Effects of confronting the feared outcome during exposure therapy on the return of fear: An analogue study

• Published in: Journal of behavior therapy and experimental psychiatry Vol. 76; p. 101747
• Main Authors: Jessup, Sarah C., Olatunji, Bunmi O.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-09-2022; Elsevier Science Ltd
• Subjects: Anxiety disorders; Behavior; Biting; Cue exposure; Cues; Emotional responses; Exposure; Exposure therapy; Extinction; Fear; Fear & phobias; Phobia; Psychological distress; Reinforcement; Reminders; Threats; Variability; Fear; Phobia; Exposure; Extinction
• ISSN: 0005-7916; 1873-7943
• DOI: 10.1016/j.jbtep.2022.101747

Although exposure therapy is an efficacious treatment for anxiety disorders, fear often returns after treatment. From an inhibitory learning perspective, long-term improvement depends not only on learning that feared stimuli are safe, but also that it is safe to experience the emotional response triggered by these stimuli. Accordingly, the current study examined the effects of occasional threat reinforcement during repeated exposure to multiple cues on the return of fear in snake phobia by incorporating reminders of the feared outcome.
Snake fearful community adults (N = 74) were randomized to either repeated exposure to multiple cues or exposure to multiple cues that also explicitly depicted the feared outcome (snake biting someone). A measure of self-reported threat expectancy and a threat-relevant behavioral approach task (BAT) were administered pre-exposure, post-exposure, and at a one-week follow-up.
Compared to the multiple-cue exposure group, the multiple-cue + fear-outcome group showed significantly less subjective expectancy for a snake to bite and increased behavioral approach of snake images at one-week follow-up. The fear-outcome group also reported significantly greater variability in distress during exposure than the multiple-cue exposure group and this difference mediated the intervention effect on behavioral approach at follow-up.
Findings are limited by the use of videos as an analogue to exposure and a computer-delivered BAT.
These findings suggest presentation of the feared outcome may result in more variability in distress during exposure therapy and this may partially explain the maintenance of behavioral gains.
•Fear often returns after successful exposure.•Occasional reminders of feared outcome during exposure may attenuate fear renewal.•Emotion variability mediates relationship between group and post-exposure outcome.