Expectancy violation during exposure therapy: A pilot randomized controlled trial

Despite empirical support for the efficacy of exposure-based therapy anxiety-related disorders, many individuals do not respond to this intervention or else experience a return fear after treatment. Inhibitory learning theory has informed novel approaches exposure delivery that aim improve both short- and long-term outcomes. One optimization strategy is maximize expectancy violation (i.e., difference between expected actual outcomes), which thought strengthen inhibitory non-threat) associations enhance extinction. In practice, traditionally preceded by cognitive restructuring lessen magnitude harm expectancies. Yet technique may restrict discrepancy outcomes, thus reducing potency limiting durability treatment gains. The present study examined effects manipulating timing techniques during randomly assigning 45 participants with spider phobia one three conditions: (a) before (CR-EXP; n = 15), (b) (EXP-CR; (c) stress management control (SM; 15). Although CR-EXP EXP-CR were more effective than SM, there no significant differences on measures fear, avoidance, spider-related cognitions, change in expectancy. Clinical implications, limitations, future directions are discussed.