Effects of Confronting the Feared Outcome during Exposure Therapy on the Return of Fear: An Analogue Study
Although exposure therapy is an efficacious treatment for anxiety disorders, a common shortfall is that 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 that is triggered by these stimuli. Accordingly, the current study examined the effects of occasional threat reinforcement during repeated exposure in multiple contexts 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 a snake in multiple contexts or exposure in multiple contexts 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 context exposure alone group, the multiple context + fear-outcome group showed significantly less subjective expectancy for a snake to bite and increased behavioral approach of snake images at the one-week follow-up. The fear-outcome group also reported significantly greater variability in distress during exposure than the multiple context exposure alone group and this difference mediated the intervention effect on behavioral approach at follow-up. These findings suggest that reminders of the feared outcome may result in more variability in distress during exposure therapy and this may then partially explain the maintenance of behavioral gains.