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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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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
“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
The cited source says what the claim attributes to it.
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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“In addition to anxiety habituation, the exposure tasks provided the opportunity for inhibitory learning to occur (Craske et al., 2014) and the opportunity for Zahra to be able to disconfirm her negative predictions.”
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“Craske et al. (2014) formulierten einige Optimierungsstrategien, umdieBehandlungserfolgeweiter zu verbessern.”
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Rowe, C., & Kangas, M. (2020) · Behaviour Change · doi:10.1017/bec.2020.9 · Cited by 12
“…of the literature revealed conceptual differences in the theoretical underpinnings of ET based on the habituation, cognitive, and inhibitory learning models, which also guide the application of various treatment components (Abramowitz et al., 2012; Clark & Beck, 2010; Craske et al., 2012, 2014).”
BackgroundLeeuwerik, T., Caradonna, G., Cavanagh, K., Forrester, E., Bibby-Jones, A.-M., Lea, L., Rosten, C., & Strauss, C. (2022) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12430 · Cited by 10
“…refraining from compulsions, breaking the vicious cycle of OCD through a process of habituation (Kozak & Foa, 1997) and/or inhibitory learning (Craske et al., 2014). five main themes that captured participants' perceived facilitators and barriers to engagement in therapy: ‘Group processes’,…”
BackgroundA review of the phenomenology, aetiology and treatment of animal phobia and insights for biophobia
Norberg, M. M., Visvalingam, S., Stevenson, R. J., & Saluja, S. (2023) · People and Nature · doi:10.1002/pan3.10514 · Cited by 15
Session-by-session change in misophonia: a descriptive case study using intensive CBT
Gregory, J. E., & Foster, C. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000107 · Cited by 13
“From an inhibitory learning perspective, this promoted ‘ deepened extinction ’ by combining multiple stimulus cues and generalisability through variability in the way we delivered the experiments (Craske et al ., 2014).”
Chard, I., Zalk, N. V., & Picinali, L. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1159549 · Cited by 12
Larsen, J. K., Hollands, G. J., Garland, E. L., Evers, A. W. M., & Wiers, R. W. H. J. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105408 · Cited by 12
van Veen, S. C., Zbozinek, T. D., van Dis, E. A. M., Engelhard, I. M., & Craske, M. G. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104490 · Cited by 13
Self-citationKlein, A., Hagen, A., Mobach, L., Zimmermann, R., Baartmans, J. M. D., Rahemenia, J., de Gier, E., Schneider, S., & Ollendick, T. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00476-5 · Cited by 12
“This promotes generalization and reinforces the newly learned non-catastrophic association, thereby reducing the chance of relapse (Craske et al., 2014, 2022).”
BackgroundThe effects of an intensive outpatient treatment for PTSD
Matthijssen, S. J. M. A., Menses, S. D. F., & Dijk, H. M. H. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2341548 · Cited by 12
“Therapists followed the principles of the inhibitory learning approach in delivering PE, where expectancy violation is considered a crucial factor (Craske et al., 2014).”
Mindfulness as a therapeutic option for obsessive-compulsive disorder
Reis, A., Westhoff, M., Quintarelli, H., & Hofmann, S. G. (2024) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2024.2365945 · Cited by 18
“…those mechanisms underlying OCD, involving negative interpretations of obsessive thoughts [41], impairments in the process of extinction learning [42], increased concerns about harm, impaired control of unwanted responses, and excessive preoccupation with the regulation of thoughts (for a brief…”
Zickgraf, H. F., & Schwartz, R. A. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104677 · Cited by 13
Johnsson, A., Ljótsson, B., Liliequist, B. E., Skúladóttir, H., Maurex, L., Boberg, I., Ólafsdóttir, E., Klavebäck, S., Braunschweig, F., Mellbin, L., et al. (2025) · European Heart Journal Open · doi:10.1093/ehjopen/oeaf020 · Cited by 12
“Exposure-based cognitive behaviour therapy (CBT) targets the cycle of anxiety, avoidance behaviour, and associated impairments 13 and has been shown to effectively alleviate psychological distress related to somatic disorders.”
Rethinking the Subjective Units of Distress Scale: Validity and Clinical Utility of the SUDS
Mattera, E. F., & Zaboski, B. A. (2025) · Clinics and Practice · doi:10.3390/clinpract15070123 · Cited by 18
“For instance, because expectation violation is crucial during modern exposure-based practice [71,72], a 100-point expectancy rating scale (from 0, “will not occur,” to 100, “definitely will occur”) can be used with clients to measure the discrepancy in a client’s prediction between exposures [73].”
Jacquart, J., Papini, S., Freeman, Z., Bartholomew, J. B., & Smits, J. A. J. (2020) · Mental health and physical activity · doi:10.1016/j.mhpa.2020.100324 · Cited by 12
Generalization of extinction with a generalization stimulus is determined by learnt threat beliefs
Wong, A. H. K., Glück, V. M., Boschet, J. M., & Engelke, P. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103755 · Cited by 12
Meyerbröker, K., Nexhmedin Morina, B., KERKHOF, G. A., & Emmelkamp, P. M. G. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10269-7 · Cited by 13
Walker, D. C., & Murray, K. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.05.001 · Cited by 12
Chapter 7. Cognitive-Behavioral Theories
Leahy, R. L., Clark, D. A., & Dozois, D. J. A. (2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615375233.gg07 · Cited by 13
The origins of mental contamination
Zysk, E., Shafran, R., & Williams, T. I. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.08.007 · Cited by 12
“Such information also has the potential to help provide a rationale for the potential effectiveness of existing cognitive behavioural interventions based on learning models (Craske et al., 2014) and help engage patients in the treatment.”
Feasibility and Acceptability of a Toolkit to Facilitate Clinician Use of Exposure Therapy for Youth
Becker‐Haimes, E. M., Franklin, M. E., Bodie, J., & Beidas, R. S. (2017) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2017.1383867 · Cited by 15
“Given emerging research suggesting that it may not be necessary to engage in exposures in a linear fashion from the bottom of the hierarchy to the top (Craske et al., 2014; Peterman, Read et al., 2015), challenge cards do not need to be used in a particular order.”
BackgroundExpand your body when you look at yourself: The role of the posture in a mirror exposure task
Miragall, M., Etchemendy, E., Cebolla, A., Rodríguez, V., Medrano, C., & Baños, R. (2018) · PLoS ONE · doi:10.1371/journal.pone.0194686 · Cited by 16
Ruining the surprise: The effect of safety information before extinction on return of fear
Scheveneels, S., Boddez, Y., Ceulaer, T. D., & Hermans, D. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.11.001 · Cited by 14
“Building on the assumptions of ILT, it has been suggested in the literature that providing patients with information about the (low) probability of the occurrence of a feared outcome, decreases the room for expectancy violation during exposure (Craske et al., 2014).”
BackgroundInfluentialNeal, R. L., & Radomsky, A. S. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581900050x · Cited by 12
Benke, C., Krause, E., Hamm, A. O., & Pané‐Farré, C. A. (2017) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2017.09.013 · Cited by 12
Davis, K., MacBeth, A. M., Warwick, R., & Chan, S. W. Y. (2019) · Traumatology An International Journal · doi:10.1037/trm0000191 · Cited by 13
“131 Critically, one such catalyst for re-establishment is further exposure to adverse events 132 (Craske et al., 2014).”
BackgroundInfluentialScheveneels, S., Boddez, Y., Vervliet, B., & Hermans, D. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.03.001 · Cited by 13
Self-citationThe impacts of acquisition and extinction cues on ABC renewal of voluntary behaviorsPreprint
Nieto, J., Mason, T. A., Bernal‐Gamboa, R., & Uengoer, M. (2020) · Learning & Memory · doi:10.1101/lm.050831.119 · Cited by 11
“Renewal has been proposed as a factor contributing to relapse after behavior therapy (Bouton et al. 2012; Craske et al. 2014).”
BackgroundPattern separation of fear extinction memoryPreprint
Laing, P. A. F., & Dunsmoor, J. E. (2023) · Learning & Memory · doi:10.1101/lm.053760.123 · Cited by 13
“This may arise from the salient mode of safety learning that extinction incurs, where unreinforced CS + items evoke expectancy violation and prediction error (Craske et al. 2014; Papalini et al. 2020), while unpaired CS − items remain safe in a more passive sense.”
BackgroundNolet, K., Corno, G., & Bouchard, S. (2020) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2020.00086 · Cited by 11
Inhibitory Learning during Exposure Treatment in Anorexia Nervosa: A Practical Guide
Melles, H., Duijvis, S., & Jansen, A. (2023) · Behavioral Sciences · doi:10.3390/bs13050370 · Cited by 11
“The co-existence of two memories makes one vulnerable to spontaneous recovery of the original CS-US association [23,63,67].”
BackgroundInfluentialChaudhury, S., Samantaray, N., & Singh, P. (2018) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_35_18 · Cited by 11
“A few ERP treatment sessions were delivered by relatively less experienced mental health students whereas the majority are done by more experienced professionals, which may be a possible reason of large variances seen in within combined treatment group of SSRI plus ILT-based ERP.”
ResultInfluentialDemangeot, Y., O’Neill, S., Degache, F., Rapin, A., Asgher, U., Alfredson, H., Chester, R., Chimenti, R. L., de Vos, R., Escriche-Escuder, A., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-110183 · Cited by 12
“68”
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Psychotherapie der Angststörungen: State of the Art
Hoyer, J., & Lueken, U. (2021) · Der Nervenarzt · doi:10.1007/s00115-021-01069-1 · Cited by 11
Leuchter, M. K., Rosenberg, B. M., Schapira, G., Wong, N. R., Leuchter, A. F., McGlade, A. L., Krantz, D. E., Ginder, N. D., Lee, J. C., Wilke, S. A., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.823158 · Cited by 10
Self-citationReassurance and its alternatives: Overview and cognitive behavioural conceptualisation
Halldorsson, B., & Salkovskis, P. M. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100783 · Cited by 11
Dewitte, M. D., & Meulders, A. (2023) · The Journal of Sex Research · doi:10.1080/00224499.2022.2164242 · Cited by 16
“…violation and inhibitory learning have now been forwarded as the core mechanisms of exposure, with stronger effects being achieved when the discrepancy between expected and actual outcomes (i.e., prediction error) becomes larger (Bouton, 2004; Craske et al., 2014; Delamater, 2004; Rescorla, 2001).”
BackgroundInfluentialHunt, C., Park, J., Bomyea, J. A., & Colvonen, P. J. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115216 · Cited by 11
Stamatis, C. A., Liu, T., Meyerhoff, J., Meng, Y., Cho, Y. M., Karr, C. J., Curtis, B. L., Ungar, L., & Mohr, D. C. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100683 · Cited by 12
“Our findings around reduced novelty-seeking in communication and movement associated with self-reported social avoidance and fear align with the inhibitory learning framework (Sewart and Craske, 2020; Craske et al., 2014).”
BackgroundBogaert, L., Hallford, D. J., Loyen, E., D’Argembeau, A., & Raes, F. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12524 · Cited by 11
Task-Specific Perceived Harmfulness Predicts Protective Movement Behaviour in Chronic Low Back Pain
Matheve, T., Timmermans, A. A. A., Danneels, L. A., & Baets, L. D. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175025 · Cited by 11
“This will result in extinction of the avoidance behaviour and enable patients to participate in valued life activities again or to perform them at more natural velocities, ultimately leading to reduced disability [39].”
BackgroundRienks, K., Salemink, E., Sigurðardóttir, L. B. L., Meléndez‐Torres, G. J., Staaks, J. P. C., & Leijten, P. H. O. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104692 · Cited by 13
Barry, T. J., Vervliet, B., & Hermans, D. (2016) · Australian Journal of Psychology · doi:10.1111/ajpy.12124 · Cited by 11
Self-citationHeggdal, D., Fosse, R., & Hammer, J. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00198 · Cited by 7
Bernal‐Gamboa, R., Gámez, A. M., & Nieto, J. (2018) · Behavioural Processes · doi:10.1016/j.beproc.2018.01.021 · Cited by 15
Modulation of threat extinction by working memory load: An event-related potential study
Cheng, Y., Jackson, T. B., & MacNamara, A. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104031 · Cited by 11
Hoeboer, C. M., Oprel, D. A. C., Kooistra, M. J., Schoorl, M., van der Does, W. A. J., van Minnen, A., & de Kleine, R. A. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.06.007 · Cited by 12
Bauer, E., Wilson, K. A., Phan, K. L., Shankman, S. A., & MacNamara, A. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2022.08.009 · Cited by 12
Simonazzi, C., Natali, L., Valmaggia, L., Rowlands, K., Meregalli, V., Rabarbari, E., Comandini, A. D. L., Favaro, A., Fontana, F., Treasure, J. L., et al. (2022) · Appetite · doi:10.1016/j.appet.2022.106366 · Cited by 11
Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD
Rozenman, M. S., Peris, T. S., Bergman, R. L., Chang, S. W., O’Neill, J., McCracken, J. T., & Piacentini, J. C. (2016) · Child Psychiatry & Human Development · doi:10.1007/s10578-016-0653-4 · Cited by 11
“Moreover, a recent shift in cognitive-behavioral treatment approaches focuses on distress tolerance, rather than immediate habituation of fear, as a means to learn new, non-fearful/ threatening cognitive associations [42, 43].”
Das deutsche Forschungsnetz zu psychischen Erkrankungen
Bauer, M., Banaschewski, T., Heinz, A., Kamp‐Becker, I., Meyer‐Lindenberg, A., Padberg, F., Rapp, M. A., Rupprecht, R., Schneider, F. W., Schulze, T. G., et al. (2016) · Der Nervenarzt · doi:10.1007/s00115-016-0169-y · Cited by 12
“extinktionsoptimierte Form der KVT baut auf etablierten Therapiemanualen auf, jedoch werden Kernkomponenten der Therapie so gestaltet, dass Patienten ihren Angstsituationen in intensivierter Form begegnen, ohne dass die von ihnen befürchteten Konsequenzen eintreten [16, 60].”
BackgroundWiemer, J., & Pauli, P. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.10.008 · Cited by 11
Reminder Cues Modulate the Renewal Effect in Human Predictive Learning
Bustamante, J., Uengoer, M., & Lachnit, H. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01968 · Cited by 11
“For example, it has been reported that an extinction reminder cue reduced response recovery even though it did not pass a summation test for conditioned inhibition (Brooks and Bouton, 1993; Dibbets et al., 2008).”
BackgroundHesser, H., Hedman‐Lagerlöf, E., Lindfors, P., Andersson, E., & Ljótsson, B. (2017) · Psychological Medicine · doi:10.1017/s0033291717001167 · Cited by 11
“Exposure has long been established as a powerful psychological intervention for treating anxiety disorders and phobias by explicitly targeting similar maintaining factors (e.g. Craske et al. 2014).”
BackgroundBongers, P., Houben, K., & Jansen, A. T. M. (2017) · Appetite · doi:10.1016/j.appet.2017.11.096 · Cited by 11
“…reflect the participants' belief that the CS will be followed by the US (e.g., if I smell tasty food (CS), then I cannot resist eating it (US)), and it has been argued that violation of these expectancies is crucial to the effectiveness of cue exposure therapy (Craske et al., 2008, 2012, 2014).”
Masking exposure to phobic stimuli reduces fear without inducing electrodermal activity
Siegel, P. F., Warren, R., Jacobson, G., & Merritt, E. (2017) · Psychophysiology · doi:10.1111/psyp.13045 · Cited by 11
The effect of mindfulness training on rumination and intrusions after analogue trauma
Kubota, R., & Nixon, R. D. V. (2019) · Australian Psychologist · doi:10.1111/ap.12410 · Cited by 11
Voorendonk, E. M., Sanches, S. A., de Jongh, A., & van Minnen, A. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1654783 · Cited by 12
Temporal trends in attention disengagement from social threat as a function of social anxiety
McGlade, A. L., Craske, M. G., & Niles, A. N. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101529 · Cited by 14
Self-citationMcCormack, C. C., Mennies, R. J., Silk, J. S., & Stone, L. B. (2020) · BMC Psychology · doi:10.1186/s40359-020-00415-3 · Cited by 10
Impact of acute inflammation on the extinction of aversive gut memories
Benson, S., Rebernik, L., Pastoors, D., Brinkhoff, A., Wegner, A., Elsenbruch, S., & Engler, H. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.06.009 · Cited by 11
“Resurging fear poses a major challenge in cognitive-behavioral treatment approaches such as exposure therapy (Craske et al., 2014; de Quervain et al., 2017), which are essentially built on robust and persisting extinction of conditioned responses.”
BackgroundTesting a gamified Spider App to reduce spider fear and avoidance
Haberkamp, A., Walter, H., Althaus, P., Schmuck, M., Rief, W., & Schmidt, F. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102331 · Cited by 11
Herzog, P., Kaiser, T., Rief, W., Brakemeier, E., & Κube, T. (2022) · Assessment · doi:10.1177/10731911221089038 · Cited by 11
“…might be a promising target in the cognitive-behavioral treatment of PTSD, as they may provide the basis of behavioral experiments in which patients sample new information that helps them revise their initial expectations (Craske et al., 2014; Murray & El-Leithy, 2020; Rief et al., 2015).”
Enhancing Exposure Treatment for Youths With Chronic Pain: Co-design and Qualitative Approach
Schemer, L., Hess, C. W., Orden, A. R. V., Birnie, K. A., Harrison, L. E., Glombiewski, J. A., & Simons, L. E. (2023) · Journal of Participatory Medicine · doi:10.2196/41292 · Cited by 14
“In line with the inhibitory learning approach [26,27], the patients experienced a violation of their expectations, wherein feared situations were not as emotionally challenging or difficult as expected they them to be.”
BackgroundBelieving is seeing: Changes in visual perception following treatment for height fear
Dreyer-Oren, S. E., Clerkin, E. M., Edwards, C. B., Teachman, B. A., & Steinman, S. A. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.08.001 · Cited by 11
Castro-Camacho, L., Moreno-Villamizar, J. D., & Naismith, I. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.09.002 · Cited by 12
Ganzevoort, C. O. W., Wolters, L. H., Hornstra, R., Grieve, C. M., Højgaard, D. R. M. A., Skarphedinsson, G. A., Weidle, B., Waite, P., Bertie, L.-A., Tomlinson, M., et al. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102940 · Cited by 11
Javanbakht, A., Madaboosi, S., & Grasser, L. R. (2021) · Annals of Clinical Psychiatry · doi:10.12788/acp.0042 · Cited by 13
Essayli, J. H., Forrest, L. N., Zickgraf, H. F., Stefano, E. C., Keller, K. L., & Lane‐Loney, S. E. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.23894 · Cited by 12
Ghobadi‐Azbari, P., Khayati, R. M., & Ekhtiari, H. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1076711 · Cited by 10
“Inhibitory learning models of extinction provide strong anchors for understanding the mechanisms of cue exposure therapy in psychiatric disorders (Craske et al., 2014; Schyns et al., 2020).”
BackgroundGreenberg, L. S., & Pascual‐Leone, A. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95604-8.00012-5 · Cited by 11
Competence-based trainings for psychological treatments – A transtheoretical perspective
Rief, W., Wilhelm, M., Bleichhardt, G. M., Strauss, B. M., Frostholm, L., & von Blanckenburg, P. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.13277 · Cited by 10
“…provides students with specific strategies, such as expectancy violation and deepened extinction, to optimize the exposition to new situations, adding these strategies to traditional cognitive-behavioral approaches like 'fear habituation' and 'belief disconfirmation' (e.g., Craske et al., 2014).”
MethodCognitive Behavioral Therapy for Anxiety Disorders
Trent, E. S., & Storch, E. A. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.011 · Cited by 10
Ney, L. J., Pardo, J., & Lipp, O. V. (2024) · Psychophysiology · doi:10.1111/psyp.14686 · Cited by 10
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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