Maximizing The Effectiveness Of Exposure Therapy

Exposure therapy is the most effective treatment for anxiety disorders. It can take a number of forms:

• Graduated vs. intense (flooding)
• Brief vs. prolonged
• With or without cognitive or somatic coping strategies
• Imaginal vs. interoceptive vs. in vivo

There are a number of models which attempt to explain why exposure to a fear-inducing stimulus is an effective method for overcoming fear. These include:

1. Habituation models which focus on the reduction of fear through exposure (e.g. Foa & Kozak, 1986)
2. Cognitive models whereby behavioral testing is used to explicity disconfirm mistaken threat-laden assumptions (e.g. Salkovskis et al, 2006)
3. Inhibitory learning models which propose that the original CS-US association learned during fear conditioning is not erased during extinction but is instead inhibited by new learning about the CS-US (specifically, that the CS no longer predicts the US)

Craske and colleagues (2014) propose that inhibitory learning is the most helpful model for understanding exposure therapy. Specifically, they argue that anxious individuals show deficits in the mechanisms underpinning extinction learning and that optimizing inhibitory learning during exposure can enhance the effectiveness of treatment. They identify nine strategies which clinicians can use to maximize the effectiveness of exposure therapy including: expectancy violation, deepened extinction, occasional reinforced extinction, removal of safety signals, variability, retrieval cues, multiple contexts, reconsolidating, and affect labelling. Maximizing the Effectiveness Of Exposure Therapy is an information handout designed to help clinicians and their anxious clients plan and conduct effective exposure therapy.

• Client handout – use it as a psychoeducation resource to teach clients how to make their exposure therapy more effective
• Discussion point – use to provoke a discussion and explore client beliefs regarding avoidance and exposure
• Therapist learning tool – improve your familiarity with an inhibitory learning theory approach to exposure therapy
• Teaching resource – use it as a learning tool when training clinicians or anxious individuals how to conduct effective exposure therapy

• Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
• Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99(1), 20.
• Salkovskis, P. M., Hackmann, A., Wells, A., Gelder, M. G., & Clark, D. M. (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behaviour Research and Therapy, 45(5), 877-885.