Maximizing exposure therapy: An inhibitory learning approach
Open accessAbstract
Exposure therapy is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear after treatment. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure-based procedures. Although evidence supports an inhibitory learning model of extinction, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a ‘fear habituation’ approach and ‘belief disconfirmation’ approach within standard cognitive-behavior therapy. Exposure optimization strategies include 1) expectancy violation, 2) deepened extinction, 3) occasional reinforced extinction, 4) removal of safety signals, 5) variability, 6) retrieval cues, 7) multiple contexts, and 8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, specific phobia, and panic disorder.
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Both unlearning old catastrophic interpretations and learning a wide range of new associations form the key to therapeutic change.
“According to this rationale, both unlearning old catastrophic interpretations and learning a wide range of new associations form the key to therapeutic change.”
From Personalized exposure and experience sampling method feedback versus exposure as usual for obsessive–compulsive disorder: a study protocol for a randomized controlled trial (2024) · cites this paper as [24]
The “Inhibitory Learning Model of Extinction” section (page unavailable) says the original fear association is not erased; it remains intact while a new inhibitory association develops. This contradicts the claim that unlearning old catastrophic interpretations is a key part of the paper’s therapeutic rationale, although the paper does emphasize new learning. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe mechanisms of change in exposure therapy remain poorly understood, especially for eating disorders.
“However, the mechanisms of change in exposure therapy are still not well understood, especially in exposure therapy for EDs”
From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Craske et al., 2014
The Abstract describes inhibitory learning as a mechanism believed to underlie exposure therapy, and the Summary says further research is needed to clarify how best to enhance and implement it. Those passages support some uncertainty about exposure processes, but the paper addresses anxiety disorders, not the claim that mechanisms are especially poorly understood for eating disorders. (LLM, conf=0.79)
Experimental — accuracy not yet measuredEmotional states serve as powerful retrieval cues, and varying fear may make the safety association more salient.
“Emotional states are strong retrieval cues, and variation in fear may increase the salience of the association between a previously feared object or situation and a lack of extreme negative consequences (Bjork & Bjork, 1992, 2006; Craske et al., 2014).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Craske et al., 2014
In “Therapeutic Strategies,” section (5) Variability (page unavailable), the paper proposes that fear level may serve as a retrieval cue and that varying it may enhance learning of inhibitory associations. It does not establish that emotional states are strong retrieval cues; it also describes increased salience of the feared stimulus, not specifically of the safety association. (LLM, conf=0.84)
Experimental — accuracy not yet measuredVarying the exposure hierarchy may increase expectancy violation, which is thought to improve exposure outcomes.
“Variability in the exposure hierarchy may also enhance expectancy violation, which is proposed to maximize exposure therapy outcomes (Craske et al., 2014).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Craske et al., 2014
The ‘Variability’ section describes selecting hierarchy items out of order and reports long-term benefits. The ‘Expectancy Violation’ section proposes designing exposures to maximize the mismatch between expected and actual outcomes. Our copy does not say that varying the hierarchy itself increases expectancy violation; it presents variability and expectancy violation as distinct strategies. (LLM, conf=0.82)
Experimental — accuracy not yet measuredVariability might be introduced after a few graded, lower-difficulty exposures once the client has gained confidence in staying in the distressing situation.
“Instead of starting exposure with the premise of random progression through the exposure hierarchy, variability might be introduced after a few graded exposures of lower difficulty once the client has gained confidence in his or her ability to stay in the distressing situation (Craske et al., 2014).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Craske et al., 2014
The “Variability” section (page not provided) says variable exposure usually begins with the least anxiety-producing hierarchy item to avoid treatment refusal. It does not recommend several graded, lower-difficulty exposures before introducing variability, or make the client’s confidence in staying in the situation the criterion for doing so. (LLM, conf=0.86)
Experimental — accuracy not yet measured
SUDS are not typically part of the inhibitory learning model because that model does not emphasize habituation.
“SUDS are not typically part of the inhibitory learning model, as there is no emphasis on habituation (Craske et al., 2014).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Craske et al., 2014
The “Inhibitory Learning vs Habituation” section says inhibitory-learning strategies do not emphasize fear reduction during exposure, supporting the claim’s rationale. It does not say SUDS are typically absent; the PTSD case study even describes a hierarchy containing distress ratings. The source therefore supports the lack of emphasis on habituation, but not the generalization about SUDS. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe strategic incorporation of novelty into extinction may leverage effects of surprise that are central to inhibitory learning.
“While the precise mechanisms supporting novelty-facilitated extinction remain unclear, the strategic incorporation of novelty into extinction may leverage effects of surprise that are central to inhibitory learning (1,3).”
From When Uncertainty Is a Certainty: Optimizing Exposure-Based Therapies (2021) · cites this paper as [1]
The 'Expectancy Violation' section (page unavailable) says that mismatches between expectation and experience enhance extinction learning and asks participants to assess the 'surprise' of exposure. It does not address strategically incorporating novelty into extinction, so it supports the proposed surprise mechanism but not that specific strategy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredExposure is hypothesized to be effective when the new association becomes stronger than the old association.
“Exposure is hypothesized to be effective when the new association becomes stronger than the old association.”
From Personalized exposure and experience sampling method feedback versus exposure as usual for obsessive–compulsive disorder: a study protocol for a randomized controlled trial (2024) · cites this paper as [24]
The Inhibitory Learning Model of Extinction section says exposure develops a new inhibitory association while the original fear association remains intact. It does not say effectiveness requires the new association to become stronger than the old one; it also describes fear returning after treatment when the original association is expressed again. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe meta-analyses primarily used data from same-day or next-day uninstructed threat extinction training with only one session, limiting the generalizability of the results to real-world exposure-based therapies.
“Furthermore, the meta-analyses primarily used data from same-day or next-day uninstructed threat extinction training with only one session, limiting the generalizability of the results to real-world exposure-based therapies (i.e., which typically involve instructions about assessing the likelihood of aversive events and often comprise more than one session) (8).”
From I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training (2021) · cites this paper as [8]
The Case Studies > Specific Phobia section describes an instructed exposure program and recommends 6–12 sessions, supporting the comparison with multi-session therapy. But the paper does not assess the datasets used in the cited meta-analyses or say they primarily involved same-day or next-day, uninstructed, single-session extinction training. Its Summary calls for further translational research, but does not establish that specific generalizability limitation. No page numbers are available in our copy. (LLM, conf=0.81)
Experimental — accuracy not yet measuredDetecting patients' specific expectancies and recording belief in these expectancies before exposure can help reduce catastrophic thinking.
“To this end, it is important to detect patients’ specific expectancies and to record the belief in these expectancies before exposure starts. This technique can help to reduce catastrophic thinking (Craske et al., 2014; Schyns et al., 2016; Schyns, Roefs, et al., 2018; Schyns, van den Akker, Roefs, Hilberath & Jansen, 2018).”
From A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series. (2019) · cites this paper as Craske et al., 2014
In the Case Studies > Obsessive Compulsive Disorder section (page not provided), the paper describes identifying a feared outcome before exposure, eliciting an 80% certainty estimate, and using monitoring sheets to list anticipated outcomes. The Expectancy Violation section supports testing those expectations through exposure, but does not say that recording belief itself reduces catastrophic thinking; it cautions that trying to reduce catastrophic appraisals before exposure may undermine learning. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe treatment intervention (behavioral experiments) and treatment target (intolerance of uncertainty) are solidly grounded in the anxiety disorders literature.
“One of the main strengths of the current study is that the treatment intervention (behavioral experiments) and treatment target (intolerance of uncertainty) are solidly grounded in the anxiety disorders literature.”
From Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder (2022) · cites this paper as Craske et al., 2014
The Abstract and the ‘Expectancy Violation’ section place exposure and behavioral testing within anxiety-disorder treatment, supporting the intervention part of the claim. The paper discusses inhibitory learning and threat expectancies, but the passages do not establish intolerance of uncertainty as a treatment target; a search for that term found no matching passage. The indexed copy provides no page numbers for these sections. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTwo factors generally considered unique to CBT are exposure and coping efficacy, or skill building.
“Two factors are generally considered unique to CBT, “exposure” and “coping efficacy”, or skill building [77, 78].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [78]
The opening passage (section labeled Abstract; page unavailable) calls exposure therapy a mainstay of CBT for anxiety disorders. It says exposure can be used with or without coping strategies, but does not identify coping efficacy or skill building as a factor unique to CBT. Nor does it establish that exposure is unique to CBT. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThese findings add to growing literature suggesting that change can occur during exposure therapy without within-session reduction in distress via inhibitory learning processes.
“These findings add to the growing literature suggesting that, instead, change can occur during exposure therapy without within-session reduction in distress via inhibitory learning processes (Craske et al., 2014; Essayli et al., 2023).”
From Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders (2024) · cites this paper as Craske et al., 2014
The inhibitory learning model applies to a broad range of anxiety content.
“The inhibitory learning model is applicable to a wide spectrum of anxiety content.”
From Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic (2022) · cites this paper as Craske et al., 2014
Interoceptive exposure is more effective when it closely mimics the avoided experience and creates an expectancy violation.
“The degree to which these exposures more closely replicate the avoided experience (e.g., provoking a strong sensation) and create an expectancy violation (i.e., helping the individual to learn that outcomes differ from expectations), the more effective the interoceptive exposure.”
From Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID (2019) · cites this paper as Craske et al., 2014
Inhibitory learning is one proposed mechanism for interoceptive exposure treatments.
“One hypothesis whereby interoceptive exposure treatments exert their influence is via inhibitory learning (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
From Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID (2019) · cites this paper as Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014
Exposures that deliberately provoke interoceptive sensations should aim to disconfirm negative outcome expectancies.
“According to this model, exposures that intentionally provoke interoceptive sensations should be designed to disconfirm underlying expectancies of negative outcomes (e.g., I can’t handle pain; Craske et al., 2014).”
From Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID (2019) · cites this paper as Craske et al., 2014
Variability in context and stimuli is important for generalizing learning to novel situations and stimuli.
“Context and stimulus variability appear to be key in the generalization of learning, which allows clients to apply what they have learned to new contexts and new stimuli that were not encountered during exposure therapy (Craske et al., 2014; Kircanski et al., 2012).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Craske et al., 2014
Adding variability to exposure delivery is a possible way to enhance inhibitory learning.
“Increasing variability is one potential modification to the delivery of exposure therapy that could maximize inhibitory learning (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
From Enhancing Inhibitory Learning: The Utility of Variability in Exposure (2019) · cites this paper as Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014
Exposure therapy reduces negative affect through fear extinction.
“For example, exposure therapy works to lessen negative affect through a mechanism principal to the defensive system – fear extinction (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
From Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder. (2019) · cites this paper as Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014
Difficulty learning about safety via extinction can arise in anxiety disorders and following trauma.
“Difficulty learning about safety via extinction can arise in anxiety disorders and following trauma, and principles of extinction form the basis of exposure-based therapies (1).”
From When Uncertainty Is a Certainty: Optimizing Exposure-Based Therapies (2021) · cites this paper as [1]
Principles of extinction form the basis of exposure-based therapies.
“Difficulty learning about safety via extinction can arise in anxiety disorders and following trauma, and principles of extinction form the basis of exposure-based therapies (1).”
From When Uncertainty Is a Certainty: Optimizing Exposure-Based Therapies (2021) · cites this paper as [1]
Exposure therapy may be best optimized through strategies that enhance inhibitory learning, such as expectancy violation and variability in exposure.
“Instead, exposure therapy may be best optimized through strategies that enhance inhibitory learning, such as expectancy violation and variability in exposure (1).”
From When Uncertainty Is a Certainty: Optimizing Exposure-Based Therapies (2021) · cites this paper as [1]
Conceptualizations of the mechanisms supporting the effects of exposure therapy have increasingly shifted to emphasize inhibitory learning.
“Importantly, conceptualizations of the mechanisms supporting the effects of exposure therapy have increasingly shifted to emphasize inhibitory learning.”
From When Uncertainty Is a Certainty: Optimizing Exposure-Based Therapies (2021) · cites this paper as [1]
The extent to which fear declines over the course of an exposure does not predict clinical outcomes.
“While habituation likely plays a role in extinction and while fear often decreases over the course of an exposure, the extent to which fear declines does not predict clinical outcomes (1).”
From When Uncertainty Is a Certainty: Optimizing Exposure-Based Therapies (2021) · cites this paper as [1]
Learning is context-dependent and exposure in multiple contexts appears to counteract a return of fear.
“Several studies have shown that learning is context-dependent and that exposure in multiple contexts appears to counteract a return of fear [6, 24].”
Exposure therapy is a promising intervention that aims at breaking self-reinforcing circles of anxiety and safety behaviours.
“A promising intervention that aims at breaking such self-reinforcing circles of anxiety and safety behaviours is exposure therapy [30, 33, 34].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [30]
Recent research suggests that exposure therapy should be based on inhibitory learning principles, such as expectancy violation.
“Recent research suggests that exposure therapy should be based on inhibitory learning principles, such as expectancy violation [30, 45].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [30]
Behavioral experiments are directly in line with contemporary learning theories of fear reduction.
“behavioral experiments, which require clients to formulate specific predictions and to compare their predictions to actual outcomes following an exposure-type situation, are directly in line with contemporary learning theories of fear reduction (e.g., Craske et al., 2014).”
From Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder (2022) · cites this paper as Craske et al., 2014
Current approaches to exposure are based on findings that habituation within and between sessions is not necessary in order to achieve functional improvement.
“IU-CBT is also influenced by current approaches to exposure that are based on findings that habituation within and between sessions is not necessary in order to achieve functional improvement (Craske et al., 2008;Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014;Jacoby & Abramowitz, 2016).”
From Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study (2020) · cites this paper as Craske et al., 2014
VR/AR can maximize some strategies reported by Craske (deepened extinction, variability, exposure to multiple contexts).
“These studies are in line with the work carried out by Craske et al. [81], focused on optimizing exposure therapy based on the inhibitory learning approach, because VR/AR can maximize some strategies reported by Craske.”
From In Vivo versus augmented reality exposure in the treatment of small animal phobia: A randomized controlled trial (2016) · cites this paper as Craske et al. [81]
Consolidation of safety learning is essential for the success of exposure therapy.
“Consolidation of this “safety” learning is essential for the success of exposure therapy (Craske et al., 2014).”
From Using sleep to enhance exposure treatment for anxious children: A pilot study. (2026) · cites this paper as Craske et al., 2014
Within an inhibitory learning framework, the new learning of safety will constrain and dampen the old learning that others intend harm.
“Within an inhibitory learning framework of understanding (Craske et al., 2014), the new learning of safety will constrain and dampen the old learning that others intend harm.”
From A counterweight model for understanding and treating persecutory delusions. (2025) · cites this paper as Craske et al., 2014
Exposure therapy is an integral part of cognitive behavioral therapy for anxiety disorders.
“Exposure therapy, which involves repeatedly exposing oneself to stimuli that cause fear, is an integral part of cognitive behavioral therapy for anxiety disorders (Craske et al., 2014).”
From Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results. (2026) · cites this paper as Craske et al., 2014
Exposure therapy works through inhibitory learning, indicating that expectancy violation (and not fear decrease) should be its main objective.
“Craske, Treanor, Conway, Zbozinek, and Vervliet (2014) suggest that exposure therapy works through inhibitory learning, indicating that expectancy violation (and not fear decrease) should be its main objective.”
From A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series. (2019) · cites this paper as Craske et al., 2014
Some ARFID presentations are clearly anxiety-driven (e.g., specific phobia of choking/vomiting) and suit Craske's theory, but not all presentations are primarily characterized by anxiety.
“Whereas some presentations of ARFID are clearly anxiety‐driven (e.g., specific phobia of choking/vomiting), and appear to suit Craske's et al. (Craske et al., 2014) theory quite well, not all presentations appear to be primarily characterized by anxiety.”
From A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series. (2019) · cites this paper as Craske et al., 2014
Exposure in vivo works by setting off a process of inhibition in which the association of the conditioned stimulus (social situations) and the feared unconditioned stimulus (humiliation) is inhibited by forming new associations around the CS, of which the association with 'no-US' (no rejection) is probably the most important.
“Nowadays it is believed that exposure in vivo sets off a process of inhibition in which the association of the conditioned stimulus (CS) (social situations) and the feared unconditioned stimulus (US) (humiliation) is inhibited by the forming of new associations around the CS, of which the association with ‘no-US’ (no rejection) is probably the most important [34].”
Behavioral experiments, which require clients to formulate specific predictions and compare them to actual outcomes following an exposure-type situation, are directly in line with contemporary learning theories of fear reduction.
“behavioral experiments, which require clients to formulate specific predictions and to compare their predictions to actual outcomes following an exposure-type situation, are directly in line with contemporary learning theories of fear reduction (e.g., Craske et al., 2014).”
From Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder (2022) · cites this paper as Craske et al., 2014
Tolerance of exposure, with inhibition of an associated avoidance response, is considered the key element in cognitive behavioral therapy of anxiety disorders.
“Tolerance of exposure, with inhibition of an associated avoidance response, is considered the key element in the cognitive behavioral therapy of anxiety disorders [77, 78].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [78]
CBT, focusing on exposure to feared cues to promote extinction learning, continues to be the most widely used and most strongly validated psychotherapeutic treatment for both youth and adult anxiety disorders.
“CBT, focusing on exposure to feared cues to promote extinction learning (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014), continues to be the most widely used and most strongly validated psychotherapeutic treatment for both youth and adult anxiety disorders (Barry, Yeung, & Lau, 2018;Kodal et al., 2018).”
From Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders (2019) · cites this paper as Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014
Existing interventions for anxiety and depression emphasize negative affect reduction as the central treatment goal.
“Existing interventions for anxiety and depression emphasize negative affect reduction as the central treatment goal.”
From Upregulating the positive affect system in anxiety and depression: Outcomes of a positive activity intervention: <scp>Taylor et al.</scp> (2017) · cites this paper as [17]
Exposure generates new learning of safety-based associations that inhibit former fear response associations to the feared stimulus, thereby either extinguishing the fear response or enabling a level of fear tolerance that reduces anxious distress.
“This exposure generates new learning of safety-based associations that inhibit former fear response associations to the feared stimulus [77, 78, 118], thereby either extinguishing the fear response or enabling a level of fear tolerance that reduces anxious distress.”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [78]
Practicing these skills in different fear-inducing contexts supports generalization of inhibitory learning and stronger extinction of fear responses.
“Practicing these skills in different fear-inducing contexts supports generalization of inhibitory learning and stronger extinction of fear responses [78].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [78]
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Classical fear-conditioning in the anxiety disorders: a meta-analysis
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“In phobic samples, the availability and use of safety signals and behaviors has been shown to be detrimental to exposure therapy (Sloan & Telch, 2002), whereas instructions to refrain from using safety behaviors improved outcomes (Salkovskis, 1991).”
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“…models mean that the original CS-US association learned during fear conditioning is not erased during extinction, but rather is left intact as new, secondary inhibitory learning about the CS-US develops e specifically, that the CS no longer predicts the US (e.g., Bouton, 1993; Bouton & King, 1983).”
Reinstatement of fear to an extinguished conditioned stimulus.
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“Third, reinstatement of conditional fear occurs if unsignaled (or unpaired) US presentations occur in between extinction and retest (Hermans et al., 2005; Rescorla & Heth, 1975; Van Damme, Crombez, Hermans, Koster, & Eccleston, 2006).”
A review of the contextual interference effect in motor skill acquisition
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“A fifth strategy involves stimulus variability throughout exposure since varying the to-be-learned task enhances retention of learned non-emotional material (Magill & Hall, 1990; Schmidt & Bjork, 1992; Shea & Morgan, 1979).”
Contextual and temporal modulation of extinction: behavioral and biological mechanisms
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Fear Extinction and Relapse: State of the Art
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“frequency of retrieval opens the reconsolidation window and provides the opportunity to update the underlying memories (Vervliet et al., 2013).”
Self-citationA Meta-Analytic Review of Adult Cognitive-Behavioral Treatment Outcome Across the Anxiety Disorders
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SOP: A Model of Automatic Memory Processing in Animal Behavior
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Cognitive Therapy of Anxiety Disorders: Science and Practice
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“Fear conditioning is considered a valid model for many of the anxiety disorders, including panic disorder, social anxiety disorder, specific phobia, obsessive compulsive disorder, and posttraumatic stress disorder (Grillon, 2008).”
Impaired fear inhibition is a biomarker of PTSD but not depression
Jovanovic, T., Norrholm, S. D., Blanding, N. Q., Davis, M., Duncan, E., Bradley, B., & Ressler, K. J. (2010) · Depression and Anxiety · doi:10.1002/da.20663 · Cited by 444 · cited 1× · see citing works
“…regulation during extinction, that characterize individuals with anxiety disorders or elevated trait anxiety (e.g., Indovina, Robbins, Nunez-Elizalde, Dunn, & Bishop, 2011; Jovanovic et al., 2010; Milad et al., 2009, 2013; RougemontBucking et al., 2011; see Craske et al., 2012 for a summary).”
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Disruption of Reconsolidation Erases a Fear Memory Trace in the Human Amygdala
Ågren, T., Engman, J., Frick, A., Björkstrand, J., Larsson, E., Furmark, T., & Fredrikson, M. (2012) · Science · doi:10.1126/science.1223006 · Cited by 375 · cited 1× · see citing works
“This effect has since been demonstrated in healthy human samples (Agren et al., 2012; Schiller et al., 2010).”
Quirk, G. J. (2002) · Learning & Memory · doi:10.1101/lm.49602 · Cited by 360 · cited 1× · see citing works
“First, conditional fear shows spontaneous recovery (Quirk, 2002), meaning that the strength of the CR increases in proportion to the amount of time since the end of extinction.”
Extinction in human fear conditioning
Hermans, D., Craske, M. G., Mineka, S., & Lovibond, P. F. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.10.006 · Cited by 328 · cited 1× · see citing works
“Third, reinstatement of conditional fear occurs if unsignaled (or unpaired) US presentations occur in between extinction and retest (Rescorla & Heth, 1975; Hermans et al., 2005; Van Damme et al., 2006).”
Self-citationFear-Conditioning Mechanisms Associated with Trait Vulnerability to Anxiety in Humans
Indovina, I., Robbins, T. W., Núñez-Elizalde, A. O., Dunn, B. D., & Bishop, S. J. (2011) · Neuron · doi:10.1016/j.neuron.2010.12.034 · Cited by 310 · see citing works
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“…regulation during extinction, that characterize individuals with anxiety disorders or elevated trait anxiety (e.g., Indovina, Robbins, Nunez-Elizalde, Dunn, & Bishop, 2011; Jovanovic et al., 2010; Milad et al., 2009, 2013; RougemontBucking et al., 2011; see Craske et al., 2012 for a summary).”
Altered Processing of Contextual Information during Fear Extinction in PTSD: An fMRI Study
Rougemont-Bücking, A., Linnman, C., Zeffiro, T. A., Zeidan, M. A., Lebron-Milad, K., Rodriguez-Romaguera, J., Rauch, S. L., Pitman, R. K., & Milad, M. R. (2011) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2010.00152.x · Cited by 292 · see citing works
A retrieval cue for extinction attenuates spontaneous recovery.
Brooks, D. C., & Bouton, M. E. (1993) · Journal of Experimental Psychology Animal Behavior Processes · doi:10.1037/0097-7403.19.1.77 · Cited by 272 · see citing works
What's wrong with fear conditioning?
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A physiological model of phobic anxiety and desensitization
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Statistical theory of distributional phenomena in learning
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“Variability is believed to enhance the storage capacity of newly learned information (Bjork & Bjork, 1992, 2006), pair the information to-be-learned with more retrieval cues (Estes, 1955), or generate a rule that captures the invariance among tasks (Schmidt & Bjork, 1992), which renders the information more retrievabl…”
Davey, G. C. L. (1992) · Advances in Behaviour Research and Therapy · doi:10.1016/0146-6402(92)90010-l · Cited by 240 · cited 1× · see citing works
“expectancies regarding the frequency or intensity of aversive outcomes (Davey, 1992; Gallistel & Gibbon, 2000; Rescorla & Wagner, 1972).”
Role of inhibition in exposure therapy
Craske, M. G., Liao, B., Brown, L., & Vervliet, B. (2012) · Journal of Experimental Psychopathology · doi:10.5127/jep.026511 · Cited by 237 · cited 3× · see citing works
“…regulation during extinction, that characterize individuals with anxiety disorders or elevated trait anxiety (e.g., Indovina, Robbins, Nunez-Elizalde, Dunn, & Bishop, 2011; Jovanovic et al., 2010; Milad et al., 2009, 2013; RougemontBucking et al., 2011; see Craske et al., 2012 for a summary).”
Self-citationSloan, T., & Telch, M. J. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00007-9 · Cited by 223 · cited 1× · see citing works
“In phobic samples, the availability and use of safety signals and behaviors has been shown to be detrimental to exposure therapy (Sloan & Telch, 2002), whereas instructions to refrain from using safety behaviors improved outcomes (Salkovskis, 1991).”
Reinstatement of fear responses in human aversive conditioning.
Hermans, D., Dirikx, T., Vansteenwegenin, D., Baeyens, F., den Bergh, O. V., & Eelen, P. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.03.013 · Cited by 217 · see citing works
Adrenergic transmission facilitates extinction of conditional fear in mice
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“Notably, sustained arousal throughout extinction is associated with less fear at retest in animals (Rescorla, 2006) and in humans (Culver, Stephans & Craske, under review), arousal consolidates extinction memories (Cain et al., 2004) and in several of our studies, failure to habituate throughout exposure therapy was n…”
Conducting exposure treatment in multiple contexts can prevent relapse
Gunther, L. M., Denniston, J. C., & Miller, R. R. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10019-5 · Cited by 210 · see citing works
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“Deficits in inhibition and anxiety disorders A substantial number of individuals fail to achieve clinically significant symptom relief from exposure-based therapies (Arch & Craske, 2009) or experience a return of fear following exposure therapy (see Craske & Mystkowski, 2006).”
Self-citationExposure Therapy and Extinction: Clinical Studies.
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“Clinically, this effect parallels the return of fear that commonly occurs with the lapse of time since completion of exposure therapy (e.g., Craske & Mystkowski, 2006; Craske & Rachman, 1986).”
Self-citationEffects of varied-stimulus exposure training on fear reduction and return of fear
Rowe, M. K., & Craske, M. G. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10017-1 · Cited by 202 · cited 2× · see citing works
“We found that variability in terms of timing between exposure sessions (i.e., progressively longer intervals between exposure sessions) led to superior outcomes at follow-up than nonvariable-massed exposure in spider fearful samples (Rowe & Craske, 1998; Tsao & Craske, 2000).”
Self-citationBrooks, D. C., & Bouton, M. E. (1994) · Journal of Experimental Psychology Animal Behavior Processes · doi:10.1037//0097-7403.20.4.366 · Cited by 193 · see citing works
Protection from extinction in human fear conditioning
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Deepened extinction from compound stimulus presentation.
Rescorla, R. A. (2006) · Journal of Experimental Psychology Animal Behavior Processes · doi:10.1037/0097-7403.32.2.135 · Cited by 183 · cited 5× · see citing works
“A second strategy is “deepened extinction” (Rescorla, 2000, 2006), in which either multiple fear CSs are first extinguished separately before being combined during extinction, or a previously extinguished cue is paired with a novel CS.”
InfluentialThe effects of changing contexts on return of fear following exposure therapy for spider fear.
Mineka, S., Mystkowski, J. L., Hladek, D., & Rodriguez, B. I. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.4.599 · Cited by 177 · see citing works
Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.06.006 · Cited by 176 · cited 1× · see citing works
“Deacon et al. (2013) found that interoceptive exposure that continued until the patient’s expectancy of an aversive outcome reached less than 5% was superior to standard interoceptive exposure.”
Neural networks and perceptual learning
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“Indeed, research suggests that repeated exposure leads to improved perceptual learning/stimulus discrimination (Tsodyks & Gilbert, 2004).”
Does habituation matter? Emotional processing theory and exposure therapy for acrophobia
Baker, A., Mystkowski, J., Culver, N., Yi, R., Mortazavi, A., & Craske, M. G. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.07.009 · Cited by 161 · cited 4× · see citing works
“…evidence against habituation approaches, neither fear reduction nor ending fear levels predict long term outcome from extinction or exposure (Baker et al., 2010; Culver et al., 2012; Kircanski et al., 2012; Plendl & Wotjak, 2010; Prenoveau et al., 2013; Rescorla, 2006 e discussed in prior…”
InfluentialSelf-citationEffects of recent exposure to a conditioned stimulus on extinction of Pavlovian fear conditioningPreprint
Chan, W. Y. M., Leung, H. T., Westbrook, R. F., & McNally, G. P. (2010) · Learning & Memory · doi:10.1101/lm.1912510 · Cited by 156 · see citing works
Mental Reinstatement of Context and Return of Fear in Spider-Fearful Participants
Mystkowski, J. L., Craske, M. G., Echiverri, A. M., & Labus, J. S. (2006) · Behavior Therapy · doi:10.1016/j.beth.2005.04.001 · Cited by 154 · cited 1× · see citing works
“, 2011), although instructions to mentally reinstate what was learned during exposure (an instructional retrieval cue) had more robust effects in reducing context renewal in another study (Mystkowski et al., 2006).”
Self-citationTreatment context and return of fear in spider phobia
Mystkowski, J. L., Craske, M. G., & Echiverri, A. M. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80035-1 · Cited by 153 · cited 1× · see citing works
“These effects have been observed in clinical analog samples undergoing exposure therapy and follow-up testing in the same versus different contexts (Mystkowski et al., 2002; Mystkowski et al., 2003; Mysktowski et al., 2006; Culver, Stoyanova & Craske, 2011).”
Self-citationContext-specificity of relapse: effects of therapist and environmental context on return of fear.
Rodriguez, B. I., Craske, M., Mineka, S., & Hladek, D. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00106-5 · Cited by 152 · see citing works
Self-citationManipulations of exposure-based therapy to reduce return of fear: a replication
Lang, A. J., & Craske, M. G. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00031-5 · Cited by 149 · cited 4× · see citing works
“Also, variability in terms of the stimuli used during exposure led to positive outcomes in terms of spontaneous recovery in spider fearful and height fearful samples (Lang & Craske, 2000; Rowe & Craske, 1998), although a third study of contaminant anxiety showed trends only (Kircanski et al., 2012).”
InfluentialSelf-citationDissociation of within- and between-Session Extinction of Conditioned Fear
Plendl, W., & Wotjak, C. T. (2010) · Journal of Neuroscience · doi:10.1523/jneurosci.6038-09.2010 · Cited by 148 · cited 2× · see citing works
“…against habituation approaches, neither fear reduction nor ending fear levels predict long term outcome from extinction or exposure (Baker et al., 2010; Culver et al., 2012; Kircanski et al., 2012; Plendl & Wotjak, 2010; Prenoveau et al., 2013; Rescorla, 2006 e discussed in prior sections).”
Consolidation of Long-Term Memory: Evidence and Alternatives.
Meeter, M., & Murre, J. M. J. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.6.843 · Cited by 148 · cited 1× · see citing works
“Indeed, mental rehearsal, or in this case mental rehearsal of the inhibitory CS-no US association, is an important component of memory consolidation (Joos, 2011; Meeter & Murre, 2004).”
Vansteenwegen, D., Vervliet, B., Iberico, C., Baeyens, F., Van den Bergh, O., & Hermans, D. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.08.023 · Cited by 148 · cited 2× · see citing works
“…have been shown to offset context renewal in rodent samples (e.g., Gunther, Denniston, & Miller, 1998), in human laboratory studies (e.g., Bandarian Balooch & Neumann, 2011, Bandarian Balooch, Neumann, & Boschen, 2012) and in a clinical analog study of exposure therapy (Vansteenwegen et al., 2007).”
Self-citationIs aversive learning a marker of risk for anxiety disorders in children?
Craske, M. G., Waters, A. M., Lindsey Bergman, R., Naliboff, B., Lipp, O. V., Negoro, H., & Ornitz, E. M. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.04.011 · Cited by 146 · see citing works
Self-citationSalkovskis, P. M., Hackmann, A., Adrian Wells, A., Gelder, M., & Clark, D. M. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.02.008 · Cited by 143 · see citing works
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“, repeated increases following decreases in minute to minute fear levels) is a positive predictor of outcomes in contaminant anxiety and public speaking anxiety (Kircanski et al., 2012; Culver et al., 2012).”
InfluentialSelf-citationBrooks, D. C., & Bouton, M. E. (1994) · Journal of Experimental Psychology Animal Behavior Processes · doi:10.1037/0097-7403.20.4.366 · Cited by 139 · cited 1× · see citing works
“One option for enhancing retrieval of extinction learning and offsetting context renewal is to include retrieval cues (of the CS-no US association) during extinction training to be used in other contexts once extinction is over (Brooks & Bouton,1994; Dibbets &Maes, 2011; Vansteenwegen et al., 2006).”
Extinction in multiple contexts does not necessarily make extinction less vulnerable to relapse
Bouton, M. E., Garcı́a-Gutiérrez, A., Zilski-Pineño, J. M., & Moody, E. W. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.07.007 · Cited by 138 · see citing works
Tabibnia, G., Lieberman, M. D., & Craske, M. G. (2008) · Emotion · doi:10.1037/1528-3542.8.3.307 · Cited by 135 · see citing works
Self-citationTsao, J. C. I., & Craske, M. G. (2000) · Behavior Therapy · doi:10.1016/s0005-7894(00)80026-x · Cited by 131 · cited 1× · see citing works
“We found that variability in terms of timing between exposure sessions (i.e., progressively longer intervals between exposure sessions) led to superior outcomes at follow-up than nonvariable-massed exposure in spider fearful samples (Rowe & Craske, 1998; Tsao & Craske, 2000).”
Self-citationReacquisition following extinction in appetitive conditioning
Ricker, S. T., & Bouton, M. E. (1996) · Animal Learning & Behavior · doi:10.3758/bf03199014 · Cited by 126 · cited 1× · see citing works
“Fourth, rapid reacquisition of the CR is seen if the CS-US pairings are repeated following extinction (Ricker & Bouton, 1996).”
Memory and society psychological perspectives
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Occasional reinforced trials during extinction can slow the rate of rapid reacquisition
Bouton, M. E., Woods, A. M., & Pineño, O. (2004) · Learning and Motivation · doi:10.1016/j.lmot.2004.05.001 · Cited by 109 · cited 4× · see citing works
“As with animal studies (Bouton et al., 2004), we found that occasional reinforced extinction sustained fear arousal during extinction but attenuated the subsequent reacquisition of fear in a human conditioning study (Culver et al.”
InfluentialChanges in caffeine states enhance return of fear in spider phobia.
Mystkowski, J. L., Mineka, S., Vernon, L. L., & Zinbarg, R. E. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.2.243 · Cited by 108 · see citing works
Emotional variability and sustained arousal during exposure
Culver, N. C., Stoyanova, M., & Craske, M. G. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.10.009 · Cited by 106 · cited 4× · see citing works
“…against habituation approaches, neither fear reduction nor ending fear levels predict long term outcome from extinction or exposure (Baker et al., 2010; Culver et al., 2012; Kircanski et al., 2012; Plendl & Wotjak, 2010; Prenoveau et al., 2013; Rescorla, 2006 e discussed in prior sections).”
InfluentialSelf-citationExtinction can be enhanced by a concurrent excitor.
Rescorla, R. A. (2000) · Journal of Experimental Psychology Animal Behavior Processes · doi:10.1037//0097-7403.26.3.251 · Cited by 104 · cited 1× · see citing works
“A second strategy is “deepened extinction” (Rescorla, 2000, 2006), in which either multiple fear CSs are first extinguished separately before being combined during extinction, or a previously extinguished cue is paired with a novel CS.”
The role of extinction and reinstatement in attentional bias to threat: A conditioning approach
Damme, S. V., Crombez, G., Hermans, D., Koster, E. H. W., & Eccleston, C. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.11.008 · Cited by 103 · see citing works
Reducing contamination by exposure plus safety behaviour
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Neumann, D. L., Lipp, O. V., & Cory, S. E. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.02.001 · Cited by 90 · cited 1× · see citing works
“On the other hand, one conditioning study in rodents (Bouton, García-Gutiérrez, Zilkski, & Moody, 2006) and another conditioning study in humans (Neumann et al., 2007) failed to demonstrate detectable benefits of multiple contexts throughout extinction on context renewal, suggesting that the effects are unstable.”
The acquisition, extinction, and spontaneous recovery of a conditioned operant response.
Graham, C. H., & Gagné, R. M. (1940) · Journal of Experimental Psychology · doi:10.1037/h0060674 · Cited by 87 · see citing works
Vansteenwegen, D., Vervliet, B., Hermans, D., Beckers, T., Baeyens, F., & Eelen, P. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.10.014 · Cited by 83 · cited 1× · see citing works
“One option for enhancing retrieval of extinction learning and offsetting context renewal is to include retrieval cues (of the CS-no US association) during extinction training to be used in other contexts once extinction is over (Brooks & Bouton,1994; Dibbets &Maes, 2011; Vansteenwegen et al., 2006).”
Self-citationDeacon, B. J., Sy, J. T., Lickel, J. J., & Nelson, E. A. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2009.10.004 · Cited by 82 · see citing works
Woods, A. M., & Bouton, M. E. (2006) · Learning and Motivation · doi:10.1016/j.lmot.2006.07.003 · Cited by 81 · see citing works
Extinction treatment in multiple contexts attenuates ABC renewal in humans
Bandarian‐Balooch, S., Neumann, D. L., & Boschen, M. J. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.06.003 · Cited by 80 · see citing works
Optimizing Treatment and Instruction: Implications of a New Theory of Disuse
Bjork, R. A., & Bjork, E. L. (2013) · Psychology Press eBooks · doi:10.4324/9780203086254-13 · Cited by 79 · see citing works
Memory retrieval before or after extinction reduces recovery of fear in adolescent ratsPreprint
Baker, K., McNally, G. P., & Richardson, R. (2013) · Learning & Memory · doi:10.1101/lm.031989.113 · Cited by 78 · see citing works
All we need is a cue to remember: The effect of an extinction cue on renewal
Dibbets, P., Havermans, R. C., & Arntz, A. R. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.05.007 · Cited by 72 · cited 1× · see citing works
“One risk of retrieval cues, however, is that they may acquire an inhibitory value and became a safety signal (Dibbets et al. 2008).”
Clinical relevance of retrieval cues for attenuating context renewal of fear
Culver, N. C., Stoyanova, M., & Craske, M. G. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.10.002 · Cited by 70 · cited 1× · see citing works
“In clinical analog anxious samples, the effects of a retrieval cue (distinctive pen and clip board) upon context renewal were very weak in one study (Culver et al., 2011), although instructions to mentally reinstate what was learned during exposure (an instructional retrieval cue) had more robust…”
Self-citationBandarian‐Balooch, S., & Neumann, D. L. (2010) · Learning and Motivation · doi:10.1016/j.lmot.2010.08.008 · Cited by 65 · cited 2× · see citing works
“…have been shown to offset context renewal in rodent samples (e.g., Gunther, Denniston, & Miller, 1998), in human laboratory studies (e.g., Bandarian Balooch & Neumann, 2011, Bandarian Balooch, Neumann, & Boschen, 2012) and in a clinical analog study of exposure therapy (Vansteenwegen et al., 2007).”
Meuret, A. E., Wolitzky-Taylor, K. B., Twohig, M. P., & Craske, M. G. (2012) · Behavior Therapy · doi:10.1016/j.beth.2011.08.002 · Cited by 64 · see citing works
Self-citationFailure to replicate the deleterious effects of safety behaviors in exposure therapy
Sy, J. T., Dixon, L. J., Lickel, J. J., Nelson, E. A., & Deacon, B. J. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.005 · Cited by 61 · cited 1× · see citing works
“Similarly, Deacon and colleagues have failed to replicate the deleterious effect of continuing to engage in safety behaviors (including the availability of the safety behavior but without actual engagement of it) during exposure in claustrophobic fear (Deacon et al., 2010; Sy et al., 2011).”
Current Controversies in the Anxiety Disorders
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Human fear conditioning and extinction: Timing is everything…or is it?
Prenoveau, J. M., Craske, M. G., Liao, B., & Ornitz, E. M. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.02.005 · Cited by 48 · see citing works
Self-citationReturn of fear: Perceived skill and heart‐rate responsivity
Craske, M. G., & Rachman, S. (1987) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1987.tb01346.x · Cited by 45 · see citing works
Self-citationThe effect of an extinction cue on ABA-renewal: Does valence matter?
Dibbets, P., & Maes, J. H. R. (2011) · Learning and Motivation · doi:10.1016/j.lmot.2010.12.003 · Cited by 34 · see citing works
Optimal attentional focus during exposure in specific phobia: A meta-analysis
Podina, I. R., Koster, E. H. W., Philippot, P., Dethier, V., & David, D. O. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.10.002 · Cited by 25 · see citing works
Contingency and Relative Associative Strength
Klein, S. B., & Mowrer, R. R. (2014) · Psychology Press eBooks · doi:10.4324/9781315801896-10 · Cited by 25 · see citing works
Repetitive thought in human (fear) conditioning: Strengthening the acquisition and extinction memory
Joos, E. (2012) · Lirias · Cited by 6 · see citing works
Harman, K. (2009) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465809005141 · Cited by 2 · see citing works
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- Ponnusamy R Zhuravka I Poulos AM Huang J Wolvek D O’Neil PK Fanselow MS 8 2011 Retrieval vs Reconsolidation accounts of deepened extinction with reminder treatments Poster presented at the Gordon Research Conference
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Using Neuroscience to Help Understand Fear and Anxiety: A Two-System Framework
LeDoux, J. E., & Pine, D. S. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2016.16030353 · Cited by 1,035 · see citing works
“anxiety evoked during exposure (132), postexposure consolidation (120), or the use of particular outcome measures to”
BackgroundChildhood Adversity and Neural Development: A Systematic Review
McLaughlin, K. A., Weissman, D., & Bitrán, D. (2019) · Annual Review of Developmental Psychology · doi:10.1146/annurev-devpsych-121318-084950 · Cited by 892 · see citing works
Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0102-3 · Cited by 895 · see citing works
Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, A., Rapee, R. M., & Wittchen, H.-U. (2017) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2017.24 · Cited by 652 · see citing works
Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., Dour, H., & Rosenfield, D. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000396 · Cited by 451 · see citing works
Self-citationRiva, G., Baños, R. M., Botella, C., Mantovani, F., & Gaggioli, A. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00164 · Cited by 425 · see citing works
“These studies are in agreement with the results obtained by Craske et al. (89) on the inhibitory learning approach presenting exposure optimization strategies such as (a) “deepened 3 studies “There is no clear good quality evidence for or against using virtual reality for treatment compliance among…”
ResultLeDoux, J. E., & Daw, N. D. (2018) · Nature reviews. Neuroscience · doi:10.1038/nrn.2018.22 · Cited by 391 · see citing works
Virtual reality therapy in mental health
Emmelkamp, P. M. G., & Meyerbröker, K. (2021) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081219-115923 · Cited by 363 · see citing works
Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, É., Forget, H., Loranger, C., & Roucaut, F. X. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.184234 · Cited by 354 · see citing works
“In accordance with the inhibitory learning model, 15 the focus of the exposure was to develop new, non-threatening and adaptive interpretations of feared social situations, negative evaluation, rejection, embarrassment, loss of social status or being perceived as inadequate.”
InfluentialCurrent Definitions of “Transdiagnostic” in Treatment Development: A Search for Consensus
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017) · Behavior Therapy · doi:10.1016/j.beth.2016.09.004 · Cited by 371 · see citing works
Stade, E. C., Stirman, S. W., Ungar, L. H., Boland, C. L., Schwartz, H. A., Yaden, D. B., Sedoc, J., DeRubeis, R. J., Willer, R., & Eichstaedt, J. C. (2024) · npj Mental Health Research · doi:10.1038/s44184-024-00056-z · Cited by 391 · see citing works
“At the level of health systems, they could expedite the implementation and translation of research fi ndings into clinical practice by suggesting therapeutic strategies to psy-chotherapists, for instance, promoting strategies that enhance inhibitory learning during exposure therapy 84 .”
BackgroundDunsmoor, J. E., Niv, Y., Daw, N., & Phelps, E. A. (2015) · Neuron · doi:10.1016/j.neuron.2015.09.028 · Cited by 329 · see citing works
Fear extinction in the human brain: A meta-analysis of fMRI studies in healthy participants
Fullana, M. A., Albajes-Eizagirre, A., Soriano-Mas, C., Vervliet, B., Cardoner, N., Benet, O., Radua, J., & Harrison, B. J. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.03.002 · Cited by 308 · see citing works
Self-citationRethinking avoidance: Toward a balanced approach to avoidance in treating anxiety disorders
Hofmann, S. G., & Hay, A. C. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.03.004 · Cited by 315 · see citing works
Pittig, A., Treanor, M., LeBeau, R. T., & Craske, M. G. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.03.015 · Cited by 294 · see citing works
“…of advances in research on fear and avoidance learning to treatment and by the failure of basic science to fully model the complexity and essential features of anxiety disorders and naturalistic treatment conditions (see Craske et al., 2014, 2008a; Pittig et al., 2016; Richter et al., 2017).”
InfluentialSelf-citationState-of-the-art and future directions for extinction as a translational model for fear and anxiety
Craske, M. G., Hermans, D., & Vervliet, B. (2018) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2017.0025 · Cited by 373 · see citing works
Self-citationThe subjective experience of emotion: a fearful view
LeDoux, J. E., & Hofmann, S. G. (2018) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2017.09.011 · Cited by 268 · see citing works
“Some argue that self-reported fear is an inadequate measure of the patient’s emotional state because reduction in reported fear during exposure sessions does not predict long-term treatment effects [68,69].”
BackgroundIntegrating Empathy and Interpersonal Emotion Regulation
Zaki, J. (2019) · Annual Review of Psychology · doi:10.1146/annurev-psych-010419-050830 · Cited by 273 · see citing works
Brosschot, J., Verkuil, B., & Thayer, J. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.04.012 · Cited by 226 · see citing works
“…terms of clinical implications, GUTS is compatible with the recent focus on safety learning (Jovanovic et al., 2012; Kong et al., 2014; Pappens et al., 2014; Wendt et al., 2015) and with the idea that successful exposure therapy is dependent on successful inhibitory learning (Craske et al., 2014).”
BackgroundSartori, S. B., & Singewald, N. (2019) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2019.107402 · Cited by 236 · see citing works
An Abrupt Transformation of Phobic Behavior After a Post-Retrieval Amnesic Agent
Soeter, M., & Kindt, M. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.04.006 · Cited by 226 · see citing works
“One way to counteract the return of fear is by identifying therapeutic strategies for enhancing inhibitory learning; this form of learning forms the basis of cognitive behavioral treatment for fear and anxiety disorders (55).”
BackgroundTaylor, C. T., Lyubomirsky, S., & Stein, M. B. (2017) · Depression and Anxiety · doi:10.1002/da.22593 · Cited by 233 · see citing works
Expectancies as core features of mental disorders
Rief, W., Glombiewski, J. A., Gollwitzer, M., Schubö, A., Schwarting, R. K. W., & Thorwart, A. (2015) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000184 · Cited by 235 · see citing works
Basic strategies of cognitive behavioral therapy.
Wenzel, A. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.07.001 · Cited by 199 · see citing works
Contemporary cognitive behavior therapy: A review of theory, history, and evidence
Thoma, N., Pilecki, B., & McKay, D. (2015) · Psychodynamic Psychiatry · doi:10.1521/pdps.2015.43.3.423 · Cited by 197 · see citing works
Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance
Wolff, M., Evens, R., Mertens, L. J., Koslowski, M., Betzler, F., Gründer, G., & Jungaberle, H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00005 · Cited by 195 · see citing works
“It is well established that extinction learning in exposure treatments is most effective when negative expectancies regarding the outcomes of exposure are maximally violated (33).”
BackgroundLindner, P., Miloff, A., Hamilton, W., Reuterskiöld, L., Andersson, G., Powers, M. B., & Carlbring, P. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1280843 · Cited by 187 · see citing works
“…varying the stimuli (e.g. having many different spiders) and context (e.g. a virtual living room, shed, outdoors etc.) has been shown to improve generalizability of extinction learning, decreasing the risk of return of fear outside the therapy session (Craske et al., 2014; Vervliet et al., 2013).”
BackgroundOptimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus
Craske, M. G., Treanor, M., Zbozinek, T. D., & Vervliet, B. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104069 · Cited by 195 · see citing works
Self-citationMechanisms linking childhood adversity with psychopathology: Learning as an intervention target
McLaughlin, K. A., DeCross, S. N., Jovanović, T., & Tottenham, N. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.04.008 · Cited by 198 · see citing works
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Blakey, S. M., & Abramowitz, J. S. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.07.002 · Cited by 186 · see citing works
“To fully decontextualize inhibitory associations, however, exposure variations should eventually be completed without safety behaviors (Craske et al., 2014; Rachman et al., 2008).”
BackgroundInfluentialBullis, J. R., Boettcher, H., Sauer‐Zavala, S., Farchione, T. J., & Barlow, D. H. (2019) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12278 · Cited by 216 · see citing works
Dunsmoor, J. E., Campese, V. D., Ceceli, A. O., LeDoux, J. E., & Phelps, E. A. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2014.12.008 · Cited by 165 · see citing works
“Clinical applications could include augmenting exposure therapy to increase surprise using novel but unremarkable outcomes, in line with clinical models that highlight the critical role for belief disconfirmation for the success of exposure treatments (46, 47).”
Fear in the context of pain: Lessons learned from 100 years of fear conditioning research.
Meulders, A. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103635 · Cited by 151 · see citing works
Lindner, P., Miloff, A., Fagernäs, S., Andersen, J., Sigeman, M., Andersson, G., Furmark, T., & Carlbring, P. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.07.003 · Cited by 175 · see citing works
Memory editing from science fiction to clinical practice
Phelps, E. A., & Hofmann, S. G. (2019) · Nature · doi:10.1038/s41586-019-1433-7 · Cited by 170 · see citing works
An enactive approach to pain: beyond the biopsychosocial model
Stilwell, P., & Harman, K. (2019) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-019-09624-7 · Cited by 172 · see citing works
Hebert, E. A., & Dugas, M. J. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.07.007 · Cited by 165 · see citing works
Freeman, D. H., Lambe, S., Kabir, T., Petit, A., Rosebrock, L. E., Yu, L., Dudley, R. E. J., Chapman, K., Morrison, A. P., O’Regan, E., et al. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(22)00060-8 · Cited by 160 · see citing works
“10 In two previous studies in patients with psychosis, therapists have successfully conducted behavioural experiments using VR simulations of anxiety-provoking situations to reduce fears.”
The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research
Kotov, R., Cicero, D. C., Conway, C., DeYoung, C. G., Dombrovski, A. Y., Eaton, N. R., First, M. B., Forbes, M. K., Hyman, S. E., Jonas, K. G., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722001301 · Cited by 163 · see citing works
Self-citationMiloff, A., Lindner, P., Dafgård, P., Deak, S., Garke, M., Hamilton, W., Heinsoo, J., Kristoffersson, G., Rafi, J., Sindemark, K., et al. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.04.004 · Cited by 155 · see citing works
Embodiment in Virtual Reality Intensifies Emotional Responses to Virtual Stimuli
Gall, D., Roth, D., Stauffert, J.-P., Zarges, J., & Latoschik, M. E. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.674179 · Cited by 159 · see citing works
“This hypothesis is consistent with the theory of depersonalization, a body function that decreases intense emotional reactions in highly threatening situations (Simeon et al., 2000; Sierra and David, 2011; Dewe et al., 2016, 2018).”
ResultA complex systems approach to the study of change in psychotherapy
Hayes, A. M., & Andrews, L. A. (2020) · BMC Medicine · doi:10.1186/s12916-020-01662-2 · Cited by 149 · see citing works
Monfils, M., & Holmes, E. A. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30270-0 · Cited by 144 · see citing works
Pittig, A., Wong, A. H. K., Glück, V. M., & Boschet, J. M. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103550 · Cited by 148 · see citing works
Behavioral Conceptualization and Treatment of Chronic Pain
Vlaeyen, J. W. S., & Crombez, G. (2019) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050718-095744 · Cited by 146 · see citing works
Exposure therapy for eating disorders: A systematic review
Butler, R. M., & Heimberg, R. G. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101851 · Cited by 143 · see citing works
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“Recent evidence indicates that treatment benefits of exposure therapy accrue as a result of new inhibitory learning and not habituation of the conditioned response to phobic stimuli [55].”
BackgroundPractitioner Review: Anxiety disorders in children and young people – assessment and treatment
Creswell, C., Waite, P., & Hudson, J. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13186 · Cited by 140 · see citing works
The role of attention control in complex real-world tasks
Draheim, C., Pak, R., Draheim, A. A., & Engle, R. W. (2022) · Psychonomic Bulletin & Review · doi:10.3758/s13423-021-02052-2 · Cited by 145 · see citing works
Thabrew, H., Stasiak, K., Hetrick, S. E., Wong, S., Huss, J. H., & Merry, S. N. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012489.pub2 · Cited by 141 · see citing works
“[DOI: 10.1002/14651858.CD008324.pub3] Craske 2014 Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach.”
InfluentialExposure and response prevention for obsessive-compulsive disorder: A review and new directions
Simpson, H., & Hezel, D. (2019) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_516_18 · Cited by 137 · see citing works
“Craske et al.[39] have proposed a number of ways to enhance extinction learning based on the aforementioned inhibitory learning perspective.”
BackgroundInfluentialChu, B. C., Crocco, S. T., Esseling, P. G., Areizaga, M. J., Lindner, A. M., & Skriner, L. C. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.11.005 · Cited by 138 · see citing works
“The mechanism by which exposures work is hotly contested (Craske et al., 2014; Foa & Mcnally, 1996), but exposures might best be seen as a context in which a therapist can enact multiple behavioral principles (e.g., extinction, differential reinforcement, shaping) to encourage new…”
BackgroundScheveneels, S., Boddez, Y., Vervliet, B., & Hermans, D. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.08.015 · Cited by 136 · see citing works
Self-citationvan Woudenberg, C., Voorendonk, E. M., Bongaerts, H., Zoet, H. A., Verhagen, M., Lee, C. W., van Minnen, A., & de Jongh, A. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1487225 · Cited by 137 · see citing works
An empirical review of potential mediators and mechanisms of prolonged exposure therapy
Cooper, A. A., Clifton, E. G., & Feeny, N. C. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.07.003 · Cited by 133 · see citing works
“For instance, animal research on fear inhibition can yield concrete, testable strategies to enhance impact of individual exposures (Craske et al., 2014).”
BackgroundInfluentialSchaumberg, K., Reilly, E. E., Gorrell, S., Levinson, C. A., Farrell, N. R., Brown, T. A., Smith, K. M., Schaefer, L. M., Essayli, J. H., Haynos, A. F., et al. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101952 · Cited by 121 · see citing works
“As etiological and treatment models of ADs have evolved in recent years (L. A. Brown et al., 2017; Craske et al., 2014; Craske et al., 2018), the time is ripe to reevaluate the conceptual overlap between anxiety and EDs, incorporating updated literature.”
BackgroundResultInfluentialWeisman, J. S., & Rodebaugh, T. L. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.10.010 · Cited by 117 · see citing works
Botella, C., Pérez-Ara, M. Á., Bretón-López, J., Quero, S., García-Palacios, A., & Baños, R. M. (2016) · PLoS ONE · doi:10.1371/journal.pone.0148237 · Cited by 124 · see citing works
“These studies are in line with the work carried out by Craske et al. [81], focused PLOS ONE | DOI:10.1371/journal.pone.0148237 February 17, 2016 16 / 22 on optimizing exposure therapy based on the inhibitory learning approach, because VR/AR can maximize some strategies reported by Craske.”
BackgroundInfluentialOrigins and outlook of interoceptive exposure
Boettcher, H., Brake, C. A., & Barlow, D. H. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.10.009 · Cited by 124 · see citing works
“…patients was establishing the utility of exposure to feared situational stimuli (e.g., tunnels, animals, water; Sherman, 1972), now understood to weaken the fear response by enabling new learning that competes with initial, fearful associations (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
BackgroundThe key role of extinction learning in anxiety disorders
Pittig, A., van den Berg, L., & Vervliet, B. (2015) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000220 · Cited by 124 · see citing works
“Spanish translation of clinical case formulations and research findings for different behavioral strategies was adapted from [69].”
Self-citationCraske, M. (2015) · Verhaltenstherapie · doi:10.1159/000381574 · Cited by 124 · see citing works
Self-citationMcGovern, R. A., & Sheth, S. A. (2017) · Journal of Neurosurgery · doi:10.3171/2016.1.jns15601 · Cited by 117 · see citing works
Idiopathic Environmental Intolerance: A Comprehensive Model
Van den Bergh, O., Brown, R. J., Petersen, S., & Witthöft, M. (2017) · Clinical Psychological Science · doi:10.1177/2167702617693327 · Cited by 121 · see citing works
Hendriks, L., Kleine, R. A. D., Broekman, T. G., Hendriks, G.-J., & Minnen, A. V. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1425574 · Cited by 121 · see citing works
Transdiagnostic dimensions of anxiety: Neural mechanisms, executive functions, and new directions
Sharp, P. B., Miller, G. A., & Heller, W. (2015) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2015.07.001 · Cited by 140 · see citing works
“Habituation to fearful stimuli is a key aspect of exposure therapy (e.g., Craske et al., 2014; Foa and Kozak, 1986; Fanselow and Sterlace, 2014), an empirically-supported and efficacious treatment for many anxiety disorders.”
BackgroundMeyer, H. C., Odriozola, P., Cohodes, E. M., Mandell, J. D., Li, A., Yang, R., Hall, B. S., Haberman, J. T., Zacharek, S. J., Liston, C. M., et al. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1910481116 · Cited by 118 · see citing works
Attenuating Neural Threat Expression with Imagination
Reddan, M. C., Wager, T. D., & Schiller, D. (2018) · Neuron · doi:10.1016/j.neuron.2018.10.047 · Cited by 116 · see citing works
Olatunji, B. O., Armstrong, T., & Elwood, L. S. (2017) · Perspectives on Psychological Science · doi:10.1177/1745691616688879 · Cited by 114 · see citing works
Kindt, M., & van Emmerik, A. (2016) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125316644541 · Cited by 107 · see citing works
“Although the memory reactivation seems procedurally similar to imaginal exposure, including a violation of threat expectation [Craske et al. 2014], it should be much shorter than traditional exposure techniques in order to prevent the formation of a new inhibitory memory [Bos et al.”
BackgroundCatastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders
Gellatly, R., & Beck, A. T. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9763-3 · Cited by 112 · see citing works
“By utilizing exposures that maximally violate the client’s expectancies about aversive outcomes, deeper inhibitory learning takes place, facilitating memory consolidation (Craske et al. 2014).”
BackgroundMorriss, J., Zuj, D. V., & Mertens, G. (2021) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2021.05.011 · Cited by 108 · see citing works
“…behaviours are a natural response to threat, however maladaptive avoidance is considered a significant barrier to effective treatment by preserving conditioned threat relationships before, during, and after prolonged exposure-based therapies (Craske et al., 2014; Dymond, 2019; Pittig et al., 2018).”
BackgroundGujjar, K. R., van Wijk, A., Kumar, R., & de Jongh, A. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.12.001 · Cited by 111 · see citing works
Resilience training that can change the brain.
Tabibnia, G., & Radecki, D. (2018) · Consulting psychology journal · doi:10.1037/cpb0000110 · Cited by 114 · see citing works
The impact of social skills training for social anxiety disorder: A randomized controlled trial
Beidel, D. C., Alfano, C. A., Kofler, M. J., Rao, P. A., Scharfstein, L. A., & Sarver, N. W. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.09.016 · Cited by 108 · see citing works
Translating Across Circuits and Genetics Toward Progress in Fear- and Anxiety-Related Disorders
Ressler, K. J. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20010055 · Cited by 104 · see citing works
“Such preclinical work has recently influenced novel approaches to behavioral exposure therapy as well, by actively bringing reward systems online at the culmination of threat exposures, which appears to enhance the efficacy of extinction and exposure for anxiety- and fear-related disorders (104, 105).”
BackgroundPhobia Exposure Therapy Using Virtual and Augmented Reality: A Systematic Review
Albakri, G., Bouaziz, R., Alharthi, W. J., Kammoun, S., Al-Sarem, M., Saeed, F., & Hadwan, M. (2022) · Applied Sciences · doi:10.3390/app12031672 · Cited by 113 · see citing works
“Exposure takes various forms, including graduated versus intense (or flooding therapy), brief versus prolonged, with and without various cognitive and somatic coping strategies, and imaginal, interceptive, or in vivo (or in real life) [20].”
BackgroundBurton, C. L., Wang, K., & Pachankis, J. E. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.05.001 · Cited by 105 · see citing works
Role of Human Ventromedial Prefrontal Cortex in Learning and Recall of Enhanced Extinction
Dunsmoor, J. E., Kroes, M. C. W., Li, J., Daw, N. D., Simpson, H. B., & Phelps, E. A. (2019) · Journal of Neuroscience · doi:10.1523/jneurosci.2713-18.2019 · Cited by 110 · see citing works
“…form the basis for exposure therapy (Foa and Kozak, 1986; Milad and Quirk, 2012; Vervliet et al., 2013; Ball et al., 2017), there is motivation to develop behavioral strategies that more effectively prevent the relapse of maladaptive behavior (Craske et al., 2008, 2014; Dunsmoor et al., 2015a).”
BackgroundFactors influencing the success of exposure therapy for specific phobia: a systematic review
Böhnlein, J., Altegoer, L., Muck, N. K., Roesmann, K., Redlich, R., Dannlowski, U., & Leehr, E. J. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.12.009 · Cited by 98 · see citing works
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The validity of human avoidance paradigms.
Krypotos, A.-M., Vervliet, B., & Engelhard, I. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.10.011 · Cited by 95 · see citing works
Self-citationAn affective neuroscience model of boosting resilience in adults
Tabibnia, G. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.05.005 · Cited by 109 · see citing works
Pittig, A., Heinig, I., Goerigk, S. A., Richter, J., Hollandt, M., Lueken, U., Pauli, P., Deckert, J., Kircher, T. T. J., Straube, B., et al. (2022) · Clinical Psychological Science · doi:10.1177/21677026221101379 · Cited by 105 · see citing works
“In line with previous research, absolute EV was calculated as the average mismatch between threat expectancy and threat occurrence (i.e., threat expectancy – threat occurrence averaged across exposure exercises of an individual patient; Craske et al., 2014; de Kleine et al., 2017).”
BackgroundResultInfluentialSelf-citationA behavioural neuroscience perspective on the aetiology and treatment of anxiety disorders
Kindt, M. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.08.012 · Cited by 103 · see citing works
Gloster, A. T., Klotsche, J., Ciarrochi, J., Eifert, G., Sonntag, R., Wittchen, H.-U., & Hoyer, J. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.01.013 · Cited by 101 · see citing works
Rodent models of impaired fear extinction
Singewald, N., & Holmes, A. (2018) · Psychopharmacology · doi:10.1007/s00213-018-5054-x · Cited by 98 · see citing works
“build fear inhibitory associations can explain the high rates of fear relapse in anxiety disorder patients (Craske et al. 2014).”
BackgroundDumont, E., Jansen, A., Kroes, D., de Haan, E., & Mulkens, S. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23053 · Cited by 98 · see citing works
Behavioral and neural processes in counterconditioning: past and future directions
Keller, N., Hennings, A. C., & Dunsmoor, J. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103532 · Cited by 80 · see citing works
“Likewise, in real world scenarios the absence of a feared outcome is oftentimes insufficient to disconfirm threat expectancy, nor do encounters with a phobic stimulus itself constitute effective exposure treatment (Craske et al., 2014).”
BackgroundAvoidance behavior in chronic pain research: a cold case revisited
Volders, S., Boddez, Y., De Peuter, S., Meulders, A., & Vlaeyen, J. W. S. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.11.003 · Cited by 97 · see citing works
Gillett, C. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.01.007 · Cited by 99 · see citing works
Exposure therapy for obsessive-compulsive disorder: an optimizing inhibitory learning approach
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“However, OCD along with most other anxiety disorders can be explained by fear conditioning models (see Craske et al. (2014)).”
Enkema, M. C., McClain, L., Bird, E. R., Halvorson, M. A., & Larimer, M. E. (2020) · Mindfulness · doi:10.1007/s12671-020-01442-2 · Cited by 97 · see citing works
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“Furthermore, a number of human studies have shown that greater expectancy violation may be among the most important variables involved in exposure therapy (reviewed in Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
BackgroundDopamine-dependent prefrontal reactivations explain long-term benefit of fear extinction
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Revisiting the Cognitive Model of Depression: The Role of Expectations
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“Exposure therapy in anxiety disorders has been reformulated as a therapy to disconfirm negative expectations, and to increase inhibition of avoidance behavior (Craske, 2015; Craske et al., 2014).”
BackgroundUnderstanding the Etiology of Chronic Pain From a Psychological Perspective
Linton, S. J., Flink, I. K., & Vlaeyen, J. W. S. (2018) · Physical Therapy · doi:10.1093/ptj/pzy027 · Cited by 93 · see citing works
Augmentation of Extinction and Inhibitory Learning in Anxiety and Trauma-Related Disorders
Lebois, L. A. M., Seligowski, A. V., Wolff, J. D., Hill, S. B., & Ressler, K. J. (2019) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050718-095634 · Cited by 93 · see citing works
- Authors
- Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B.
- Affiliations
- University of California, Los Angeles (US)
- KU Leuven (BE)
- Corresponding author
- Craske, Michelle G.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 58
- Pages
- 10-23
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4114726
- OpenAlex
- W2057906075
- Semantic Scholar
- 0d5de00a9991db7a0f004d29efca3e1c6f367c0f
- Cited by
- 2,339
- References
- 108
- Citations by year
- 2026: 304 · 2025: 247 · 2024: 265 · 2023: 196 · 2022: 233 · 2021: 245 · 2020: 213 · 2019: 175 · 2018: 156 · 2017: 124 · 2016: 107 · 2015: 59 · 2014: 12
- FWCI
- 139.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Lirias (submittedVersion, other-oa)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (R34MH101359, R21MH081299, R01MH065651)
- National Human Genome Research Institute (T32HG002536)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- exposure therapy, inhibitory learning, extinction learning, anxiety disorders, treatment optimization, expectancy violation, safety signals, retrieval cues, affect labeling, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobia, panic disorder
- MeSH terms
- Adult, Anxiety Disorders, Extinction, Psychological, Female, Humans, Implosive Therapy, Inhibition, Psychological, Learning, Male
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