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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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“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]
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In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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
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In the citing paper
“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
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In the citing paper
“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
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In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“Several studies have shown that learning is context-dependent and that exposure in multiple contexts appears to counteract a return of fear [6, 24].”
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
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In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
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In the citing paper
“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]
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In the citing paper
“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
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In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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].”
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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: Taylor et al. (2017) · cites this paper as [17]
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King, S., Stapert, S. Z., Winkens, I., van der Naalt, J., van Heugten, C. M., & Rijkeboer, M. M. (2024) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000942 · Cited by 9
“11 This has led to the development of therapeutic strategies, which cultivate nonthreat associations and enhance retrieval of these newly learnt associations.”
Kuckertz, J. M., Najmi, S., Baer, K., & Amir, N. (2023) · Behavior Modification · doi:10.1177/0145445519841055 · Cited by 9
“…role of anxiety reduction in the context of exposure (i.e., WSH and BSH), more recent inhibitory learning models of exposure emphasize ability to tolerate anxiety or to perform a given task despite the presence of anxiety (Craske et al., 2008; Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
BackgroundZbozinek, T. D., Charpentier, C. J., Qi, S., & Mobbs, D. (2021) · Computational Psychiatry · doi:10.5334/cpsy.79 · Cited by 11
“Indeed, it is very common in therapy for a clinically anxious or depressed individual to overestimate the likelihood or magnitude that negative outcomes will occur (or, underestimate positive outcomes; e.g., catastrophizing; Beck et al., 1979; Beck, 1967; Beck et al., 1974; Craske et al., 2014).”
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Ewen, A.-C. I., Bleichhardt, G. M., Rief, W., von Blanckenburg, P., Wambach, K., & Wilhelm, M. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-065946 · Cited by 10
Vanzhula, I. A., Duck, S. A., Pletch, A., Guarda, Á. S., & Schreyer, C. C. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.23940 · Cited by 9
Counterconditioning reduces contextual renewal in a novel context but not in the acquisition context
Keller, N. E., Cooper, S. E., McClay, M., & Dunsmoor, J. E. (2023) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2023.107749 · Cited by 9
Verdi, E. K., Katz, A. C., Gramlich, M. A., ROTHBAUM, B. O., & Reger, G. M. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.09.011 · Cited by 12
Trent, E. S., Lanzillo, E. C., Wiese, A. D., Spencer, S. D., McKay, D., & Storch, E. A. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01258-x · Cited by 9
“Research examining distress among patients receiving ERP reflects the expected trajectory of discomfort accord - ing to theoretical models (Craske et al., 2014 ).”
Rentinck, E. M., van Mourik, R., de Jongh, A., & Matthijssen, S. J. M. A. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2451478 · Cited by 9
“Prolonged exposure involves continuous controlled exposure to traumatic memories to reach extinction through the disconfirmation of harm expectancy, based on the inhibitory learning theory (Craske et al., 2014; Foa et al., 2007).”
State of the Science: Hoarding Disorder and Its Treatment.
Tolin, D. F., Worden, B. L., & Levy, H. C. (2025) · The Behavior Therapist · doi:10.1016/j.beth.2025.03.002 · Cited by 8
Szeska, C., Ventura‐Bort, C., Giraudier, M., & Weymar, M. (2025) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2025.1595737 · Cited by 12
Murray, S. B., Levinson, C. A., Farrell, N. R., Nagata, J. M., Compte, E. J., & Grange, D. L. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23397 · Cited by 9
“This violation of fear-based expectancies is thought to help generate new, nonfear associations to previously feared cues, which in turn, serves to inhibit fear and anxiety in future exposures to previously feared cues (Craske et al., 2008, 2014).”
BackgroundThe role of intolerance of uncertainty in the acquisition and extinction of reward
Morriss, J., Biagi, N., Lonsdorf, T. B., & Andreatta, M. (2021) · European Journal of Neuroscience · doi:10.1111/ejn.15173 · Cited by 9
“Given that IU is transdiagnostic and that associative learning principles underpin current exposure therapies (Craske et al., 2014), examining whether IU is related to the acquisition and extinction of reward may provide crucial information relevant to the pathology and treatment of a number of mental health disorders…”
BackgroundWolters, L. H., Ball, J., Brezinka, V., Bus, M., Huyser, C., & Utens, E. M. W. J. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100645 · Cited by 9
McInerney, J., Brown, P., Bird, J. C., Nickless, A., Brown, G. P., & Freeman, D. H. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103928 · Cited by 12
Estradiol during (analogue-)trauma: Risk- or protective factor for intrusive re-experiencing?
Franke, L. K., Miedl, S. F., Danböck, S. K., Lohse, J., Liedlgruber, M., Bürkner, P., Pletzer, B. A., & Wilhelm, F. H. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105819 · Cited by 11
Implementing Cognitive-Behavioral Therapy in Children and Adolescents with Anxiety Disorders
Patriarca, G. C., Pettit, J. W., & Silverman, W. K. (2022) · Clinical Psychology and Special Education · doi:10.17759/cpse.2022110207 · Cited by 9
“114 aversive outcomes [11], with less regard for the intensity of the fear.”
BackgroundInfluentialMilgram, L., Sheehan, K. G., Cain, G. H., Carper, M. M., O’Connor, E., Freeman, J. B., Garcia, A. M., Case, B. G., & Benito, K. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100760 · Cited by 9
Cameron, G., Quigley, M., Zuj, D. V., & Dymond, S. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101801 · Cited by 9
Lønfeldt, N. N., Clemmensen, L. K. H., & Pagsberg, A. K. (2023) · JMIR Research Protocols · doi:10.2196/45123 · Cited by 10
“Alternatively, the inhibitory learning theory states that successful exposures are characterized by reduction in expectancy of an aversive outcome by creating alternative harmless associations that compete with the feared expectations [60].”
BackgroundSelf-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample
Fang, A., Baran, B., Feusner, J. D., Phan, K. L., Beatty, C. C., Crane, J., Jacoby, R. J., Manoach, D. S., & Wilhelm, S. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.01.018 · Cited by 10
González-Medina, G., & Quezada-Scholz, V. E. (2016) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2016.192 · Cited by 9
A Case Report of Harm‐Related Obsessions in Pediatric Obsessive‐Compulsive Disorder
Wu, M. S., & Storch, E. A. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22392 · Cited by 9
Enhanced Family Approaches for the Anxiety Disorders
Lippert, M. W., Pflug, V., Lavallee, K. L., & Schneider, S. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108235655.009 · Cited by 10
Kuhlman, K. R., Treanor, M., Imbriano, G., & Craske, M. G. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104657 · Cited by 10
Self-citationNorberg, M. M., Handford, C. M., Magson, N. R., & Basten, C. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.04.003 · Cited by 9
Cognitive Behavioral Therapy with Eating Disordered Youth
Essayli, J. H., & Vitousek, K. M. (2020) · Neuromethods · doi:10.1007/978-1-0716-0700-8_9 · Cited by 9
Stech, E. P., Chen, A. Z., Sharrock, M. J., Grierson, A. B., Upton, E. L., Mahoney, A., Grisham, J. R., & Newby, J. M. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102382 · Cited by 9
Benke, C., Alius, M. G., Hamm, A. O., & Pané‐Farré, C. A. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01298-7 · Cited by 10
Minding the Gap: Leveraging Mindfulness to Inform Cue Exposure Treatment for Substance Use Disorders
Vinci, C., Sawyer, L. E., & Yang, M.-J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.649409 · Cited by 10
Ching, T. H. W. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.04.006 · Cited by 15
Expectancy violation during exposure therapy: A pilot randomized controlled trial
Buchholz, J. L., Blakey, S. M., Hellberg, S. N., Massing‐Schaffer, M., Reuman, L., Ojalehto, H. J., Friedman, J. B., & Abramowitz, J. S. (2022) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2021.12.004 · Cited by 11
Piloting the Update: The Use of Therapeutic Relationship for Change – A Free Energy Account
Hauke, G., & Lohr, C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.842488 · Cited by 9
Remote, online assessment of avoidance learning
Cameron, G., Zuj, D. V., Dymond, S., & Quigley, M. (2022) · Learning and Motivation · doi:10.1016/j.lmot.2022.101805 · Cited by 13
“However, persistent maladaptive avoidance when the likelihood of threat is low is a hallmark diagnostic symptom of numerous psychiatric disorders that is targeted by behavioural therapies (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014; Dymond, 2019; Penninx, Pine, Holmes, & Reif, 2021).”
Functional Analysis in Differential Diagnosis
Waltman, S. H. (2015) · Clinical Case Studies · doi:10.1177/1534650115571003 · Cited by 9
The Use and Misuse of Exposure Therapy for Obsessive-Compulsive and Related Disorders
Abramowitz, J., & Jacoby, R. (2014) · Current Psychiatry Reviews · doi:10.2174/1573400510666140714171934 · Cited by 8
“In fact, randomness in exposures appears to enhance extinction [14].”
BackgroundBerman, N. C., Hezel, D. M., & Wilhelm, S. (2020) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101615 · Cited by 10
Becker, E. S., & Rinck, M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00128-x · Cited by 9
Imaginal Exposure for Disordered Eating Related Fears: An Initial Randomized Controlled Trial
Butler, R. M., & Heimberg, R. G. (2023) · Behavior Modification · doi:10.1177/01454455221091783 · Cited by 8
“Based on an inhibitory learning approach, a main goal of exposure therapy is to introduce new evidence that undermines the believability of the feared outcome (i.e., “violates expectancies”; Craske et al., 2014).”
BackgroundOllendick, T. H. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.06.005 · Cited by 8
Szeska, C., Mohrmann, H., & Hamm, A. O. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.12.009 · Cited by 8
Ruiz, S. M. A., Tikochinsky, E., Rubovitch, V., Pick, C. G., & Attali, B. (2023) · AIMS neuroscience · doi:10.3934/neuroscience.2023003 · Cited by 8
“Fear extinction is a form of inhibitory learning [13,14].”
Research on psychotherapy in India: A systematic review
Selvapandiyan, J., Das, A., & Singh, G. (2024) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_682_23 · Cited by 8
“[39] Manjula et al .”
Anker, E. A., Sture, S. E. B., Hystad, S. W., & Kodal, A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1254050 · Cited by 12
“Exposure therapy is considered the fi rst choice of treatment for anxiety disorders in youth (38, 39).”
BackgroundConceptualizing avoidant/restrictive food intake disorder via an executive functioning lens
Richson, B. N., Abber, S. R., & Wierenga, C. E. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24233 · Cited by 9
“For example, flexibility promotes integrating exposure learning while IC prevents avoidance and maximizes attention (Craske et al., 2014), suggesting certain EF differences may impede exposure effectiveness.”
Attenuating conditioned fear using imagery-based interventions: An overview
Mitra, S., & Asthana, M. K. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105751 · Cited by 9
Transdiagnostic and transtherapeutic strategies for optimising autobiographical memory
Barry, T. J., & Hallford, D. J. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104575 · Cited by 8
Gamified Closed‐Loop Intervention Enhances Tic Suppression in Children: A Randomized Trial
Rotstein, M. S., Zimmerman‐Brenner, S., Davidovitch, S., Ben‐Haim, Y., Koryto, Y., Sion, R., Rubinstein, E., Djerassi, M., Lubianiker, N., Peleg, T. P., et al. (2024) · Movement Disorders · doi:10.1002/mds.29875 · Cited by 8
“29,30 Thus, XTics introduces a variety of tic-triggering events.”
Emotional activation in a cognitive behavioral setting: extending the tradition with embodiment
Hauke, G., Lohr, C., & Shafir, T. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1409373 · Cited by 13
“For the purpose of emotional activation, i.e., the deliberate and artificial evocation of an emotion through imagination in therapy, classical CBT relies on various in-vivo exposure procedures (Craske et al., 2014) and on in-sensu exposure in particular.”
MethodMotahari-Nezhad, H., Ashourioun, A.-H., & Sadeghdaghighi, A. (2024) · Community Dental Health · doi:10.1922/cdh_00160nezhad08 · Cited by 17
High intensity approaches to exposure and response prevention for obsessive-compulsive disorder
Trent, E. S., Zhou, R. J., Mammo, L., Goodman, W. K., & Storch, E. A. (2025) · Behavioural Brain Research · doi:10.1016/j.bbr.2025.115427 · Cited by 11
Examining the Psychometric Network Structure of Social Anxiety: A Scoping Review
Noda, S., Nishiuchi, M., Andreoli, G., & Hofmann, S. G. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70032 · Cited by 10
“This technique involves exposing individuals to feared situations without avoidance, thereby reducing the discrepancy between the anticipated frequency of aversive outcomes and the actual result (Craske et al. 2014).”
Monzel, M., Ågren, T., Tengler, M., Karneboge, J., & Reuter, M. (2025) · Psychophysiology · doi:10.1111/psyp.14756 · Cited by 10
“Thus, highly emotional arousal may not be decisive, but rather the omission of avoidance and safety strategies that previously prevented the examination of erroneous beliefs (Craske et al. 2014).”
Chen, Y., Wang, P., & Li, Z. (2025) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2025.106192 · Cited by 9
Representational dynamics during extinction of fear memories in the human brain
Pacheco, D., Bouyeure, A., Jacob, G., Fellner, M.-C., Lehongre, K., Lambrecq, V., Frazzini, V., Navarro, V., Güntürkün, O., Shen, L. H., et al. (2025) · Nature Human Behaviour · doi:10.1038/s41562-025-02268-5 · Cited by 8
“Both rodent studies 3,17 and clinical studies in humans 70–73 suggest that high context specificity during extinction predicts renewal, that is, a reoccurrence of fear memories in acquisition contexts or novel contexts.”
Management of obsessive-compulsive disorder in adults
Abramowitz, J. S., Amitai Abramovitch, A., McKay, D., & Draffin, A. (2026) · BMJ · doi:10.1136/bmj-2024-083443 · Cited by 10
“20 55 Specifically, feared stimuli are now understood to retain their original threat related meaning while also acquiring an inhibitory (that is, safety) meaning.”
Schumacher, S., Schopka, N. M., Heinrich, M., & Knaevelsrud, C. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000371 · Cited by 6
“…is not erased, but kept intact as new secondary inhibitory learning develops (Bouton, 1993), i.e., the person learns that the phobic stimulus does not lead to the feared consequence, and therefore the originally association learned during fear conditioning is inhibited (Craske et al., 2014).”
BackgroundBanducci, A. N. (2021) · Clinical Case Studies · doi:10.1177/1534650121993547 · Cited by 9
“Thus, successful emotional processing includes activation of an emotional response, within/between session extinction of the emotional response, and changes in PTSD related cognitions (Craske et al., 2014; Foa et al., 2019).”
BackgroundLau‐Zhu, A., Farrington, A., & Bissessar, C. B. (2022) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x22000058 · Cited by 8
“What might be the exact nature of these competing representations? Inhibitory learning models (Craske et al., 2014) posit the original association, where a conditioned stimulus (e.”
BackgroundMacatee, R. J., Preston, T. J., Afshar, K., Schmidt, N. B., & Cougle, J. R. (2022) · Psychology of Addictive Behaviors · doi:10.1037/adb0000815 · Cited by 8
EMDR Therapy and PTSD: A Goal-Directed Predictive Processing Perspective
Vanderschoot, T., & Dessel, P. V. (2022) · Journal of EMDR Practice and Research · doi:10.1891/emdr-2022-0009 · Cited by 10
Paradoxic Intention as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia
Jansson‐Fröjmark, M., Sandlund, C., & Norell‐Clarke, A. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2022.10.001 · Cited by 8
Changing Biased Interpretations in CBT: A Brief History and Overview
Woud, M. L., & Hofmann, S. G. (2023) · CBT: science into practice · doi:10.1007/978-3-031-23650-1_12 · Cited by 11
de Jong, R., Hofs, A., Lommen, M. J. J., van Hout, W. J. P. J., de Jong, P. J., & Nauta, M. H. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102712 · Cited by 10
Kirchner, L., Κube, T., D’Astolfo, L., Strahler, J., Herbstreit, R., & Rief, W. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101859 · Cited by 9
The next frontier: Moving human fear conditioning research online
Ney, L. J., O'Donohue, M. P., Wang, Y., Richardson, M., Vasarhelyi, A., & Lipp, O. V. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108715 · Cited by 11
“…the mechanisms of fear learning and fear memory, researchers aim to develop more effective treatments and interventions for these conditions (Craske et al., 2014; Graham & Milad, 2011; Lipp, Waters, et al., 2020; Ney, Crombie, et al., 2022; Vervliet & Boddez, 2020; Zuj & Norrholm, 2019).”
BackgroundHeyman, R. E., Daly, K. A., Slep, A. M. S., & Wolff, M. S. (2023) · Journal of Public Health Dentistry · doi:10.1111/jphd.12598 · Cited by 8
Hui, H., Hong, A., Gao, J. J., Yu, J., & Wang, Z. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.01.027 · Cited by 8
Velkoff, E. A., Lusich, R., Kaye, W. H., Wierenga, C. E., & Brown, T. A. (2024) · European Eating Disorders Review · doi:10.1002/erv.3099 · Cited by 9
When Exposures Go Right: Effective Exposure-Based Treatment for Obsessive–Compulsive Disorder
Jordan, C., Reid, A. M., Guzick, A. G., Simmons, J., & Sulkowski, M. L. (2016) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-016-9339-2 · Cited by 8
“Engaging in more abnormal exposures can help continue to evoke anxiety in patients as they progress in treatment and subsequently result in greater symptom reduction (Craske et al. 2014).”
BackgroundHerrera, P., Mstibovskyi, I., Roubal, J., & Brownell, P. H. (2018) · REVISTA ARGENTINA DE CLINICA PSICOLOGICA · doi:10.24205/03276716.2018.1066 · Cited by 10
Fletcher, R., BRAITHWAITE, F., Woodhouse, M., MacInnes, A. I., & Stanton, T. R. (2019) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2019.1636436 · Cited by 8
“Indeed, exposure-based cognitive behavioural therapy is already a mainstay in the treatment of anxiety disorders (Craske et al., 2014).”
BackgroundStress-induced cortisol reactivity as a predictor of success in treatment for affective dimensions
Roque, A. D., Craske, M. G., Treanor, M., Rosenfield, D., Ritz, T., & Meuret, A. E. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104646 · Cited by 11
“We hypothesize that NAT may lead to additional cortisol mobilization and memory consolidation of extinction learning (Craske et al., 2014; Singewald et al., 2015) throughout treatment (but specifically during the first half of treatment which features exposure).”
BackgroundSelf-citation
Metadata
- 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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