Expectancy violation during exposure therapy: A pilot randomized controlled trial - 20/02/22
, Shannon M. Blakey b, c, Samantha N. Hellberg a, Maya Massing-Schaffer a, Lillian Reuman d, Heidi Ojalehto a, Joe Friedman e, Jonathan S. Abramowitz aAbstract |
Despite empirical support for the efficacy of exposure-based therapy for anxiety-related disorders, many individuals do not respond to this intervention or else experience a return of fear after treatment. Inhibitory learning theory has informed novel approaches to exposure therapy delivery that aim to improve both short- and long-term outcomes. One exposure optimization strategy is to maximize expectancy violation (i.e., the difference between expected and actual outcomes), which is thought to strengthen inhibitory (i.e., non-threat) associations and enhance long-term fear extinction. In practice, exposure therapy is traditionally preceded by cognitive restructuring to lessen the magnitude of harm expectancies. Yet this technique may restrict the discrepancy between expected and actual outcomes, thus reducing the potency of exposure and limiting the durability of treatment gains. The present study examined the effects of manipulating the timing of cognitive techniques during exposure-based therapy by randomly assigning 45 participants with spider phobia to one of three conditions: (a) cognitive restructuring before exposure (CR-EXP; n=15), (b) exposure before cognitive restructuring (EXP-CR; n=15), and (c) stress management control (SM; n=15). Although both CR-EXP and EXP-CR were more effective than SM, there were no significant differences between CR-EXP and EXP-CR on measures of fear, avoidance, spider-related cognitions, or change in harm expectancy. Clinical implications, study limitations, and future directions are discussed.
Le texte complet de cet article est disponible en PDF.Keywords : Exposure therapy, Inhibitory learning theory, Specific phobia
Plan
Vol 32 - N° 1
P. 13-24 - mars 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?
