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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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In the citing paper
“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]
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
“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
The cited source says what the claim attributes to it.
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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Obsessive–Compulsive Disorder in Children and Adolescents
Stiede, J. T., Spencer, S. D., Onyeka, O. “., Mangen, K. H., Church, M. J., Goodman, W. K., & Storch, E. A. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080822-043910 · Cited by 27
Hoppe, J. M., Holmes, E. A., & Ågren, T. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2021.113632 · Cited by 21
“Corresponding to how in vivo extinction has been widely used as an experimental analogue of in vivo exposure therapy to inform treatment development (Craske et al., 2014) we suggest that imaginal extinction could be used as an experimental analogue of imaginal exposure to explore the link between imagery vividness and…”
Labrenz, F., Woud, M., Elsenbruch, S., & Icenhour, A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.841734 · Cited by 22
“Inspired by their wide application in anxiety disorders (30, 32, 36, 77), exposure therapy has been established as an integral part of multimodal interventions for disorders characterized by disturbed interoception (78), including chronic pain (38, 54, 79, 80), disorders of the gut-brain axis, particularly irritable b…”
BackgroundAre different reading problems associated with different anxiety types?
Francis, D. A., Hudson, J. L., Robidoux, S., & McArthur, G. M. (2022) · Applied Cognitive Psychology · doi:10.1002/acp.3970 · Cited by 23
“This avoidance may then seek to strengthen rather than inhibit this fear memory (Craske et al., 2014).”
BackgroundPupil dilation and skin conductance as measures of prediction error in aversive learning
Stemerding, L., van Ast, V. A., Gerlicher, A. M. V., & Kindt, M. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104164 · Cited by 24
Szeska, C., Pünjer, H., Riemann, S., Meinzer, M., & Hamm, A. O. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02174-8 · Cited by 24
“Such treatment builds upon extinction learning and serves as an efficient therapeutic regimen for anxiety, stressor- and traumarelated mental disorders [5, 13, 74, 81].”
BackgroundCooper, S. E., Dunsmoor, J., Koval, K., Pino, E. R., & Steinman, S. A. (2022) · Psychophysiology · doi:10.1111/psyp.14242 · Cited by 13
“We report RC due to the continued interest in and practice of using conditioning tasks as biobehavioral measures of underlying pathological mechanisms that are targets of intervention research, particularly exposure therapy research (Craske et al., 2014; Raeder et al., 2020).”
BackgroundLangthorne, D., Beard, J., & Waller, G. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2191824 · Cited by 23
Javanbakht, A., Duval, E. R., Cisneros, M. E., Taylor, S. F., Kessler, D. A., & Liberzon, I. (2016) · Cognition & Emotion · doi:10.1080/02699931.2016.1169997 · Cited by 24
“Alternatively, it is possible that safety information preceding extinction may have inhibited the fear response, and hence the opportunity for prediction error-based extinction learning (Craske et al., 2014).”
BackgroundSchäfer, S. K., Ihmig, F. R., Hernandez, K. A. L., Neurohr, F., Kiefer, S., Staginnus, M., Lass‐Hennemann, J., & Michael, T. (2018) · Trials · doi:10.1186/s13063-018-2554-2 · Cited by 27
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“It contains exposure as the main treatment mechanism (cf [23]), which has been described in more detail elsewhere and has shown promising improvement of symptoms [36].”
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The Impact of Intolerance of Uncertainty and Cognitive Behavioural Instructions on Safety Learning
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Natali, L., Meregalli, V., Rowlands, K., Di Pietro, J., Treasure, J., Collantoni, E., Meneguzzo, P., Tenconi, E., Favaro, A., Fontana, F., et al. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24155 · Cited by 25
“In recent years, the proposal that habituation is the main mechanism of fear extinction has been questioned and a new framework has been developed, the “ inhibitory learning model ” (Craske et al., 2014).”
BackgroundLatent-state and model-based learning in PTSD
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When Is Seeking Safety Functional? Taking a Pragmatic Approach to Distinguishing Coping From Safety
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“…and perhaps during school transition, successive exposures to a feared stimuli or situation in the absence of any aversive consequences, should result in the individual learning that their feared object is not predictive of an aversive outcome and ultimately anxiety is reduced (Craske et al. 2014).”
Mechanisms of harmful treatments for obsessive–compulsive disorder.
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Sookman, D., Phillips, K. A., Anholt, G. E., Bhar, S. S., Bream, V., Challacombe, F. L., Coughtrey, A. E., Craske, M. G., Foa, E. B., Gagné, J.-P., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113752 · Cited by 23
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A latent profile analysis of math anxiety and core beliefs toward mathematics among children
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Norell‐Clarke, A., Hagström, H. M., & Jansson‐Fröjmark, M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.677538 · Cited by 23
Exposure Therapy for Gambling Disorder: Systematic Review and Meta-analysis
Bergeron, P.-Y., Giroux, I., Chrétien, M., & Bouchard, S. (2022) · Current Addiction Reports · doi:10.1007/s40429-022-00428-5 · Cited by 22
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Middle childhood attachment‐based family therapy: Theory and model description
Vlierberghe, L. V., Diamond, G. S., & Bosmans, G. (2023) · Family Process · doi:10.1111/famp.12887 · Cited by 30
Schwob, J. T., & Newman, M. G. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102749 · Cited by 23
MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations
Kangaslampi, S., & Zijlmans, J. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02310-9 · Cited by 27
Roesmann, K., Leehr, E. J., Böhnlein, J., Gathmann, B., Herrmann, M. J., Junghöfer, M., Schwarzmeier, H., Seeger, F. R., Siminski, N., Straube, T., et al. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102790 · Cited by 27
Renewal in human fear conditioning: A systematic review and meta-analysis
Wang, Y., Olsson, S., Lipp, O. V., & Ney, L. J. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105606 · Cited by 23
“Thus, fear conditioning provides a framework for investigating the mechanisms underlying therapy for anxiety and trauma and can provide insights as to how to improve treatment efficacy (Craske et al., 2014; Lipp et al., 2020).”
Waters, A. M., Potter, A., Jamesion, L., Bradley, B. P., & Mogg, K. (2015) · Behaviour Change · doi:10.1017/bec.2015.6 · Cited by 22
“Regarding the underlying mechanisms, enhancing the salience of the feared stimulus (Pearce & Hall, 1980) and ensuring that fear structures are fully activated during exposure therapy are thought to be critical determinants of treatment outcomes (Craske et al., 2014; Rauch & Foa, 2006).”
BackgroundTraining interpretation biases among individuals with body dysmorphic disorder symptoms.
Premo, J. E., Sarfan, L. D., & Clerkin, E. M. (2016) · Body image · doi:10.1016/j.bodyim.2015.11.004 · Cited by 20
Kennedy, S. M., & Ehrenreich, J. T. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-016-9581-7 · Cited by 23
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Individual variation in working memory is associated with fear extinction performance
Stout, D. M., Acheson, D. T., Moore, T. M., Gur, R. C., Baker, D. G., Geyer, M. A., & Risbrough, V. B. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.01.002 · Cited by 22
Pietrzak, T., Lohr, C., Jahn, B., & Hauke, G. (2018) · Behavioral Sciences · doi:10.3390/bs8030029 · Cited by 23
“Beck’s cognitive model has enjoyed much success, with numerous studies demonstrating the effectiveness of CBT for the treatment of anxiety through exposure protocols and inhibitory learning [4] and for depression [5].”
MethodErwartungsfokussierte psychotherapeutische Interventionen bei Personen mit depressiver Symptomatik
Κube, T., Glombiewski, J. A., & Rief, W. (2019) · Verhaltenstherapie · doi:10.1159/000496944 · Cited by 22
Klan, T., Bräscher, A., Vales, A., Liesering‐Latta, E., Witthöft, M., & Gaul, C. (2020) · Cephalalgia · doi:10.1177/0333102420928076 · Cited by 22
“as described by Craske and colleagues) (38).”
Gatzounis, R., & Meulders, A. (2020) · Journal of Pain · doi:10.1016/j.jpain.2020.02.003 · Cited by 17
Behavioral Interventions in the Treatment of Eating Disorders
Waller, G., & Raykos, B. C. (2019) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2019.01.002 · Cited by 22
Family-Based Cognitive Behavioral Therapy for Youth With Misophonia: A Case Report
Dover, N., & McGuire, J. F. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.05.005 · Cited by 22
“Given concerns regarding safety signals/safety behaviors during exposures (Craske et al., 2014), it is possible that the use of relaxation strategies unintentionally undermined the quality of therapeutic learning (i.e., extinction learning) during exposures early on in treatment.”
Wechsler, T. F., Pfaller, M., Eickels, R. E. V., Schulz, L. H., & Mühlberger, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.751272 · Cited by 21
Olatunji, B. O., Tomarken, A., Wentworth, B., & Fritzsche, L. (2017) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.09.004 · Cited by 23
Livanou, M., Whittenbury, K., & Basilio, D. D. (2023) · Stress and Health · doi:10.1002/smi.3353 · Cited by 24
State of the Science: Written Exposure Therapy for the Treatment of Posttraumatic Stress Disorder
Sloan, D. M., & Marx, B. P. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.02.004 · Cited by 21
“Specifically, some have proposed that exposure reduces PTSD symptoms through a process known as inhibitory learning (Craske et al., 2014).”
Emetophobia – A Metacognitive Therapeutic Approach for an Overlooked Disorder
Simons, M., & Vloet, T. D. (2016) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000464 · Cited by 21
The Use of the Plate-by-Plate Approach for Adolescents Undergoing Family-Based Treatment
Sterling, W. M., Crosbie, C., Shaw, N., & Martin, S. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.06.011 · Cited by 21
“Typically, distress tolerance skills are not recommended to be utilized during exposures, because they have been shown to minimize the effectiveness of the exposures.(30) If those struggling with eating disorders can face their food fears, over time, they will become used to them, while building positive experiences t…”
BackgroundLinking Pavlovian Disgust Conditioning and Eating Disorder Symptoms: An Analogue Study
Olatunji, B. O. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.06.002 · Cited by 21
Carsten, H. P., Härpfer, K., & Riesel, A. (2022) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2022.06.018 · Cited by 20
Ney, L. J., Nichols, D. S., & Lipp, O. V. (2023) · Psychophysiology · doi:10.1111/psyp.14297 · Cited by 21
“One of the core principles of fear conditioning is that conditioning— whether it be fear acquisition or extinction— occurs when a participant's expectancy of what is about to occur is violated (Bouton et al., 2020; Craske et al., 2014; Rescorla & Wagner, 1972).”
BackgroundPowell, J. K., Costa, N., Schram, B. L., Hing, W. A., & Lewis, J. S. (2023) · Physical Therapy · doi:10.1093/ptj/pzad088 · Cited by 25
“It is theorized that a mismatch between expectation and experience is critical for new learning 61,62 and the updating of possible unhelpful understandings about pain.”
Reward Processes in Extinction Learning and Applications to Exposure Therapy
Rosenberg, B. M., Barnes‐Horowitz, N. M., Zbozinek, T. D., & Craske, M. G. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102911 · Cited by 22
Self-citationPavlovian safety learning: An integrative theoretical review
Laing, P. A. F., Vervliet, B., Dunsmoor, J. E., & Harrison, B. J. (2024) · Psychonomic Bulletin & Review · doi:10.3758/s13423-024-02559-4 · Cited by 27
“Since fear extinction has been studied extensively (Craske et al., 2014; Delamater & Westbrook, 2014; VanElzakker et al., 2014; Vervliet, Baeyens, et al., 2013a, Vervliet, Craske, et al., 2013b), this can create the perception that safety learning (via inhibitory learning) is already…”
Self-citationBoutelle, K. N., Liang, J., Knatz, S., Matheson, B. E., Risbrough, V. B., Strong, D. R., Rhee, K. E., Craske, M. G., Zucker, N. L., & Bouton, M. E. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.11.011 · Cited by 23
“Following an exposure learning session, the children will verbalize what they have learned as a result of the session to enhance inhibitory processes [26].”
Self-citationAllen, J. D., Krompinger, J. W., Mathes, B. M., Crosby, J. M., & Elias, J. A. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2015.11.004 · Cited by 20
Cognitive Behavioral and Psychodynamic Therapies: Points of Intersection and Divergence.
Pilecki, B., Thoma, N. C., & Mckay, D. (2015) · Psychodynamic Psychiatry · doi:10.1521/pdps.2015.43.3.463 · Cited by 19
Graham, B. M., & Scott, E. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.05.003 · Cited by 21
“A critical component of exposure therapy involves engaging in additional exposures, outside of the therapeutic setting, that may be either planned or opportunistic (Craske et al., 2014).”
Clemmensen, L., Bouchard, S., Rasmussen, J., Holmberg, T. T., Nielsen, J. H., Jepsen, J. R. M., & Lichtenstein, M. B. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-2453-4 · Cited by 26
Harrewijn, A., Kitt, E. R., Abend, R., Matsumoto, C., Odriozola, P., Winkler, A. M., Leibenluft, E., Pine, D. S., & Gee, D. G. (2020) · Behavioural Brain Research · doi:10.1016/j.bbr.2020.112994 · Cited by 20
“CBT-based exposure is based on these processes of threat learning and extinction [20].”
BackgroundLee, D. J., Marx, B. P., Thompson‐Hollands, J., Gallagher, M. W., Resick, P. A., & Sloan, D. M. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103918 · Cited by 21
Bennett, J., Bickley, J. A., Vernon, T., Olusoga, P., & Maynard, I. W. (2017) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.11.2.96 · Cited by 21
“A major component of trauma-focused CBT is graded exposure that aims to reduce avoidance through repeated exposure to the threatening cue, while challenging unhelpful/harmful thoughts/beliefs associated with the stimuli (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
A comparison of behavioral and pharmacological interventions to attenuate reactivated fear memoriesPreprint
Monti, R. I. F., Alfei, J. M., Mugnaini, M., Bueno, A. M., Beckers, T., Urcelay, G. P., & Molina, V. A. (2017) · Learning & Memory · doi:10.1101/lm.045385.117 · Cited by 24
“Great research efforts have been devoted to enhancing extinction learning and maximizing the benefits of exposure therapy (Urcelay et al. 2009a,b), but the endurance of the original fear memory always makes the return of fear a possibility (Craske et al. 2008, 2014).”
BackgroundSiegel, P., Wang, Z., Murray, L., Campos, J., Sims, V., Leighton, E., & Peterson, B. S. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30285-6 · Cited by 20
Nothing to Fear but Fear Itself: A Mechanistic Test of Unconscious Exposure
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Bonnert, M., Särnholm, J., Andersson, E., Bergström, S.-E., Lalouni, M., Lundholm, C., Serlachius, E., & Almqvist, C. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100415 · Cited by 20
“In this treatment, a behavioral pattern of avoidance is targeted and reduced in order to overcome excessive fear of anxiety-provoking stimuli and situations (Craske et al., 2014).”
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Virtual reality exposure therapy for reducing school anxiety in adolescents: Pilot study
Beele, G., Liesong, P., Bojanowski, S., Hildebrand, K., Weingart, M., Asbrand, J., Correll, C. U., Morina, N., & Uhlhaas, P. J. (2024) · JMIR Mental Health · doi:10.2196/56235 · Cited by 20
“The “inhibitory learning model” [51] emphasizes the relevance of expectancy violations, that is, the mismatch between expected and actual outcomes during exposure.”
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“For GCBT, this was based on the group CBT protocol for SAD (Heimberg & Becker, 2002) and more recent insights into working mechanisms of exposure in vivo (Craske et al., 2014).”
Guadagnoli, L. A., Heathcote, L. C., Oudenhove, L. V., Elsenbruch, S., & Keefer, L. (2025) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(25)00205-5 · Cited by 25
State of the Science: Intolerance of Uncertainty
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“Thus, successful avoidance adds to the CS+ an additional inhibitory association (CS+ > noUS) that coexists with the original excitatory association (CS+ > US) established through prior Pavlovian pairings (see Craske et al., 2014).”
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High avoidance despite low fear of a second-order conditional stimulus
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Self-citationSubsequent memory effects on event-related potentials in associative fear learning
Wiemer, J., Leimeister, F., & Pauli, P. (2021) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsab015 · Cited by 20
“It further supports recent suggestions of optimizing exposure therapy of anxiety disorders (Craske et al., 2014).”
BackgroundResultHarnessing Home-School Partnerships and School Consultation to Support Youth With Anxiety
Conroy, K., Hong, N., Poznanski, B., Hart, K. C., Ginsburg, G. S., Fabiano, G. A., & Comer, J. S. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.02.007 · Cited by 21
Ridderbusch, I. C., Wroblewski, A., Yang, Y., Richter, J., Hollandt, M., Hamm, A. O., Wïttchen, H., Ströhle, A., Arolt, V., Margraf, J., et al. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2021.118157 · Cited by 21
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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