The Dynamics of Learning and Retention Following an Exposure Exercise for Fear of Public Speaking

2026/07/01 by Vera Bouwman, Andre Pittig, Iris.M. Engelhard +2
Psychology · #Communication in Education and Healthcare

paper · pdf · doi:10.1016/j.beth.2026.07.005

Abstract

Exposure-based CBT is an effective treatment for anxiety disorders. However, individual differences in response to exposure indicate that many patients do not fully benefit from therapy. Examining individual changes over time in threat expectancy, a theorized working mechanism of exposure based on classic learning models, may help optimize individual treatment success. This study aimed to examine the dynamics of learning during one exposure exercise for fear of public speaking and the retention of learning in daily life. Participants with elevated fear of public speaking (70 women, M age = 23.10) completed an exposure exercise designed to violate an idiosyncratic threat expectancy. They gave two, three, or four presentations to at least halve threat expectancy likelihood. Ecological momentary assessments were used to measure threat expectancy eight times a day for four days before and four days after the exposure exercise. Results showed individual differences in how fast threat expectancy decreased after each presentation during the exposure exercise. Furthermore, there were individual differences in how much this transfered to a decrease in threat expectancy in daily life and how long participants retained the decrease. Additionally, after the exposure exercise, we found a decrease in threat expectancy severity, anticipatory anxiety, avoidance tendency, and an increase in willingness to give a presentation in daily life. Future research could examine whether individual differences in the dynamics of learning and retention in daily life following an exposure exercise are clinically relevant as predictor of overall treatment success.

Citations

• Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure
• Associations among threat prediction error, prediction change, and anxiety during an exposure therapy analogue in adults with healthy to clinical social anxiety
• Return of negative interpretation bias after positive interpretation training as a dynamic predictor of treatment outcome in fear of public speaking
• Ecological momentary assessment of post-event processing in between two speech tasks: Relationships with cognitive and affective factors involved in the maintenance of social anxiety
• Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus
• Optimizing exposure: Between-session mental rehearsal as an augmentation strategy

Related

• Same same but different: Threat expectancy change and fear reduction as readouts of exposure rationales are only weakly associated and contribute differentially to treatment outcome in anxiety disorders
• Associations among threat prediction error, prediction change, and anxiety during an exposure therapy analogue in adults with healthy to clinical social anxiety
• Return of negative interpretation bias after positive interpretation training as a dynamic predictor of treatment outcome in fear of public speaking
• Joy beyond fear: Positive emotions after exposure in patients with anxiety disorders and their link to threat expectancy and treatment outcome
• Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure