in the in-person part of the study. Among this sample,
36 were women (95%), 23 indicated that they were first-year college students (61%), 29
reported their ethnicity as “Caucasian” (76%), and 26 were nineteen years of age or younger
(69%).
8
Prescreening Measures
After the participants went through the consent procedure, participants completed a
prescreening survey via the SONA online survey management tool. The online prescreening
survey included measures of social anxiety as well as fear of public speaking.
Social phobia. The Social Phobia Scale (SPS; Mattick & Clarke, 1998) is a 20-item self-
report measure of anxiety and distress regarding being observed by others in social situations.
The SPS consists of 20 items measured on a 5-point Likert scale from 0 indicating “Not at all
characteristic or true of me,” to 4 indicating “Extremely characteristic or true of me.” The SPS
total score can range from 0 to 80, with higher scores indicative of greater social anxiety. The
SPS demonstrated high levels of test-retest reliability (α = .91), internal consistency (α = .89),
and a exhibited a positive association with other measures of social anxiety (Mattick & Clarke,
1998). For a participant to be eligible for the in-person portion of the study, they had to score
above the cutoff score of 20 (Goldfarb, 2009; Block & Wulfert, 2000; Spencer, 2017), which
indicates at least moderate levels of social anxiety. The SPS scores from the current study
yielded a range of 20-61, (M=36.42, SD=11.50).
Fear and avoidance related to public speaking. The second prescreening measure
contained two items from the Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987). Two
items from this instrument were used to rate participant’s level of fear and avoidance in relation
to public speaking. The first item asked participants to rate their level of fear using a 4-point
Likert Scale ranging from 0 (none), 1 (mild), 2 (moderate), to 3 (severe). The second item asked
participants to rate their level of avoidance regarding public speaking, using also a 4-point Likert
Scale ranging from 0 (never), 1 (occasionally), 2 (often), to 3 (usually). In the current study,
37% of participants reported “usually” avoiding public speaking situations, and 34% endorsed a
9
“severe” level of fear regarding public speaking. Inclusion criteria required participants to rate at
least a “moderate” level of fear and “occasional” avoidance of public speaking situations, criteria
that were also used by Goldfarb (2009).
Pre- and Post-Speech Outcome Measures
Participant were asked to complete a demographic survey as well as a series of outcomes
measures both prior to giving and speech and after the speech. These measures will be describe
in detail below.
State anxiety. The Spielberger State Anxiety Inventory (SSAI; Spielberger, 1983) is a
20-item, self-report instrument used to measure an individual’s current level, or state, of anxiety.
Items are rated on a Likert scale with 1 indicating “Not at all,” and 4 meaning “Very much so”.
with 10 of the items being reverse-scored. The SSAI’s composite score consists of the sum of 20
items, ranging from 20 to 80. Higher scores signify greater anxiety. Previous research has shown
that the SSAI demonstrated good test-retest reliability (α=.65-.75), good internal consistency (α
=.86-.95), and evidence of sufficient concurrent and construct validity (Speilberger & Vagg,
1984).
State distress. The Subjective Units of Discomfort Scales (SUDS; Wolpe & Lazarus,
1966) are a self-report, subjective measure of the amount of state distress one is experiencing at a
given moment. SUDS ratings are reported on a scale of 0 – 100, with 0 representing “No
distress,” and 100 representing “The most conceivable distress.” Tanner (2012) found that
SUDS ratings demonstrated outstanding convergent validity with clinician ratings of patient
distress.
Psychological inflexibility. The Acceptance and Action Questionnaire-II (AAQ-II; Bond
et al., 2011) is a seven-item, self-report measure of psychological inflexibility and experiential
10
avoidance. The AAQ-II consists of seven statements that individuals report on a Likert scale of
1-7, with 1 meaning “Never true,” and 7 meaning “Always true.” The AAQ-II composite score
consists of the sum of all seven items, ranging from 10 to 42. Higher scores suggest greater
psychological inflexibility and experiential avoidance. Bond and his colleagues found that the
AAQ-II demonstrated good content validity (a=.84), as well as adequate internal consistency (α
=.80) and test-rest reliability (α=.81, .79). Bond et al., (2011) also found that clinical samples
typically yielded AAQ-II scores from 24-28, whereas non-clinical samples yielded AAQ-II
typically had scores from 18-19.
Speech performance. The Perception of Speech Performance (PSP; Rapee & Lim, 1992)
is a 17-item self- or other-report rating of the perception of public speaking performance. The
PSP consists of 12 specific behavioral items (i.e., “Had long pauses; Fidgeted”) and 5 global
items (i.e., Appeared nervous; Made a good overall impression). Items were rated on a Likert
scale with 0 meaning “Not at all,” and 4 meaning “Very much.” A few items are reverse-
scored, and previous research has conventionally combined the specific and global items to form
a collective score (Glassman et al., 2016; Rapee & Lim, 1992). Higher scores signify worse
speech performance. The PSP has been found to have sufficient levels of internal consistency
with a Cronbach’s α of .79 (Rapee & Heimberg, 1997; Rapee & Lim, 1992).
Two research assistants, who were blinded to participant condition, rated the video
recordings of each participant’s speech using the PSP. One research assistant served as the
primary rater, while a second rater evaluated 30% of the videos to provide a measure of
interobserver agreement (IOA). Both research assistants underwent extensive training from the
first author about how to evaluate the speeches. IOA as calculated using a Pearson product
moment correlation coefficient was .41.
11
Apparatus
Heart rate was measured as a means of assessing physiological arousal/anxiety. Heart
rate (i.e., beats per minute; bpm), was measured using a portable Fitbit. The Fibit was placed on
the participant after the consent process was completed and was removed after post-speech
questionnaires were completed. Heart rate data then were analyzed included peak bpm prior to
giving the speech, during the speech, as well as following the speech.
Procedures
All study procedures were approved by the University’s Institutional Review Board.
Participants first completed the online pre-screening surveys described above. Eligible
participants were then invited to participate in the in-person part of the study. After completing
the informed consent process and being fitted with the Fitbit, participants were randomly
assigned to receive either an acceptance-based, a cognitive-based, or psychoeducational-based
intervention. Prior to participating to the assigned condition, participants completed the self-
report measures of state anxiety, subjective level of psychological distress, and psychological
inflexibility/emotional avoidance. The three intervention conditions were scripted, administered
by the first author, and were designed to be comparable in terms of (a) duration (15 min), (b)
components included, such as rationale and realistic implementation, and (c) sequence of
components.
Cognitive restructuring condition. The cognitive restructuring (CR) protocol used in
this study was adopted from the study by Goldfarb (2009). This protocol was 15 minutes in
length and based on the Feeling Good Handbook by David Burns (1999). The protocol began
with a brief description of fear related to public speaking and clarified the nature of social
anxiety (see Appendix F). Then it introduced a cognitive component to social anxiety, and taught
12
participants to critically evaluate their way of thinking by identifying cognitive distortions and
replacing those thoughts with more adaptive ones. Participants were then instructed to engage in
an cognitive restructuring exercise with the researcher. This exercise involved recording their
thoughts related to the upcoming public speaking task and public speaking in general (i.e., “If I
am nervous I won’t be able to do this”), identifying maladaptive thinking patterns about public
speaking (i.e., “Personalization and blame”), and replacing these cognitions (Spencer, 2017).
Conclusively, the participants were instructed to utilize the CR strategies that they had just
learned for the upcoming public speaking task.
Acceptance-based condition. The acceptance-based protocol used in this study was also
adopted from Goldfarb (2009), who based the protocol on the work of Block and Wulfert (2000)
and Eifert and Forsyth (2005). The acceptance-based protocol provided directions for accepting
distressing thoughts and emotions and proposed that controlling one’s thoughts and feelings may
represent an unworkable agenda (see Appendix G). The acceptance-based protocol also
introduced the participant to a metaphor (i.e., Quicksand metaphor; Hayes, 2005, p. 3-4). The
metaphor emphasized the importance of accepting upsetting thoughts in accordance of one living
life according to one’s values. Similar to the CR protocol, the acceptance-based protocol also
featured a pragmatic cognitive defusion exercise that required participants to identify and label
thoughts, emotions, and sensations and to accept these experiences in the context of the public-
speaking task (Hayes et al., 2013; Spencer, 2017). Lastly, participants in the acceptance
condition were instructed to use these strategies during the public speaking task.
Psychoeducational-based condition. The psychoeducational-based protocol was also
adapted from Goldfarb (2009) study, which was based on the work of Barlow (2002) and Rathus
& Greene (2008). The psychoeducational control-based protocol provided education on: 1) the
13
definitions of anxiety and fear and the differences between the two concepts (see Appendix 3), 2)
the relationship between social anxiety and public speaking, 3) the DSM-V criteria for social
phobia, 4) the prevalence of social phobia (Goldfarb, 2009), and 5) the different psychological
and medicinal treatments for social phobia.
Public Speaking Task
Following the intervention, participants were given five-minutes to prepare for a five-
minutes speech. The topic of the speech was autobiographical in nature and participants were
asked to respond to five separate prompts. The prompts asked participants to describe one time
when they dealt with adversity in addition to the strengths and weaknesses of their personality.
Speeches were then videotaped for purposes of collecting public speaking performance data.
Previous research has found that public speaking tasks that provide participants with freedom to
select the topic of speech are ecological valid (Glassman et al., 2016; Spencer, 2017).
Use and Usefulness of Instructed Strategies
Following the speech, participants were also asked to rate their appointed intervention in
terms of: 1) actual use of strategies described in the intervention during the public speaking task,
and 2) perceived usefulness of the assigned intervention. Using a 4-point scale, ranging from 1
(not at all) to 4 (Quite a bit), participants rated how much the following statements applied to
them: 1) “I used the assigned strategies during preparation for and delivery of my speech” (actual
usage of appointed treatment strategy); 2) “I found this strategy to be very useful for preparation
and delivery of my speech” (i.e., efficacy of strategy).
Results
Means and standard deviations of all outcome measures are included in Table 1.
Descriptive and inferential statistics for the depended variables on all three experimental
14
conditions are provided in Table 2. A chi-square test of independence has shown that CBT, ACT
and psychoeducational control groups did not significantly differ regarding ethnicity, 2(8)=9.41,
p=.31, gender, 2(2)=1.10, p=.58, years in school, 2(6)=11.85, p=.07, and anxiolytic use,
2(2)=.396, p=.82. A one-way ANOVA found no statistically significant difference between the
groups with regard to age, CBT (M=20.38, SD=2.79), ACT, (M=18.77, SD=1.36), and control,
(M=18.75, SD=.75), F(2,35)=3.25, p=.051.
Hypothesis 1: Participants in ACT and CBT conditions will exhibit greater reduction in
anxiety following the speech task in comparison to no treatment, control group. There were no
pre-speech differences between the three conditions on the STAI-pre, CBT, (M=50.00,
SD=12.54), ACT, (M=42.69, SD=11.40), and control, (M=51.25, SD=10.33) groups. A repeated
measures ANOVA also confirmed that there was no significant difference between the groups,
F(2,35)=2.06, p=.142. Although, participants in the Control condition reported greater levels of
anxiety post-speech STAI-post (M=53.33, SD=13.36), in comparison to CBT condition
(M=49.08, SD=10.31) and the ACT condition (M=45.31, SD=10.81). An ANOVA also found no
statistically significant difference between conditions F(2,35)=1.51, p=.234.
Hypothesis 2: Participants receiving either ACT or CBT protocol will have greater
public speaking performance than the control group. Although, participants in the CBT condition
exhibited greater levels of speech performance (M=22.08, SD=5.81) than in the ACT condition
(M=22.23, SD=4.80), or in the control condition (M=24.33, SD=7.08), an ANOVA did not find
statistically significant difference between the conditions F(2,35)=.556, p=.578. In addition,
there were no statistically significant between group differences in the PSP micro items
(M=13.18, SD=3.54), F(2,35)=.009, p=.991, or in the PSP global items (M=9.34, SD=3.02),
F(2,35)=.313, p=.733.
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Hypothesis 3: Participants in ACT protocol will show less avoidance post intervention
than participants in the CBT group, or participants in the control group. Participants in CBT and
ACT conditions reported less avoidance post speech, CBT (M=24.38, SD=7.87), and ACT
(M=28.54, SD=6.29), compared to their pre-speech scores, CBT (M=26.08, SD=6.58), and ACT
(M=29.23, SD=6.34). However, the control group exhibited an increase in avoidance post-
speech, control pre-speech (M=25.41, SD=10.49), and control post-speech (M=26.58,
SD=10.97). Nonetheless, a repeated measures ANOVA did not show a statistically significant
difference between conditions in AAQ-II pre and post measures F(2,35)=.773, p=.470. A visual
representation for this interaction is depicted in Figure 2.
Hypothesis 4: Participants in the control condition will have higher subjective distress
during and after the task compared to other two groups. An ANOVA found that all participants
experienced significant differences in subjective distress ratings in measurement over time (pre,
during, and post). A Mauchly’s test indicated that the assumption of sphericity has not been met
2 (2)=8.28, p=.02. As a consequence, the degrees of freedom were adjusted using a
Greenhouse-Geiser correction (=.818), F(1.64, 55.65)=17.97, p<.001. Post hoc tests revealed
participants’ subjective distress at their peak moment of their speech (M=75.09, SD=21.20),
being significantly higher, (all groups’ p<.05) than the ratings given post speech (M=58.54,
SD=28.17), or the rating given pre-speech (M=43.35, SD=26.75). There were no statistically
significant differences between pre and post speech SUDS ratings (p>.05). Participants in the
control condition exhibited higher subjective distress during the speech (M=82.27, SD=20.26),
than participants in the CBT condition (M=74.26, SD=21.70), or participants in the ACT
condition (M=69.84, SD=21.38), there were no statistically significant differences between the
groups F(2,34)=2.35, p=.11, η=.12. A visual interaction for all conditions is depicted in Figure 3.
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A exploratory analysis was done to examine if there was a statistical significant difference
between SUDS ratings-during and treatment type. A t-test found no statistical significant
difference between ACT or CBT, (M=72.06, SD=21.22), and control (M=82.27, SD=20.26),
t(35)=-1.36, p=.184.
Hypothesis 5: Participants in the control condition will have higher physiological
anxiety levels during and after the task compared to other two groups. An ANOVA found that all
participants experienced significant differences in heart rate over time (pre, during, and post). A
Mauchly’s test indicated that the assumption of sphericity has not been met 2 (2)=8.24, p=.02.
As a consequence, the degrees of freedom were adjusted using a Greenhouse-Geiser correction
(=.823), F(1.65, 57.61)=16.26, p<.001. Post hoc tests revealed participants’ heart rate at the
highest point of their speech (M=105.57, SD=13.46), being significantly higher, (all groups’
p<.001) than the ratings given post speech (M=90.18, SD=18.06), or the rating given pre-speech
(M=105.50, SD=16.31). There were no statistically significant difference between pre and post
speech BPM ratings (p>.05). Although participants in the control condition exhibited higher
physiological anxiety during their speech (M=109.83, SD=10.83), than participants in the ACT
condition (M=106.38, SD=13.88), or participants in the CBT condition (M=100.84, SD=14.68),
there were also no statistically significant difference between the groups F(2,35)=.02, p=.98,
η=.00. A visual interaction for all conditions in heart rate is depicted in Figure 4. A exploratory
analysis was done to examine if there was a statistical significant difference between bpm rates-
during the speech and treatment type. A t-test found no statistical significant difference between
ACT or CBT, (M=103.61, SD=14.28), and control (M=109.83, SD=10.83), t(36)=-1.34, p=.189.
Participant Usage of Interventions: Fifty-three percent of participants reported they
used the intervention during the preparation for their speech “somewhat”. In addition, 42% of
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the participants found the intervention “somewhat” useful. A chi-square goodness of fit showed
that participants’ rating for usage of the intervention 2 (6)=6.53, p=.37, and usefulness of the
intervention 2 (6)=12.02, p=.06, did not significantly differ from what would be expected by
chance. Table.. depicts detailed descriptions of participants ratings of the interventions.
Participant Ratings of Public Speaking Task: Following the speech, participants
provided information for the public speaking task and 58% of them reported experiencing live
audience of two confederates during the speech “moderately distressing”. In addition, 34% of
the participants reported experiencing the presence of confederates during their speech
“extremely distressing”. Moreover, 79% of the participants reported that the confederates’ non-
comital behavior during the speech caused “increased anxiety”. A chi-square goodness of fit
showed that participants’ rating of distress caused by confederates, 2 (4)=12.86, p<.05, and the
confederates’ non-comital behavior during intervention 2 (4)=1.14, p=.89, significantly differed
from what would be expected by chance. Table.. depicts detailed descriptions of participants
ratings of the public speaking task.
Discussion
The purpose of the present study was to investigate whether acceptance, cognitive
reappraisal, or psychoeducational-based brief interventions were more effective for increasing
public speaking performance among anxious individuals. The main finding was that there were
no statistically significant differences between conditions regarding reductions in anxiety and
public speaking performance. Results indicated that participants who received either an
acceptance-based, or a cognitive-based protocol, showed less distress during the public speaking
task compared to those who received the psychoeducational-control protocol. In addition, most
of the participants rated the public speaking task as considerably distressing, providing support
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for the external validity of the public speaking task. Most of the participants also found these
interventions “somewhat” useful.
There were no statistically significant differences between groups in avoidance post
intervention, although participants who received the cognitive-reappraisal protocol exhibited less
avoidance post intervention and participants who received the psychoeducational-control
protocol showed an increase in avoidance post speech. This finding is inconsistent with previous
research, which found that decreases in avoidance mediated the relationship between ACT and
decreases in distressing symptoms (Hayes et al., 2006; Spencer, 2017). It is important to note,
however, that this study was not indented as a mediation analysis.
As expected, participant ratings of distress (as measured by SUDS ratings) during the
speech were significantly higher than ratings before, or after the speech. These findings indicate
that the public speaking task induced subjective distress in participants, providing some evidence
for the external validity of the public speaking task. Moreover, participants who received the
acceptance-based protocol reported lower levels of subjective distress during the public speaking
task than participants in the other two conditions, although the difference among interventions
was not statistically significant. This finding was consistent of what one would expect from a
self-reported measure and also consistent with previous research, which found that ACT works
through teaching acceptance of distressing private events, rather than decreasing the content of or
the distress associated with unpleasant private experiences (Hayes et al., 2013; Spencer, 2017).
Overall, findings provide some preliminary evidence that the acceptance-based intervention may
help participants in managing their distress during public speaking because acceptance may be
associated with greater cognitive resources available for other tasks, such as giving a speech
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(Hayes et al., 2013). In addition, the time given to participants for speech preparation was very
short, which may have artificially increased the amount of stress and physiological activity in
response to the speech.
Findings from previous research has indicated that participants in all three conditions
exhibited increases in heart rate during the speech (Goldfarb, 2009). In the current study, heart
rate data indicated greater anxiety during the speech compared to before or after the speech for
participants in the acceptance-based and psychoeducational-control protocols. Those in the
cognitive-reappraisal protocol, conversely, showed decreases in anxiety during and after the
speech compared to before the speech. This finding might have occurred because cognitive
restructuring promoted controlling and changing maladaptive thoughts instead of accepting
them. These between-group differences with regard to heart rate data were not statistically
significant, however
Limitations and Future Directions
Some limitations of this study were related to the interventions used. For example, the
current study utilized very brief interventions (15 minutes in length). Most of the protocols
utilized in the existing literature, however, are longer and therefore may have greater benefits
(i.e. 60-90 minutes; Glassman et al., 2016; Gutierrez, Luciano, Rodriguez, & Fink, 2004). In
addition, data from this study suggests that the brief nature of the intervention may have reduced
the intended impact on participants. For example, only 26.3% of the participants reported using
the intervention “a little bit” while 16% of participants used the intervention “quite a bit” when
preparing for their speech. As expected, due to the nature of the study participants were not
overtly pursuing an intervention to improve public speaking performance, rather they were
