Behavior Modification

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A Preliminary Evaluation of Repeated Exposure for

Depersonalization and Derealization
Elliot Weiner and Dean McKay
Behav Modif published online 1 November 2012
DOI: 10.1177/0145445512461651

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461651
51Behavior ModificationWeiner and McKay
BMOXXX10.1177/01454455124616

Behavior Modification

A Preliminary Evaluation XX(X) 1­–17

© The Author(s) 2012
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DOI: 10.1177/0145445512461651
for Depersonalization http://bmo.sagepub.com

and Derealization

Elliot Weiner1 and Dean McKay1

Abstract
Dissociative symptoms including depersonalization and derealization are
commonly experienced by individuals suffering from panic disorder or post-
traumatic stress disorder (PTSD). Few studies have been published investi-
gating the specific treatment of these symptoms in individuals diagnosed with
panic disorder or PTSD, despite evidence that the subset of individuals with
panic disorder who experience depersonalization and derealization report
more panic attacks as well as greater panic severity and functional impair-
ment. Furthermore, it has been shown that these symptoms can impede
treatment and recovery in PTSD. Finally, recent research has shown that
interoceptive exposure generally enhances the efficacy of treatment out-
come for PTSD and PTSD with comorbid panic. This study investigated the
use of a novel interoceptive exposure technique for treatment of deperson-
alization and derealization in individuals with high anxiety sensitivity and/or
symptoms of PTSD. Results indicated significant reductions on six of seven
items as well as total score on an outcome measure of depersonalization and
derealization.Thus, this technique appears to hold promise for utilization as a
form of interoceptive exposure in the treatment of these symptoms.

Keywords
depersonalization, derealization, PTSD, panic, anxiety sensitivity
1
Fordham University, Bronx, NY, USA

Corresponding Author:
Dean McKay, Department of Psychology, Fordham University, 441 East Fordham Road,
Bronx, NY 10458, USA
Email: mckay@fordham.edu

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2 Behavior Modification XX(X)

Dissociative symptoms including depersonalization and derealization are

commonly experienced by individuals suffering from panic disorder (Hunter,
Sierra, & David, 2004) and posttraumatic stress disorder (PTSD; for example,
Briere, Scott, & Weathers, 2005). In the context of panic disorder, these symp-
toms are fairly common and are included among the Diagnostic and Statisti-
cal Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American
Psychiatric Association, 2000) diagnostic criteria for panic attacks (American
Psychiatric Association, 2000). Epidemiology research suggests rates of
depersonalization and derealization in panic to range from under 10% to as
high as 82.6% (Hunter et al., 2004). In addition, it has been suggested that
those who experience depersonalization and derealization during panic may
constitute a subgroup of sufferers, as one study found that the presence of
depersonalization and derealization was associated with more panic attacks,
greater impairment in functioning, and higher scores on almost all clinical
assessments (Marquez, Segui, Garcia, Canet, & Ortiz, 2001). Two other stud-
ies found that individuals who experienced these symptoms reported greater
panic severity (Marshall et al., 2000; Segui et al., 2000). This poorer prognosis
may be due to the fact that these symptoms are frequently interpreted as loss
of cognitive control (Hunter, Phillips, Chalder, Sierra, & David, 2003)—
typical of the catastrophic misinterpretations underlying panic disorder in
general (Clark, 1986; Wells, White, & Carter, 1997).
With regard to PTSD, there is limited research that specifically considers
depersonalization and derealization; rather, the broader construct of dissocia-
tive symptoms has been examined, whereby depersonalization and derealiza-
tion are included among a number of other symptoms such as subjective sense
of numbing or detachment, reduced awareness of one’s surroundings, disso-
ciative amnesia, altered passage of time, increased speed of thoughts, unusu-
ally distinct or vivid thoughts, automatic movement, and lack of emotion (e.g.,
Noyes & Kletti, 1976, 1977). As several researchers have argued that dissocia-
tion as it is currently conceptualized is most likely a multifaceted construct
(Bryant, 2007; Feeny & Danielson, 2004; McNally, 2003), it may be best to
consider these distinct reactions separately, rather than grouping them together
under a single label (McNally, 2003).
The relationship between PTSD and dissociation has been studied most
with regard to peritraumatic dissociation—dissociation that occurs during the
traumatic event and immediately afterward. Such a relationship has been
reported in the context of various traumatic experiences, as greater peritrau-
matic dissociation has been associated with PTSD in Vietnam veterans
(Bremner & Brett, 1997; Bremner et al., 1992; Marmar et al., 1994), survi-
vors of motor vehicle accidents (Ursano et al., 1999), individuals with severe

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Weiner and McKay 3

injuries (Shalev, Peri, Canetti, & Schreiber, 1996), victims of violent assault
(Birmes et al., 2001), and survivors of natural disasters (Koopman, Classen,
& Spiegel, 1994; Weiss, Marmar, Metzer, & Ronfeldt, 1995).
A common feature of panic and PTSD is elevated anxiety sensitivity (Berenz,
Vujanovic, Coffey, & Zvolensky, 2012; Zvielli & Amit Berenz, 2012) as well as
depersonalization. Although it was noted above that panic with prominent
depersonalization have poorer treatment prognosis, this symptom in PTSD may
be considered associated with faulty processing of the traumatic event, inter-
fering with the encoding and immediate processing of traumatic memories
(Briere et al., 2005; Bryant, 2007; Marmar et al., 1994). This may account for
the relationship between peritraumatic dissociation and poorer long-term func-
tioning (Bremner & Brett, 1997; Bremner et al., 1992). Specifically, as the trau-
matic event is later not available to ordinary conscious representation, this can
distort subsequent perceptions and behaviors and lead to easy triggering of the
reexperiencing and hyperarousal symptoms of PTSD.
Accordingly, it is reasonable to expect that ongoing depersonalization
would have a larger effect on PTSD by obstructing such processing over an
extended period of time (Briere et al., 2005). Such persistent depersonaliza-
tion may have the additional effect of impeding recovery. According to infor-
mation processing models of PTSD, fear structures containing mental
representations of a traumatic experience develop following such an event;
these structures must then be activated to begin the process of modifying
them and recovering from the trauma (Foa & Kozak, 1986). Thus, persistent
depersonalization can impede activation of the fear structure and preclude the
resolution of traumatic memories necessary for recovery (Foa & Hearst-
Ikeda, 1996).
Studies that have considered persistent depersonalization have supported
the assertion that it could have a greater impact on the development and
maintenance of PTSD than peritraumatic dissociation. Persistent dissociation
was more strongly associated with PTSD than peritraumatic dissociation
among survivors of motor vehicle accidents (Murray, Ehlers, & Mayou,
2002) and community participants with a history of traumatic exposure
(Briere et al., 2005). In addition, Panasetis and Bryant (2003) found that
acute stress disorder was more strongly associated with persistent dissocia-
tion than peritraumatic dissociation.
Despite these indications that depersonalization and derealization are asso-
ciated with poorer prognosis in panic disorder, and of the importance of per-
sistent dissociative symptoms in the etiology and maintenance of PTSD,
virtually no empirical studies have been published to date investigating the
treatment of these symptoms in the context of panic disorder and PTSD. It has

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4 Behavior Modification XX(X)

generally been assumed that if the disorders are successfully treated, the
depersonalization symptoms will remit as an indirect result of therapy. Thus,
for example, it is expected that exposure therapy for PTSD will lead to the
integration of traumatic memories, allowing for the previously obstructed pro-
cessing to occur—and consequently, for the repair of any dissociative symp-
tomatology (Chu, 2007; Foa & Hearst-Ikeda, 1996; Kreidler, Zupancic, Bell,
& Longo, 2000). The same type of assumption is likely often used by clini-
cians who treat panic disorder without specifically targeting depersonalization
and derealization. No empirical findings have been published to support these
assumptions, though. However, recent investigations with samples of indi-
viduals with PTSD with or without comorbid panic have shown improved
efficacy when trauma-focused exposure therapy was preceded by interocep-
tive exposure (Wald & Taylor, 2008). Among the interoceptive exercises eval-
uated in this trial were shaking the head from side to side for 30 s, quickly
lifting the head after holding it between the knees, spinning, hyperventilation,
and staring at a visual grid. The use of strategies such as these have been found
efficacious in treating an individual with combat-related PTSD (Wald &
Taylor, 2010) and motor vehicle accident PTSD (Wald, Taylor, Chiri, & Sica,
2010). As noted above, clinical observations also indicate persistent deperson-
alization may impede recovery, as exposure therapy for PTSD would be inef-
fective for those who dissociate during imaginal reliving of traumatic
experiences (Foa & Hearst-Ikeda, 1996). For such individuals, depersonaliza-
tion symptoms certainly require direct treatment.
One of the challenges of developing effective treatment methods for
depersonalization and derealization is the difficulty of eliciting, maintaining,
and managing these unique perceptual experiences through interoceptive
exposure. Several procedures intended to induce these symptoms have been
studied in individuals with panic disorder, with staring at a dot on the wall,
staring at a mirror, and staring at a light immediately followed by reading all
found to induce increases above baseline (Antony, Ledley, Liss, & Swinson,
2006; Miller, Brown, DiNardo, & Barlow, 1994). In addition, a follow-up
study found that hyperventilating (whether for 1 or 5 min) standing in front
of a strobe light in a dark room and staring at a wall (i.e., with the strobe light
behind the subject), hyperventilating while standing in front of a strobe light
in a dark room and staring at a wall, and hyperventilating while staring at a
moving spiral on a computer screen elicited significantly greater depersonali-
zation and derealization than staring at a dot on the wall or staring at a mirror
(Lickel, Nelson, Hayes, & Deacon, 2008). No such studies have been pub-
lished with individuals with PTSD.

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Weiner and McKay 5

In addition to these techniques, unpublished research in our laboratory

indicated that staring at a strobe light while wearing 3D glasses was particu-
larly effective in eliciting depersonalization and derealization among indi-
viduals with PTSD or elevated anxiety sensitivity. The exploration of this
technique was prompted by a preliminary investigation, which indicated that
repeated prolonged exposure using a combination of a strobe light and 3D
glasses resulted in alleviation of panic symptoms (McKay & Moretz, 2008).
In the present study, the effectiveness of the latter task in reducing deper-
sonalization and derealization through repeated prolonged exposure among
individuals with elevated anxiety sensitivity and/or significant prior trauma
history was assessed. We hypothesized that, as our previous study showed
that staring at a strobe light while wearing 3D glasses induced significant
increases in depersonalization and derealization, repeated prolonged expo-
sure to this task would lead to habituation and, consequently, decreased levels
of these symptoms.

Material and Method

Participants

Three hundred fifty-two participants were recruited from the Fordham

University undergraduate subject pool. All participants received class credit.
This sample was composed of 67.3% females (n = 230) and 32.7% males (n
= 122), with a mean age of 20.05. With regard to race, 80.7% of the partici-
pants identified themselves as White (n = 284), 4.5% as Black (n = 16), 6.8%
as Asian (n = 24), 1.4% as Native Hawaiian or Pacific Islander (n = 5), and
9.9% as Other (n = 35). In addition, 13.9% identified their ethnicity as
Hispanic (n = 49).

Screening Selection Measures

Anxiety Sensitivity Index–3 (ASI-3). The ASI-3 (Taylor et al., 2007) is an 18-item
self-report measure on which participants rate their fear of an array of anxiety
symptoms. The ASI-3 has adequate reliability, with multiple replication studies
reporting alpha of .70 or higher (Taylor et al., 2007). In addition, correlations
between the three subscales (Social, Cognitive, and Physical Concerns) were
found to range from .70-.79 in seven replication studies conducted with interna-
tional samples. Finally, the ASI-3 was shown to have strong criterion-related
validity in identifying individuals prone to panic disorder, with η2 = .08.

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6 Behavior Modification XX(X)

PTSD Checklist–Specific (PCL-S). The PCL-S is a 17-item self-report measure

of the DSM-IV symptoms of PTSD that asks about symptoms in relation to an
identified stressful experience or specific type of event. Items are rated on a
5-point scale assessing how much the participant has been bothered by each
symptom in the past month, ranging from “not at all” to “extremely.” Thus, the
measure provides information regarding both diagnosis and symptom sever-
ity. The reliability and validity of the PCL-S have been supported in studies
with a number of samples. Among survivors of motor vehicle accidents and
sexual assault victims, PCL-S and Clinician-Administered PTSD Scale
(CAPS; Blake et al., 1995) scores were correlated (r = .93), with α = .94 for
the PCL-S. Using a cutoff score of 44 maximized diagnostic efficiency, with
sensitivity = .94, specificity = .86, and overall efficiency = .90 (Blanchard,
Jones-Alexander, Buckley, & Forneris, 1996). Among French survivors of a
variety of traumatic events, PCL-S total score was also found to have excellent
internal consistency (α = .86) and test–retest reliability (.80), and using a cut-
off score of 44 led to sensitivity = .97, specificity = .87, and overall diagnostic
efficiency = .94 (Ventureya, Yao, Cottraux, Note, & De Mey-Guillard, 2002).

Additional Measures
Two measures were used to assess dissociation. The Dissociative Experiences
Scale–II (DES-II; Carlson & Putnam, 1993) is a brief self-report questionnaire
designed to identify patients with dissociative psychopathology and to provide
a means of quantifying dissociative experiences. The scale assesses a broad
range of dissociative experiences, including disturbances in memory, identity,
and cognition, and feelings of derealization, depersonalization, absorption, and
imaginative involvement. Items are endorsed along an 11-point Likert-type
scale, and total scores are obtained by averaging the 28-item scores. The
original DES had excellent reliability and validity. The DES-II has been shown
to have excellent convergent validity with the original DES (r = .96), and
therefore the DES-II may be considered psychometrically sound, as well
(Ellason, Ross, Mayran, & Sainton, 1994).
The Degree of Depersonalization and Derealization Scale (DDDS) is a
visual analog scale developed specifically for this study. Items were adapted
from the Peritraumatic Dissociative Experiences Questionnaire (PDEQ;
Marmar, Weiss, & Metzler, 1997), with only those items indicating deperson-
alization or derealization retained. The DDDS asks participants to rate their
experiences during specific tasks by making a slash mark on a 100-mm,
numerically anchored line, with responses ranging from 0% to 100%. Slash
marks were then converted to a numerical score by measuring the distance of

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Weiner and McKay 7

Baseline DDDS
3 minutes: Strobe light only
3 minutes: Strobe light and 3D glasses
2 minutes: rest, DDDS #2
3 minutes: Strobe light and 3D glasses
2 minutes: rest, DDDS #3
3 minutes: Strobe light and 3D glasses
2 minutes: rest, DDDS #4
2 minutes: Brief relaxation exercise

Figure 1. Timeline of exposure procedures

Note: DDDS = Degree of Depersonalization and Derealization Scale.

the mark in millimeters from the left end of the line. This measure was only
administered to participants who returned to the lab for the experimental
phase of the study, and was not part of the screening battery.

Procedure
Participants in the screening sample who scored in the upper quartile of the
screening sample on the ASI-3 (i.e., scores greater than 23), the PCL-C (i.e.,
scores greater than 39), or both were contacted and offered vouchers for free
movie tickets in exchange for returning to participate in a follow-up experi-
mental phase of the study that would include three 20-min sessions, once per
week for 3 weeks. The informed consent for this phase of the study was
characterized as an intervention related to the treatment of different percep-
tual disturbances associated with different anxious states. A total of 39 par-
ticipants comprised the sample that completed the experimental phase of the
study, including 10 with only elevated ASI-3 scores, 15 with only elevated
PCL-C scores, and 14 with elevated scores on both measures.
Upon return, participants were informed that they would be asked to par-
ticipate in a 20-min task, during which they would be given a questionnaire
several times regarding certain mild unusual perceptual experiences sensa-
tions that they might experience. Participants were assured that all answers
would remain confidential, and written consent was obtained from each par-
ticipant before participation in the experimental phase.
The procedure in each exposure session is outlined in Figure 1. In total, the
DDDS was completed four times in each of the three exposure sessions,
including one baseline DDDS prior to the initiation of exposure and three

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8 Behavior Modification XX(X)

DDDSs immediately following each of the 3-min exposure phases. Participants

were instructed in a brief relaxation exercise following the final rest phase and
DDDS to ensure that they were comfortable and ready to leave the laboratory;
upon completion of this exercise, participants were provided a debriefing form
and invited to contact the experimenter with any additional questions.
In addition, participants completed the ASI-3, PCL-C, and DES-II prior to
the first exposure session and following completion of the third exposure ses-
sion to allow for evaluation of the potential impact of this interoceptive expo-
sure exercise on these symptoms.

Results
To evaluate the relevance of depersonalization experiences to individuals
with elevated anxiety sensitivity, evaluated with the ASI-3, or posttraumatic
experiences, evaluated with the PCL-C, correlations were examined for
these scales with the DDDS at each time point. This analysis showed that
all correlations were significant (rs ranged from .37 to .54, all ps < .05).
This suggests that symptoms of either posttraumatic experiences or anxiety
sensitivity are significantly associated with dissociative experiences pro-
voked in the lab.
To consider changes in levels of depersonalization and derealization, peak
within-session amplitude was calculated for DDDS total scores. The results
are depicted in Figure 2. Repeated measures ANOVA were then conducted to
compare within-session peak amplitude across the three sessions. There were
significant decreases in DDDS total scores across the three exposure ses-
sions, F(2, 37) = 31.41, p < .001, partial η2 = .452. In addition, pairwise
comparisons indicated that the mean decrease in DDDS total score from
Session 1 to Session 2 (M = −8.17, SE = 1.53, p < .001) and from Session 2
to Session 3 (M = −2.77, SE = 1.132, p < .05) were significant.
Peak within-session amplitude was then calculated for each DDDS item,
and repeated measures ANOVA were again conducted to compare within-
session peak amplitude across the three sessions. The results are depicted in
Figure 3 and Table 1. Significant decreases were found for each DDDS item
across the three exposure sessions, F(2, 37) = 6.19 to 37.18, ps < .005, partial
η2 = .140 to .495, with the exception of the final item, “I felt like a spectator
watching what was happening to me,” which was nonsignificant.
As the exposure sample consisted of three subgroups—individuals with
only elevated ASI-3 scores, only elevated PCL-C scores, or elevated scores on
both measures—ANOVA was conducted to compare change in DDDS scores
between the three groups. No significant differences were found between the

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Weiner and McKay 9

Figure 2. Degree of Depersonalization and Derealization Scale total scores

Note: There were significant decreases in Degree of Depersonalization and Derealization
Scale total scores across the three exposure sessions (p < .001), and mean decreases from
Session 1 to Session 2 (p < .001) and from Session 2 to Session 3 (p < .05) were significant.

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10 Behavior Modification XX(X)

Figure 3. Degree of Depersonalization and Derealization Scale item scores

Note: There were significant decreases in Degree of Depersonalization and Derealization
Scale scores across the three exposure sessions on each of the first six items (*p < .005, **p
< .001). There was no significant decrease on the final item, “I felt like a spectator watching
what was happening to me.”

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Weiner and McKay 11

Table 1. Repeated Measures ANOVA Results for Degree of Depersonalization and

Derealization Scale Item Scores

Item F(2, 37) p value Partial η2

Spaced out 37.18 <.001 .50
Slow motion 21.57 <.001 .36
Dream state 15.06 <.001 .28
Nervous 15.64 <.001 .29
Disconnected 6.19 .003 .14
Confused 12.99 <.001 .26
Spectator 0.74 .482 .02
Note: Significant decreases were found for each item across the three exposure sessions with
the exception of the final item, “I felt like a spectator watching what was happening to me.”

groups in change on DDDS total score, F(2, 37) = .732, p = .488, partial η2 =
.039, or change on any of the seven-item scores, F(2, 37) = .15 to .86, ps = .43
to .86, partial η2 = .008 to .046.
Finally, paired samples t tests were conducted to assess changes on the pre
and post ASI-3, PCL-C, and DES-II. There was a significant decrease in
ASI-3 scores, t(38) = 2.418, p < .05, but there were no significant changes in
PCL-C or DES-II scores.

Discussion
In the present study, staring at a strobe light while wearing 3D glasses over
three 20-min interoceptive exposure sessions was found to lead to significant
decreases in depersonalization and derealization. This analog investigation is
the first, as far as we are aware, of any sustained multisession standard inter-
vention for depersonalization. The results suggest, preliminarily, that deper-
sonalization-oriented interoceptive exposure procedures may alleviate these
symptoms either as a stand-alone intervention or as part of a larger program
directed at alleviating anxiety symptoms associated with this specific percep-
tual disturbance.
On one particular item—“I felt like a spectator watching what was happening
to me”—a significant difference was not found. In considering differences
between the individual items that make up the DDDS, it is noteworthy that par-
ticipants reported higher levels of the items representing derealization (i.e., “I
felt spaced out,” “Things felt in slow motion,” and “I felt I was in a dream state”)
than the remaining items. Thus, it is possible that the exposure exercise used in

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12 Behavior Modification XX(X)

this study is more effective in eliciting derealization than depersonalization. It

remains unclear what set this item apart from the other non-derealization items,
however, and in particular from the other item (“I felt disconnected from my
own body”) that appears to clearly represent depersonalization.
No significant differences in the effectiveness of this task were found
between individuals with elevated scores on the ASI-3, on the PCL-C, and on
both measures. This suggests that depersonalization and derealization have
common underlying mechanisms regardless of whether they present in the
context of panic disorder or PTSD. Accordingly, interventions that target
these symptoms should be effective regardless of the disorder in which they
appear. In the context of this study, the unifying mechanism is elevated anxi-
ety sensitivity, which has been found to be elevated in trauma-exposed indi-
viduals (Berenz et al., 2012; Zvielli & Amit Berenz, 2012) as well as panic.
Although we cannot at this point conclusively determine the role of deper-
sonalization for panic and PTSD in the maintenance of the condition, recent
research supports the efficacy of interoceptive exposure as a means of
increasing the benefit of other specific symptom-related exposure procedures
(Wald & Taylor, 2008).
The application of interoceptive exposure exercises for depersonalization
and derealization may enhance both treatment outcome and treatment reten-
tion among individuals suffering from PTSD or panic disorder. First, as noted
earlier, the presence of depersonalization and derealization is associated with
greater symptom severity and poorer treatment outcome among individuals
with panic (Marquez et al., 2001) and interferes with processing exposure for
trauma-related material in PTSD (Briere et al., 2005; Bryant, 2007; Marmar
et al., 1994). By isolating and reducing depersonalization and derealization,
additional interventions may be more effectively pursued. This might include
eliminating depersonalization as a preparatory intervention for additional
exposure exercises to improve processing in treatment for panic or PTSD.
Reducing depersonalization and derealization through interoceptive expo-
sure may also increase the degree to which clinicians can engage in exposure
for primary symptoms of panic or PTSD. Recent research has suggested cli-
nicians are frequently reticent about conducting exposure for PTSD in par-
ticular as there is a widespread assumption that exposure leads to increased
dropout (van Minnen, Hendriks, & Olff, 2010). If depersonalization and
derealization could be reduced, it could facilitate treatment outcome for
exposure to primary symptoms and create conditions whereby symptom
provocation during exposure would be lower than under circumstances where
depersonalization and derealization are untreated. Recent research has sup-
ported this view with particular reference to PTSD resulting from combat

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Weiner and McKay 13

(Wald & Taylor, 2010), motor vehicle accidents (Wald et al., 2010), and in a
group examination of individuals with PTSD, as well as PTSD with comor-
bid panic disorder (Wald & Taylor, 2008).
There are a few limitations worth noting. First, the fact that this study used
an undergraduate sample limits the generalizability of the findings. Second,
as self-report measures were used in the screening sample, no formal diagno-
ses could be determined. Therefore, it is not possible to draw any conclusions
regarding the impact of this interoceptive exposure technique in a clinical
sample. Last, the small size of the subgroups that comprised the exposure
sample (i.e., those with elevated scores on the ASI-3, the PCL-C, or both)
limits statistical power for the group differences considered.
With regard to future directions, it would be important to investigate
whether the effects of this exposure task carry over and impact symptomatol-
ogy outside the laboratory. In addition, the effectiveness of this task in
decreasing other dissociative symptoms was not considered. This question is
particularly important in light of the debate discussed in the introduction to
this article regarding whether dissociation is a unified or multifaceted con-
struct. Finally, it would be interesting to consider the possible impact of this
task on other symptoms of panic disorder or PTSD. Pre and post ASI-3 scores
in this study showed a significant decrease in anxiety sensitivity; in addition,
a preliminary investigation by McKay and Moretz (2008) reported that this
technique led to decreases in panic symptoms. Thus, it appears that this inter-
vention may have broader effects than its impact on depersonalization and
derealization.

Authors’ Note
Portions of these data were presented at the annual meeting of the Association for
Behavioral and Cognitive Therapies, November 2011, Toronto, Ontario, Canada.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or pub-
lication of this article.

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Bios
Elliot Weiner, PhD, completed his doctorate at Fordham University. His research
interests are in cognitive behavioral models of the conceptualization and treatment of
trauma. He is presently completing a postdoctoral fellowship at the Honolulu
Veteran’s Affairs.

Dean McKay, PhD, is a professor of psychology at Fordham University. His primary

areas of interest are anxiety disorders and their treatment.

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