Mechanisms of cognitive-behavioral and psychodynamic interventions for anxiety sensitivity- A randomized, controlled single-session study

Objective: This study utilized a single-session, randomized controlled analog design to investigate the mechanisms underlying cognitive–behavioral therapy (CBT) and psychodynamic therapy in treating anxiety sensitivity (AS). We hypothesized that changes in catastrophic interpretations of bodily sensations would predict reductions in AS in CBT, whereas improvements in panic-specific reflective functioning (pRF) would predict changes in the psychodynamic intervention (PDTp). Methods: Participants with elevated AS (N = 110; Mage = 43, 91 women) were randomized to CBT, PDTp, or a control group. Pre-to-post changes in mechanisms were examined as predictors of changes in AS at post-treatment and one-month follow-up. Results: Results partially supported the hypotheses. Catastrophic interpretations changed significantly in the CBT condition. However, pRF did not change in any group. The relationship between changes in mechanisms and AS was more complex than predicted. In CBT, reductions in AS were closely tied to changes in interpretations. Within-session, distress declined in CBT but did not consistently predict AS change. pRF change was related to AS reductions only in CBT. Conclusion: These findings highlight the clinical relevance of targeting catastrophic thinking in brief CBT for AS, and suggest that pRF may play a secondary role. Future work should test these mechanisms in clinical settings and longer treatments.