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

2025/09/24 by Sophie Thaon de Saint André, Ingmar Heinig, Volker Arolt +22 · 1 voice
Psychology · #Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes #Child and Adolescent Psychosocial and Emotional Development #Mental Health Research Topics

paper · doi:10.1016/j.brat.2025.104856

openalex publication_date 2025/09/24 · openalex created_date 2025/10/11 · openalex updated_date 2026/07/22

Abstract

Responses to exposure therapy vary across individuals, emphasizing the need for a deeper understanding of its underlying mechanisms. This study examined two key processes during exposure that serve as readouts of different clinical rationales: (1) within-session fear reduction (measured as the decline from peak to end fear within an exposure exercise) and (2) threat expectancy processes (assessed via expectancy violation, expectancy change, and learning rate). Data from 516 patients with anxiety disorders who completed at least 10 exposure exercises in a clinical trial were analyzed. Results showed that expectancy measures and fear reduction were only weakly correlated within exposure exercises. While no significant differences were found in their time courses, both readouts independently predicted treatment success. Specifically, a higher learning rate and greater relative fear reduction were associated with better outcomes. These findings highlight the clinical relevance of monitoring fear reduction and expectancy-related readouts as indicators of two distinct exposure rationales - the fear reduction rationale and the threat expectancy rationale. Although it remains unclear whether they reflect separate mechanisms of change or different aspects of a shared mechanism, addressing both rationales may help optimize and personalize exposure therapy.

Citations

• Maximizing exposure therapy: An inhibitory learning approach
• Biases in Dynamic Models with Fixed Effects
• Emotional processing of fear: Exposure to corrective information.
• The Gaussian Graphical Model in Cross-Sectional and Time-Series Data
• Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus
• Associations among threat prediction error, prediction change, and anxiety during an exposure therapy analogue in adults with healthy to clinical social anxiety
• Remission in CBT for adult anxiety disorders: A meta-analysis
• The Gaussian Graphical Model in Cross-sectional and Time-series Data
• Response rates for CBT for anxiety disorders: Need for standardized criteria
• Fitting Linear Mixed-Effects Models using lme4

Discussions

• 🧩 New article! Same same but different: Threat expectancy change and fear reduction as readouts of exposure rationales are only weakly associated to treatment outcome in anxiety disorders Now publis [bsky, 3 points, 0 comments]

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