The impact of cognitive restructuring and distraction on repeated hyperventilation among college students

Cognitive and behavioral treatments for anxiety disorders often involve repeated interoceptive exposure (repeated exposure to physical sensations characteristic of anxiety). While exposure is an effective technique, it is unclear whether adding a cognitive component to this procedure increases its effectiveness. To determine the most effective mechanism for reducing anxiety, the present study examined both cognitive and behavioral explanations of the psychological mechanisms of interoceptive exposure. Specifically, subjects (N = 88) underwent repeated hyperventilation in one of four conditions: hyperventilation alone, hyperventilation with a distraction task, hyperventilation with delayed cognitive restructuring (method of challenging catastrophic thoughts used between trials), and hyperventilation with concurrent cognitive restructuring (challenging catastrophic thoughts while hyperventilating). As expected, subjects taught to restructure their catastrophic cognitions during hyperventilation decreased their anxiety level significantly more than did individuals who relied on habituation alone, distraction or cognitive restructuring between trials. Contrary to expectations, however, there was no evidence that brief, interoceptive exposure resulted in a decrease in anxious symptoms. These results provide support for the idea that adding a cognitive component to repeat exposure increases its utility in the treatment of anxiety disorders.