Acceptance and commitment therapy for public speaking anxiety: a case series study of effects on self-reported, implicit, imaginal, and in-vivo outcomes

Public speaking anxiety (PSA) is a common problem, and in some cases can lead to significant social and occupational difficulties. While exposure therapy combined with cognitive restructuring is currently the most effective treatment available, approximately 25% of individuals fail to respond. Acceptance and Commitment Therapy (ACT), a third-wave behavioural approach predicated on supposed different mechanisms of change, may have additional benefits to more traditional interventions, and may be more acceptable to those individuals with PSA who find exposure based therapy too difficult. A multiple single-case design was used to examine the effects of a self-help ACT intervention for PSA on self-reported, implicit, imaginal, and in-vivo outcomes, across six replications. All participants reported a reduction in speech anxiety, with evidence of reliable change in three cases. The four participants who reported an increase in willingness to approach a feared public speaking scenario, also completed an in-vivo voluntary speech task. Triangulation of quantitative (daily and weekly measures) and qualitative data (change-interview) indicate that mindfulness (self-as-context and present-moment awareness) may be a key mechanism of change in ACT for individuals with PSA. The findings offer support for ACT delivered in a self-help format to treat speech anxiety, however, further research is needed to generalise these findings and examine the long term effects