Enhancing Inhibitory Learning: The Utility of Variability in Exposure
Open accessAbstract
Exposure therapy has strong empirical support as a treatment for anxiety and related disorders, yet not all participants see clinically meaningful reduction in symptoms, and some experience return of fear. In this review, we examine the theoretical models of exposure therapy, from early precursors to the contemporary inhibitory learning model. The inhibitory learning model is applied to examine one potential method of improving outcomes in exposure therapy: increasing variability in the progression of the exposure hierarchy. We explore mechanisms that support the use of variability in exposure, including the violation of expectancies to enhance learning. In addition, the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders. Suggestions for future research are then offered. © 2018
AI snapshot
Written from the paper’s full text.
TL;DR
This review argues that increasing variability in exposure—stimulus, context, or hierarchy order—may strengthen inhibitory learning and target intolerance of uncertainty more effectively than traditional graded exposure. It synthesizes historical and contemporary exposure models and offers hypothetical adult case examples, while noting that direct tests of variable hierarchy progression remain limited.
Key findings
- The inhibitory learning model reframes exposure as forming new safety associations rather than relying on habituation; fear need not decline during exposure for learning to occur.
- Two studies directly examined variable hierarchy progression: in height-fearful college students, variable and graded exposure produced similar height-fear reductions, but variable exposure yielded greater reductions on the Beck Anxiety Inventory (Lang & Craske, 2000); in contamination-fearful students, both conditions improved, and greater within-session variability in subjective fear predicted lower follow-up fear (Kircanski et al., 2012).
- Higher emotional variability during exposure predicted greater fear reduction at one-week follow-up in public-speaking fear (Culver et al., 2012), and multiple-context exposure reduced renewal/return of fear relative to single-context exposure in spider and snake phobia laboratory studies.
- High intolerance of uncertainty is linked to poorer threat-safety discrimination and slower extinction, and is described as transdiagnostic across anxiety and depression; variable exposure is proposed to increase tolerance of uncertainty, though this remains untested.
Methods
- Narrative review, not an empirical study; traces exposure theory from systematic desensitization, flooding, modeling, and emotional processing to the inhibitory learning model.
- Synthesizes prior experimental and clinical findings on variability in exposure stimuli, contexts, and hierarchy order, including studies with college-student analogue samples and specific phobia, contamination, and public-speaking fears.
- Presents hypothetical case examples of variable exposure for adult clients with driving phobia, contamination-based OCD, and social anxiety; no new data or formal meta-analysis.
Limitations
- The authors state that research is needed to test whether random variable exposure outperforms graded exposure, whether increased uncertainty tolerance mediates anxiety treatment, and whether variable exposure can increase uncertainty tolerance; they also call for examination of moderators such as age and possible differences between fear- and disgust-based disorders.
- The paper states that adults are the primary focus and that child applications need more research; it also notes that the case examples involve motivated adults, which may not generalize to less motivated clients or children.
- Evident from the text: the proposal is largely theoretical and supported by indirect or analogue evidence, with only two studies directly examining hierarchy variability and no definitive test of the mechanism or clinical superiority.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
26 of 84 cited sources checked · 12 supported · 1 flagged · accuracy not yet measured
- Premisecitation
People high in intolerance of uncertainty do not discriminate between threat and safety cues during fear acquisition.
“Two recent studies have demonstrated that individuals with high intolerance of uncertainty do not discriminate between threat and safety cues during fear acquisition and have slower fear extinction than those with low intolerance of uncertainty (Morriss, Macdonald, & van Reekum, 2016; Morriss, Christakou, & van Reekum, 2016).”
Quote in the paperSubstantial claim2 of 2 sources checked- cites Morriss, Macdonald, & van Reekum, 2016 source
- cites Morriss, Christakou, & van Reekum, 2016 source
The Discussion reports no evidence that intolerance of uncertainty predicted differential responses to threat and safety cues during fear acquisition. It says high-IU individuals did not generalize fear to safety cues during acquisition under the study’s 100% reinforcement schedule; the reported generalization occurred during extinction, not acquisition. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
- Premisecitation
Some individuals experience a return of fear following exposure therapy.
“some experience return of fear”
Quote in the paperSubstantial claim2 of 3 sources checked- cites Eisen et al., 2013 source
The Results section (page unavailable) reports that 49 of 83 participants with OCD who achieved remission subsequently relapsed, supporting the general idea that symptoms can return. It does not identify the returning symptoms as fear or establish that relapse followed exposure therapy; the Methods section says treatment effects were not comprehensively analyzed. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites Simpson, Franklin, Cheng, Foa, & Liebowitz, 2005 source
The Description of the Sample reports that some patients relapsed after exposure and ritual prevention, with relapse defined as a return to pretreatment OCD severity. The paper does not establish that fear specifically returned; it measures OCD symptoms and clinical severity. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites Vervliet, Craske, & Hermans, 2013 source
- Premisecitation
Variability in context and stimuli is important for generalizing learning to novel situations and stimuli.
“Context and stimulus variability appear to be key in the generalization of learning, which allows clients to apply what they have learned to new contexts and new stimuli that were not encountered during exposure therapy (Craske et al., 2014; Kircanski et al., 2012).”
Quote in the paperSubstantial claim1 of 2 sources checked - Premisecitation
Exposure therapy is well supported empirically as a treatment for anxiety and related disorders.
“Exposure therapy has strong empirical support as a treatment for anxiety and related disorders”
Quote in the paperSubstantial claim1 of 2 sources checked - Premisecitation
Some individuals do not achieve clinically meaningful symptom reduction from exposure therapy.
“yet not all participants see clinically meaningful reduction in symptoms”
Quote in the paperSubstantial claim1 of 2 sources checked
- Interpretationcitation
Adding variability to exposure delivery is a possible way to enhance inhibitory learning.
“Increasing variability is one potential modification to the delivery of exposure therapy that could maximize inhibitory learning (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014 source
- Premisecitation
In laboratory studies, using multiple contexts during exposure led to less renewal of fear in spider phobia and snake phobia than single-context exposure.
“In laboratory studies, the use of multiple contexts during exposure has led to less renewal of fear in those with spider phobia (Bandarian-Balooch, Neumann, & Boschen, 2015; Shiban, Pauli, & Mühlberger, 2013) and snake phobia (Olatunji, Tomarken, Wentworth, & Fritzsche, 2017) compared to those with whom exposure was conducted in a single context.”
Quote in the paperSubstantial claim1 of 3 sources checked- cites Bandarian-Balooch, Neumann, & Boschen, 2015 source
The Discussion reports that fear renewal occurred after single-context exposure and was attenuated after multiple-context exposure. But the Method Participants and Discussion specify that this study involved people with moderate to high spider fear who were not formally assessed for spider phobia; it does not establish the result for people with spider phobia. The sentence attributes the snake-phobia finding to a different citation. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites Shiban, Pauli, & Mühlberger, 2013 source
- cites Olatunji, Tomarken, Wentworth, & Fritzsche, 2017 source
- Rests on an assumption: Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
- Premisecitation
Intolerance of uncertainty may influence fear learning and fear extinction.
“Intolerance of uncertainty may affect fear learning and fear extinction.”
Quote in the paperSubstantial claim2 of 2 sources checked- cites Morriss, Macdonald, & van Reekum, 2016 source
- cites Morriss, Christakou, & van Reekum, 2016 source
The Discussion reports that higher intolerance of uncertainty predicted greater fear expression during extinction, supporting the fear-extinction part of the claim. It also says the study found no evidence that intolerance of uncertainty predicted differential responses during fear acquisition and calls for further work on conditioned-fear acquisition. Thus, an effect on initial fear learning is not established by this paper. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premisecitation
When people high in intolerance of uncertainty generalize threat to safety cues, they show greater amygdala activity than people low in intolerance of uncertainty.
“The generalization of threat to safety cues among those high in intolerance of uncertainty compared to those low in intolerance of uncertainty is also characterized by greater activity in the amygdala (Morriss, Christakou, & van Reekum, 2015), which is a key brain structure involved in fear conditioning and extinction (Davis, 1992; Etkin & Wager, 2007; Myers & Davis, 2007; Phillips & Ledoux, 1992)”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Morriss, Christakou, & van Reekum, 2015 source
- Premisecitation
People high in intolerance of uncertainty show slower fear extinction than people low in intolerance of uncertainty.
“Two recent studies have demonstrated that individuals with high intolerance of uncertainty do not discriminate between threat and safety cues during fear acquisition and have slower fear extinction than those with low intolerance of uncertainty (Morriss, Macdonald, & van Reekum, 2016; Morriss, Christakou, & van Reekum, 2016).”
Quote in the paperSubstantial claim2 of 2 sources checked- cites Morriss, Macdonald, & van Reekum, 2016 source
The Results (SCR magnitude; page unavailable) and Discussion report that people with higher intolerance of uncertainty discriminated between threat and safety cues later than those with lower intolerance during extinction. The Discussion says this *may* prolong the exposure needed to extinguish threat; it does not establish slower fear extinction itself as a measured outcome. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites Morriss, Christakou, & van Reekum, 2016 source
- Premisecitation
Surprise, arising partly from prediction error, improves learning and memory recall.
“The experience of surprise, partly due to the recognition of a prediction error, enhances learning and memory recall (Alexander & Brown, 2012; Chumbley et al., 2014; Egner, 2011; Holland & Gallagher, 2006), and thus may be critical in inhibitory learning.”
Quote in the paperSubstantial claim2 of 3 sources checked- cites Alexander & Brown, 2012 source
The discussion of the PRO model says surprise signals modulate the effective learning rate, and Simulation 6 reports faster adaptation when contingencies change. The paper does not establish that surprise generally improves learning: its Computational Model section says infrequent surprises in stable environments reduce the learning rate. The retrieved passages do not address memory recall. Section and page numbers were not supplied for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites Chumbley et al., 2014 source
The Introduction (page not provided) describes prediction errors as signals of surprising outcomes that help adjust expectations, and the paper discusses surprise in reward learning. The Procedure and Rationale section probes what participants learned after the task, but does not show that surprise improves memory recall. The paper also identifies surprise responses that are not reducible to prediction error. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites Egner, 2011 source
- Interpretationcitation
Varying the exposure hierarchy may increase expectancy violation, which is thought to improve exposure outcomes.
“Variability in the exposure hierarchy may also enhance expectancy violation, which is proposed to maximize exposure therapy outcomes (Craske et al., 2014).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Craske et al., 2014 source
The ‘Variability’ section describes selecting hierarchy items out of order and reports long-term benefits. The ‘Expectancy Violation’ section proposes designing exposures to maximize the mismatch between expected and actual outcomes. Our copy does not say that varying the hierarchy itself increases expectancy violation; it presents variability and expectancy violation as distinct strategies. (LLM, conf=0.82)
Experimental — accuracy not yet measured
- Interpretationreasoning
Nonlinear progression through a hierarchy may help clients tolerate a range of fear levels.
“Clients may learn to better tolerate varying levels of fear if they do not proceed linearly through a hierarchy.”
Quote in the paperSubstantial claim - Premisecitation
Variable exposure did not outperform graded exposure on outcomes.
“While random, variable exposure did not lead to better outcomes than traditional graded exposure, participants who experienced more variability in their fear during the exposure session, regardless of condition, achieved lower fear ratings at follow-up.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kircanski et al., 2012 source
- Interpretationreasoning
Moving through a fear hierarchy in order is not required for clients to become more tolerant of fear.
“Although clients may learn to tolerate increasing amounts of fear as they progress through a standard exposure hierarchy, hierarchical progression is not a necessary condition of increased fear tolerance.”
Quote in the paperSubstantial claim - Premisecitation
More variability in subjective fear predicted lower fear at follow-up.
“Interestingly, greater variability in subjective fear was found to predict lower subjective fear at follow-up.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kircanski et al., 2012 source
- Premisecitation
In that height-fear study, variable exposure led to larger decreases on the Beck Anxiety Inventory than graded exposure.
“However, those in the variable exposure group reported greater reductions on a broad measure of anxiety, the Beck Anxiety Inventory, than those in the graded exposure group (Lang & Craske, 2000).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Lang & Craske, 2000 source
- Premisecitation
In public-speaking fear, higher emotional variability during exposure predicted greater fear reduction one week later.
“Consistent with this view, a study of individuals with public-speaking fear found that those who experienced higher emotional variability during exposure had greater reduction of fear at follow-up one week later (Culver, Stoyanova, & Craske, 2012).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Culver, Stoyanova, & Craske, 2012 source
- Premisecitation
Exposure therapy is grounded in fear extinction principles.
“Exposure therapy is based on principles of fear extinction, in which classically conditioned stimuli gradually lose their phobic quality through repeated exposure without the feared negative consequences (Myers & Davis, 2007).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Myers & Davis, 2007 source
- Interpretationreasoning
Fluctuating fear levels during exposure might improve learning.
“This variability is likely to produce variable levels of fear during the course of exposure, which may enhance learning.”
Quote in the paperSubstantial claim - Premisecitation
Among height-fearful college students, variable exposure and graded exposure produced comparable reductions in fear of heights.
“In a study of college students with a fear of heights, those who completed exposure in a random, variable manner by approaching the outside railing of various floors of a building in a random order experienced similar reductions in their fear of heights compared to those in the graded exposure condition, who went through exposure at gradually increasing heights.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Lang & Craske, 2000 source
- Premisecitation
In spider phobia, exposure with multiple spiders produced better maintenance of gains than exposure with one spider.
“The importance of variable stimuli was demonstrated by a study of spider phobia using multiple spiders in exposure, which led to better maintenance of treatment gains compared to exposure using a single spider (Rowe & Craske, 1998).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rowe & Craske, 1998 source
- Premisecitation
Children with dog phobia who watched models interact with several dogs showed more approach behavior at follow-up than those who watched a single dog.
“Bandura and Menlove (1968) tested modeling for children with dog phobia and found that those who observed models interacting with multiple dogs of various sizes and breeds performed more approach behaviors at follow-up compared to children who observed modeled behavior with a single dog.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Bandura & Menlove, 1968 source
- Premisereasoning
Even after successful exposure therapy, anxiety can return when clients leave the original treatment setting, usually the therapist's office.
“Even when clients have successfully completed an adequate trial of exposure therapy, they may find that their anxiety returns once they leave the original treatment context, typically the therapist’s office.”
Quote in the paperSubstantial claim - Interpretationcitation
People high in intolerance of uncertainty may not fully benefit from traditional exposure-based interventions that rely on extinction learning principles.
“These findings suggest that those high in intolerance of uncertainty may not fully benefit from traditional exposure-based interventions that are based on extinction learning principles.”
Quote in the paperSubstantial claim - Premisereasoning
Varying exposure, including merely varying the exposure environment unpredictably, may substantially improve learning.
“In contrast, varying exposure (even just varying the exposure environment in an unpredictable fashion) may significantly facilitate learning.”
Quote in the paperSubstantial claim - Premisenone given
Compared with single-context exposure, multiple-context exposure led to an attenuated physiological response at follow-up.
“Compared to single-context exposure, multiple-context exposure led to lower self-reported anxiety, attenuated physiological response, and greater approach in behavioral approach tasks at follow-up.”
Quote in the paperSubstantial claim- Rests on an assumption: Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
- Premisecitation
Using multiple contexts reduces distress toward disgust stimuli.
“The use of multiple contexts has also been found to reduce distress toward disgust stimuli, which may have implications for disorders in which disgust plays a crucial role, such as contamination-based OCD (Viar-Paxton & Olatunji, 2012).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Viar-Paxton & Olatunji, 2012 source
- Rests on an assumption: Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
- Premisenone given
Compared with single-context exposure, multiple-context exposure led to greater approach on behavioral approach tasks at follow-up.
“Compared to single-context exposure, multiple-context exposure led to lower self-reported anxiety, attenuated physiological response, and greater approach in behavioral approach tasks at follow-up.”
Quote in the paperSubstantial claim- Rests on an assumption: Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
- Premisenone given
Compared with single-context exposure, multiple-context exposure led to lower self-reported anxiety at follow-up.
“Compared to single-context exposure, multiple-context exposure led to lower self-reported anxiety, attenuated physiological response, and greater approach in behavioral approach tasks at follow-up.”
Quote in the paperSubstantial claim- Rests on an assumption: Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
- Premisecitation
Exposure conducted in multiple contexts tends to produce less return of fear than exposure conducted in a single context.
“However, when exposure is conducted in multiple contexts, clients tend to experience less return of fear than when exposure is conducted in a single context.”
Quote in the paperSubstantial claim- Rests on an assumption: Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
- Premisecitation
Variability in the exposure context matters for the return of fear.
“Variability in the exposure context has important implications for the return of fear (Bouton, 1993).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Bouton, 1993 source
- Premisecitation
Specific phobias can be effectively treated with a single session of exposure.
“While PTSD and OCD usually require a full course of exposure therapy treatment (eight to twelve sessions or more), many phobias can be effectively treated in a single session (Ollendick et al., 2009; Öst, 1989).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Ollendick et al., 2009 source
- cites Öst, 1989
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Intolerance of uncertainty has been linked to OCD, PTSD, panic disorder, and most other anxiety disorders.
“intolerance of uncertainty has also been linked to OCD (Holaway, Heimberg, & Coles, 2006; Jacoby, Fabricant, Leonard, Riemann, & Abramowitz, 2013; Tolin, Abramowitz, Brigidi, & Foa, 2003), PTSD (Boelen, Reijntjes, & Smid, 2016; Oglesby, Boffa, Short, Raines, & Schmidt, 2016), panic disorder (Carleton et al., 2014; Carleton, Fetzner, Hackl, & McEvoy, 2013), and most other anxiety disorders (see Car”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
If expectancies are violated during exposure, memory for the safety association should be strengthened.
“Thus, recall of new associations between a feared object and the lack of a feared consequence resulting from interaction with that object would be strengthened if expectancies can be violated during exposure therapy.”
Quote in the paperSubstantial claim - Interpretationcitation
Subjective fear variability during exposure may be a key change mechanism that varying hierarchy items can promote.
“Variability of the subjective fear experienced during exposure may be an important mechanism of change that can be facilitated by varying the items on an exposure hierarchy.”
Quote in the paperSubstantial claim - Premisecitation
Surprise may direct attention to the learned association, increasing its salience and recall.
“It is theorized that surprise facilitates attention to the association being learned, which may enhance the salience and recall of that specific association (Rescorla & Wagner, 1972; Mackintosh, 1975; Schultz & Dickinson, 2000).”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
People high in intolerance of uncertainty may benefit from an exposure approach in which the situations or stimuli faced are uncertain.
“This suggests that those high in intolerance of uncertainty may benefit from an exposure approach in which the situations or stimuli to be faced are uncertain.”
Quote in the paperNot a substantial claim- Rests on an assumption: The mechanisms of fear extinction and inhibitory learning observed in laboratory conditioning paradigms operate in clinical exposure therapy.
- Interpretationreasoning
Intolerance of uncertainty is acquired, at least partly, through a person's learning history.
“We propose that intolerance of uncertainty is acquired, at least in part, through one’s learning history.”
Quote in the paperSubstantial claim
- May combine two claims. 37
- Classified as probably not a substantial claim. 40
May combine two claims.
PremisecitationEmotional states serve as powerful retrieval cues, and varying fear may make the safety association more salient.
“Emotional states are strong retrieval cues, and variation in fear may increase the salience of the association between a previously feared object or situation and a lack of extreme negative consequences (Bjork & Bjork, 1992, 2006; Craske et al., 2014).”
Quote in the paperSubstantial claim1 of 3 sources checked- cites Bjork & Bjork, 1992
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Bjork & Bjork, 2006
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Craske et al., 2014 source
In “Therapeutic Strategies,” section (5) Variability (page unavailable), the paper proposes that fear level may serve as a retrieval cue and that varying it may enhance learning of inhibitory associations. It does not establish that emotional states are strong retrieval cues; it also describes increased salience of the feared stimulus, not specifically of the safety association. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationImproving distress tolerance is a central aim of CBT and ACT.
“Notably, increased emotional distress tolerance is a key goal of several behavioral therapies, including cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999; Leyro, Zvolensky, & Bernstein, 2010).”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites Hayes, Strosahl, & Wilson, 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Leyro, Zvolensky, & Bernstein, 2010 source
The Abstract (page not available) says that many behavioral therapies target distress tolerance directly or indirectly and explicitly names ACT and mindfulness-based cognitive therapy. It does not establish that improving distress tolerance is a key goal of CBT generally; the listed cognitive therapy is a more specific approach. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe amygdala is a key brain structure in fear conditioning and extinction.
“which is a key brain structure involved in fear conditioning and extinction (Davis, 1992; Etkin & Wager, 2007; Myers & Davis, 2007; Phillips & Ledoux, 1992)”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites Davis, 1992 source
- cites Etkin & Wager, 2007 source
The Results section (page unavailable) reports increased amygdala activity during fear conditioning, supporting that part of the claim. The Discussion section on emotion regulation and fear extinction (page unavailable) instead emphasizes the ventromedial prefrontal cortex and its inhibitory projections to the amygdala; it does not establish the amygdala itself as a key structure in extinction. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites Myers & Davis, 2007 source
May combine two claims.
PremisecitationIntolerance of uncertainty is considered a transdiagnostic factor across anxiety and depression and a major potential treatment target.
“Intolerance of uncertainty is now considered a transdiagnostic factor across anxiety and depression (Carleton et al., 2012; McEvoy & Mahoney, 2011) and is a major potential target for treatment (Boswell, Thompson-Hollands, Farchione, & Barlow, 2013; Einstein, 2014; McEvoy & Erceg-Hurn, 2016).”
Quote in the paperSubstantial claim1 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationInhibitory learning mechanisms have been suggested to play a role in fear extinction for children with anxiety disorders as well as adults.
“Inhibitory learning mechanisms have been suggested to play a role in fear extinction for children with anxiety disorders as well as adults (McGuire, Orr, Essoe et al., 2016; McGuire, Orr, Wu et al., 2016), but more research examining the inhibitory learning model in exposure with children is needed.”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites McGuire, Orr, Essoe et al., 2016 source
- cites McGuire, Orr, Wu et al., 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSUDS are not typically part of the inhibitory learning model because that model does not emphasize habituation.
“SUDS are not typically part of the inhibitory learning model, as there is no emphasis on habituation (Craske et al., 2014).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Craske et al., 2014 source
The “Inhibitory Learning vs Habituation” section says inhibitory-learning strategies do not emphasize fear reduction during exposure, supporting the claim’s rationale. It does not say SUDS are typically absent; the PTSD case study even describes a hierarchy containing distress ratings. The source therefore supports the lack of emphasis on habituation, but not the generalization about SUDS. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationA general fear of the unknown is common in young children, especially behaviorally inhibited children, and may serve an adaptive purpose of avoiding danger when vulnerable or without a protective caretaker.
“A general fear of the unknown is common in young children, especially behaviorally inhibited young children (Kagan & Snidman, 2004), and may serve an adaptive purpose of avoiding danger when vulnerable or in the absence of a protective caretaker (Bowlby, 1973; Carleton, 2016).”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites Kagan & Snidman, 2004
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Bowlby, 1973
- cites Carleton, 2016 source
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationcitationVariability might be introduced after a few graded, lower-difficulty exposures once the client has gained confidence in staying in the distressing situation.
“Instead of starting exposure with the premise of random progression through the exposure hierarchy, variability might be introduced after a few graded exposures of lower difficulty once the client has gained confidence in his or her ability to stay in the distressing situation (Craske et al., 2014).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Craske et al., 2014 source
The “Variability” section (page not provided) says variable exposure usually begins with the least anxiety-producing hierarchy item to avoid treatment refusal. It does not recommend several graded, lower-difficulty exposures before introducing variability, or make the client’s confidence in staying in the situation the criterion for doing so. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Rests on an assumption: Variable exposure can be delivered in clinical practice without unacceptable harm when unnecessary risks are avoided.
May combine two claims.
PremisecitationHelping clients avoid difficult exposures can be harmful and can increase the likelihood of relapse.
“In fact, helping clients avoid difficult exposures can be harmful and increase the likelihood of relapse (Gillihan, Williams, Malcoun, Yadin, & Foa, 2012).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Gillihan, Williams, Malcoun, Yadin, & Foa, 2012 source
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationSince disgust habituates more slowly than fear, variable exposure may have weaker effects on contamination fear than on other phobias.
“Because disgust habituates more slowly than fear (McKay, 2006; Smits, Telch, & Randall, 2002), it is possible that the effects of variable exposure on contamination fear, in which disgust is a key component, may be weaker than its effects on other phobias.”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
InterpretationreasoningUnpredictable item selection in an exposure hierarchy may both aid fear tolerance and increase external validity.
“The unpredictability of varying the items on an exposure hierarchy creates a treatment context that not only facilitates fear tolerance but also has more external validity.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationThe inhibitory learning model holds that forming new associations between feared stimuli and safety is central to extinction.
“this model asserts that learning new associations between feared objects or situations and a lack of objective danger is central to fear extinction”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Craske et al., 2008 source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationOriginal fear memories persist while new inhibitory CS-US associations are acquired and strengthened.
“the original fear learning remains intact, but new inhibitory associations between the conditioned stimulus (CS) and the unconditioned stimulus (US) are formed and strengthened (Bouton, 1993)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Bouton, 1993 source
May combine two claims.
PremisecitationVariability improves memory storage and provides extra retrieval cues.
“It is suggested that variability enhances the storage capacity for new information and creates additional cues for memory retrieval (Bjork & Bjork, 1992, 2006; Estes, 1955).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Bjork & Bjork, 1992
- cites Bjork & Bjork, 2006
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Estes, 1955 source
Classified as probably not a substantial claim.
PremisecitationThe inhibitory learning model has been proposed as an alternative account of how exposure works.
“The inhibitory learning model has been proposed as an alternative explanation for the mechanisms of exposure (Craske et al., 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Craske et al., 2008 source
Classified as probably not a substantial claim.
PremisecitationThe inhibitory learning model proposes that exposure does not necessarily reduce fear but instead teaches greater fear tolerance.
“According to the inhibitory learning model, fear is not necessarily reduced in exposure; rather, an increased tolerance of fear is learned (Craske et al., 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Craske et al., 2008 source
May combine two claims.
InterpretationcitationVariable exposure appears no less effective than standard exposure and may improve generalization of fear learning.
“These initial findings indicate that variable exposure is at least as effective as standard exposure, with variable exposure potentially leading to increased generalization in fear learning.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIn contamination-fearful college students, both standard and variable exposure reduced contamination fear, obsessions and compulsions, and subjective fear from pre- to post-treatment.
“In a study of college students with contamination fear, participants in both the standard and variable exposure groups had decreases in contamination fear, obsessions and compulsions, and subjective fear ratings during exposure from pre- to post-treatment (Kircanski et al., 2012).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kircanski et al., 2012 source
Classified as probably not a substantial claim.
InterpretationreasoningExposure therapy aims to make the inhibitory safety association stronger than the original fear association.
“The goal of exposure therapy, therefore, is to strengthen this inhibitory association so that it becomes stronger than the original excitatory fear association (Figure 1).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationIntolerance of uncertainty was first conceptualized as a key component of worry and is especially relevant to generalized anxiety disorder.
“Although intolerance of uncertainty was originally conceptualized as a key component underlying worry, and therefore is especially relevant in generalized anxiety disorder (GAD; Freeston, Rheaume, Letarte, Dugas, & Ladouceur, 1994; Ladouceur et al., 2000)”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisereasoningGreater tolerance of negative emotions is crucial for reducing functional impairment.
“Increasing tolerance of negative emotional experiences is key to reducing functional impairment, as distressed clients learn how to cope with their emotional and physiological responses to stress and return to activities they had previously avoided.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationWhen exposure happens in constrained and predictable conditions, learning becomes tied to the therapy context and does not always transfer to other settings.
“When exposure occurs under conditions that are constrained and predictable, learning tends to be contextualized.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Bouton, 1993 source
May combine two claims.
PremisecitationIntensive interoceptive exposure outperformed standard interoceptive exposure for panic disorder, with effects mediated by greater fear tolerance and expectancy violation.
“An experimental examination of intensive interoceptive exposure for panic disorder demonstrated that intensive interoceptive exposure was more effective than standard interoceptive exposure, which was fully mediated by improvement in fear toleration and violation of the expectation of negative outcomes (Deacon et al., 2013).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Deacon et al., 2013 source
May combine two claims.
PremisecitationInitial fear activation, within-session habituation, and between-session habituation are not required for learning in exposure.
“Additionally, a thorough review of the evidence suggests that emotional processing theory’s indices of learning (initial fear activation, within-session habituation, and between-session habituation) are not necessary for learning to occur (Craske et al., 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Craske et al., 2008 source
Classified as probably not a substantial claim.
PremisecitationExpectancy violation rests on the idea that a mismatch between expected and actual outcomes is essential for learning.
“Expectancy violation is based on the premise that incongruence between an expected outcome and the actual outcome is critical for learning (Rescorla & Wagner, 1972; Schultz & Dickinson, 2000).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Rescorla & Wagner, 1972
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Schultz & Dickinson, 2000 source
May combine two claims.
PremisecitationOne-session treatment for specific phobias yields outcomes comparable to five sessions, with gains maintained up to four years.
“One-session treatment of flying phobia, blood-injection-injury phobia, spider phobia, claustrophobia, and other specific phobias has shown comparable outcomes to five-session treatment, with clinically significant improvements maintained for follow-up periods as long as four years (Öst, Alm, Brandberg, & Breitholtz, 2001; Öst, Brandberg, & Alm, 1997; Öst, Hellström, & Kåver, 1992).”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone givenThe inhibitory learning approach suggests there may be value in a more variable approach to progressing through the fear hierarchy for some clients, along with variability in stimuli and context.
“Although traditional approaches to exposure therapy have called for gradual progression though the fear hierarchy, the inhibitory learning approach suggests that there may be value in a more variable approach to progressing through the fear hierarchy for some clients, along with the introduction of variability in other aspects of exposure including stimuli and context.”
Quote in the paperNot a substantial claim- Rests on an assumption: The mechanisms of fear extinction and inhibitory learning observed in laboratory conditioning paradigms operate in clinical exposure therapy.
Classified as probably not a substantial claim. May combine two claims.
InterpretationreasoningExposure lets clients learn that feared situations are not harmful and that they can tolerate increased anxiety.
“Exposure allows clients to learn that feared situations are not harmful, and that they can tolerate increased anxiety.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenFor clients with social anxiety, attempting a presentation without prior practice may lead to negative evaluation from peers, although the result is unlikely to be as disastrous as these clients predict.
“For clients with social anxiety, attempting to give a presentation at work or school without any prior practice may lead to negative evaluation from their peers, although the result is unlikely to be as disastrous as might be predicted by these individuals.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
InterpretationreasoningWorking on basic social skills may be necessary before exposure, but repeating skill-building exercises without exposure to feared situations is unlikely to benefit a socially anxious client.
“Working on basic social skills may be necessary before exposure, but repeating skill-building exercises over and over is unlikely to benefit a socially anxious client without some exposure to feared situations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningA client's experience of high anxiety is not in itself problematic, and clients should not necessarily expect anxiety to decrease during exposure after psychoeducation on the inhibitory learning model.
“A client’s experience of high anxiety is not in itself problematic, as therapists can emphasize the importance of tolerating anxiety, and clients should not necessarily expect their anxiety to decrease during exposure after receiving psychoeducation on the inhibitory learning model.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
InterpretationreasoningIf intolerance of uncertainty is stable and does not change over treatment, it may be a moderator rather than a mediator, and people high in intolerance of uncertainty might benefit more from learning uncertainty-no negative consequence associations in variable exposure than people lower in intolerance of uncertainty.
“If intolerance of uncertainty is a more stable construct and does not change over the course of treatment, it may be a moderator of treatment outcomes instead of a mediator; individuals with high intolerance of uncertainty might experience additional benefit from learning associations between uncertainty and a lack of negative consequences in variable exposure compared to individuals with lower”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEffective exposure treatment involves desirable difficulties.
“Emphasizing that effective exposure treatment involves desirable difficulties (Bjork, 1994; Craske et al., 2008; Jacoby & Abramowitz, 2016) may help clients understand that exposure is not an easy task, but tolerating discomfort and arousal and working together to attempt challenges are some of the principal goals of therapy.”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
InterpretationreasoningA child who is constantly overprotected has limited experience with uncertainty and cannot learn that uncertainty is not inherently dangerous; avoidance prevents fear extinction and maintains long-term anxiety.
“A child who is constantly overprotected has limited experience with uncertainty and therefore cannot learn that uncertainty is not inherently dangerous, just as avoidance prevents fear extinction (or new inhibitory fear learning) and maintains long-term anxiety.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
InterpretationreasoningSeparating fear and uncertainty SUDS may help some clients see that their distress is partly due to uncertainty, which can motivate them to increase tolerance of uncertainty as well as fear.
“Separating these concepts may help some clients realize that the distress they feel is partly due to uncertainty, providing motivation to increase tolerance of uncertainty as well as fear.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationown dataAll the case examples involve motivated adults, which may make them less useful for exposure therapy with children brought by their parents.
“Finally, all of our case examples involve adults who are motivated to complete exposure therapy, which may be less useful for conducting exposure therapy with children who are there at the behest of their parents.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningVariable exposure may increase tolerance of uncertainty by promoting inhibitory learning and approach behavior in uncertain real-world situations, which could improve treatment outcomes.
“Variable exposure may increase tolerance of uncertainty by promoting inhibitory learning and increasing approach behavior in uncertain, real-world situations, which could potentially result in better treatment outcomes.”
Quote in the paperNot a substantial claim- Rests on an assumption: The mechanisms of fear extinction and inhibitory learning observed in laboratory conditioning paradigms operate in clinical exposure therapy.
May combine two claims.
InterpretationreasoningIn exposure therapy, clients learn new associations between uncertainty and a lack of inherent danger and learn to tolerate anxiety in uncertain situations.
“In exposure therapy, the client learns new associations between uncertainty and a lack of inherent danger, and they learn to tolerate their anxiety even in uncertain situations.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenSome clients may resist variable exposure even after thorough psychoeducation about variability and the inhibitory learning model.
“Like Matthew, some clients may be resistant to the idea of variable exposure, even after thorough psychoeducation on the benefits of variability in exposure and the inhibitory learning model.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone givenVariability may benefit the client.
“Variability may benefit the client, but as with traditional exposure, the process of implementing the intervention should always be a collaborative effort between client and therapist.”
Quote in the paperNot a substantial claim- Rests on an assumption: Variable exposure can be delivered in clinical practice without unacceptable harm when unnecessary risks are avoided.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenRandomly selected difficult exposure items may potentially induce very high anxiety in clients.
“Randomly-selected difficult exposure items may potentially induce very high anxiety in clients.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenResistance to variable exposure may lead to a rupture in the therapeutic alliance or to treatment drop-out if it is not properly addressed.
“This resistance may lead to a rupture in the therapeutic alliance or even treatment drop-out if not properly addressed.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationnone givenPeople high in intolerance of uncertainty may be especially likely to generalize learned threat when uncertain, which then weakens fear extinction learning.
“Those high in intolerance of uncertainty may be especially prone to generalizing learned threat when uncertain, which then compromises fear extinction learning.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
Interpretationnone givenClients with high distress tolerance could probably adjust to random exposure hierarchy progression without much difficulty, while clients with low distress tolerance may need a more graded approach.
“Clients with high distress tolerance could probably adjust to random exposure hierarchy progression without much difficulty, while clients with low distress tolerance may need a more graded approach.”
Quote in the paperNot a substantial claim- Rests on an assumption: Variable exposure can be delivered in clinical practice without unacceptable harm when unnecessary risks are avoided.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
Interpretationnone givenSome level of resistance is common and can usually be worked through by reminding clients of the treatment rationale and their own motivations for treatment.
“Although the therapist should certainly not force the client to complete an exposure exercise (Abramowitz, Deacon, & Whiteside, 2011), some level of resistance is common and can usually be worked through by reminding clients of the treatment rationale and their own motivations for treatment.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningPeople can acquire high intolerance of uncertainty by observing caregivers' fear and avoidance of uncertain events or by being punished for entering uncertain situations.
“Individuals can also acquire high intolerance of uncertainty through observational learning of others’ (particularly caregivers’) fear and avoidance of uncertain events, or by being punished for venturing out into uncertain situations.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningClients could be expected to learn through exposure that uncertainty itself is not harmful and can be tolerated.
“Similarly, clients could be expected to learn through exposure that uncertainty itself is not harmful and can be tolerated.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
InterpretationreasoningParental reassurance is counterproductive and prevents direct exposure to the actual fear.
“In particular, therapists will need to make it clear to parents that providing reassurance (“I promise we’ll start with an easy item first when we do this at home”; “Nothing bad will happen when you do your homework”) is counterproductive and prevents direct exposure to the actual fear.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenIntolerance of uncertainty is only one process that may help explain the potentially beneficial effects of a variable approach to progressing through the fear hierarchy.
“It is important to note that intolerance of uncertainty is just one process that may be useful in explaining the potentially beneficial effects of a variable approach to progressing through the fear hierarchy.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone givenPeople with very high intolerance of uncertainty may be unable to handle variable exposure and may prefer a graded approach or be unwilling to agree to treatment.
“Alternatively, individuals with very high intolerance of uncertainty may be unable to handle variable exposure and may prefer a graded approach to exposure or otherwise be unwilling to agree to treatment.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationExposure is unlikely to be the only component of a client's therapy, and variability is not the only exposure aspect that can be adapted to improve inhibitory learning.
“Finally, exposure is unlikely to be the sole component of a client’s therapy, and variability is not the only aspect of exposure that can be adapted to improve inhibitory learning.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenThis parental behavior is common and interferes with a child's learning to tolerate uncertainty.
“This parental behavior is common and interferes with a child’s learning to tolerate uncertainty.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThese associations are strengthened through practice, and variable exposure may allow for additional, more generalized learning.
“These associations are strengthened through practice, and variable exposure may allow for additional, more generalized learning.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningDifficult exposures are not necessarily dangerous.
“However, difficult exposures are not necessarily dangerous.”
Quote in the paperNot a substantial claim- Rests on an assumption: Variable exposure can be delivered in clinical practice without unacceptable harm when unnecessary risks are avoided.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenDriving an unfamiliar vehicle is a task many people must do at some point and very rarely results in a car accident.
“Driving an unfamiliar vehicle is a task that many individuals must do at some point in their lives and very rarely results in a car accident.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningClients may refuse to attempt difficult exposures initially or may want to end a distressing exposure immediately.
“However, clients in these situations may refuse to attempt difficult exposures initially, or they may want to end a distressing exposure immediately.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenViolating client expectancies during therapy is typically beneficial for learning.
“While violating client expectancies during therapy is typically beneficial for learning, therapists need to be careful in planning exposure exercises to avoid unnecessary failures.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
Interpretationnone givenSuccessful treatment is marked by being able to do exposures even while distressed, not necessarily by a reduction in distress.
“Clients should be reminded, however, that successful treatment is marked by the ability to do exposures even when distressing, not necessarily in the reduction of distress.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenAnxious children might be more unwilling to accept a challenging exposure right away, and emphasizing variability in exposure stimuli or context might be more practical than introducing a variable hierarchy progression.
“Anxious children might be more unwilling to accept the possibility of completing a challenging exposure right away, and emphasizing variability in the exposure stimuli or context might be more practical than introducing a variable hierarchy progression.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Intolerance of uncertainty is a transdiagnostic mechanism in anxiety and related disorders.
“the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders.”
The paper relies on this without support.
Findings from laboratory analogue samples about multiple contexts and return of fear generalize to clinical exposure therapy for anxiety disorders.
“These effects have also been demonstrated in the laboratory in analogue samples (Culver, Stoyanova, & Craske, 2011; Mineka, Mystkowski, Hladek, & Rodriguez, 1999; Rodriguez, Craske, Mineka, & Hladek, 1999; Vervliet et al., 2013).”
The paper relies on this without support.
The mechanisms of fear extinction and inhibitory learning observed in laboratory conditioning paradigms operate in clinical exposure therapy.
“In exposure therapy, the client learns new associations between uncertainty and a lack of inherent danger, and they learn to tolerate their anxiety even in uncertain situations.”
The paper relies on this without support.
Variable exposure can be delivered in clinical practice without unacceptable harm when unnecessary risks are avoided.
“The therapist has to be able to tolerate some uncertainty in the outcome of the exposure, as long as unnecessary risks are avoided.”
Cites
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1977) · Psychological Review · doi:10.1037/0033-295x.84.2.191 · Cited by 43,925 · cited 1× · see citing works
“After observing appropriately modeled approach behavior and practicing it, the client gains coping skills and self-efficacy, which is likely to increase future approach behavior and decrease fear (Bandura, 1977).”
Rescorla, R. A. (1972) · Medical Entomology and Zoology · Cited by 7,268 · see citing works
(1999) · Cited by 5,934 · see citing works
Emotional processing of fear: Exposure to corrective information.
Foa, E. B., & Kozak, M. J. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.20 · Cited by 5,396 · see citing works
Classical conditioning II: Current research and theory.
Black, A. H., & Prokasy, W. F. (1972) · Appleton-Century-Crofts eBooks · Cited by 4,449 · see citing works
Etkin, A., & Wager, T. D. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07030504 · Cited by 3,391 · see citing works
Psychotherapy by reciprocal inhibition
Wolpe, J. (1968) · Pavlovian Journal of Biological Science · doi:10.1007/bf03000093 · Cited by 3,389 · see citing works
Differential contribution of amygdala and hippocampus to cued and contextual fear conditioning.
Phillips, R. G., & LeDoux, J. E. (1992) · Behavioral Neuroscience · doi:10.1037/0735-7044.106.2.274 · Cited by 3,292 · see citing works
Differential contribution of amygdala and hippocampus to cued and contextual fear conditioning.
Phillips, R. G., & LeDoux, J. E. (1992) · Behavioral Neuroscience · doi:10.1037//0735-7044.106.2.274 · Cited by 3,262 · see citing works
Psychotherapy by Reciprocal Inhibition
Masserman, J. H. (1958) · Archives of Neurology And Psychiatry · doi:10.1001/archneurpsyc.1958.02340090135025 · Cited by 3,087 · see citing works
A theory of attention: Variations in the associability of stimuli with reinforcement
Mackintosh, N. J. (1975) · Psychological Review · doi:10.1037/h0076778 · Cited by 2,733 · see citing works
The role of the amygdala in fear and anxiety
Davis, M. (1992) · Annual Review of Neuroscience · doi:10.1146/annurev.ne.15.030192.002033 · Cited by 2,357 · see citing works
Maximizing exposure therapy: An inhibitory learning approach
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.04.006 · Cited by 2,339 · see citing works
Fearing the unknown: A short version of the Intolerance of Uncertainty Scale
Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2006.03.014 · Cited by 2,288 · see citing works
(1973) · Cited by 2,004 · see citing works
Context, time, and memory retrieval in the interference paradigms of Pavlovian learning
Bouton, M. E. (1993) · Psychological Bulletin · doi:10.1037/0033-2909.114.1.80 · Cited by 1,896 · see citing works
Effects of an expanding-spaced vs massed exposure schedule on fear reduction and return of fear
Rowe, M. K., & Craske, M. G. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10016-x · Cited by 1,778 · see citing works
A Bio‐Informational Theory of Emotional Imagery
Lang, P. J. (1979) · Psychophysiology · doi:10.1111/j.1469-8986.1979.tb01511.x · Cited by 1,750 · cited 1× · see citing works
“Emotional processing theory drew upon Lang’s bioinformational model of fear (Lang, 1977, 1979), which notes the importance of changes in physiology (e.g., heart rate) in response to emotional stimuli as an indicator of improvement during systematic desensitization (Lang, Melamed, & Hart, 1970).”
(1994) · The MIT Press eBooks · doi:10.7551/mitpress/4561.001.0001 · Cited by 1,741 · see citing works
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994) · Personality and Individual Differences · doi:10.1016/0191-8869(94)90048-5 · Cited by 1,731 · see citing works
Optimizing inhibitory learning during exposure therapy
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.10.003 · Cited by 1,607 · see citing works
Neuronal Coding of Prediction Errors
Schultz, W., & Dickinson, A. (2000) · Annual Review of Neuroscience · doi:10.1146/annurev.neuro.23.1.473 · Cited by 1,427 · see citing works
Cognitive processes mediating behavioral change.
Bandura, A., Adams, N. E., & Beyer, J. (1977) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.35.3.125 · Cited by 1,392 · cited 1× · see citing works
“After observing appropriately modeled approach behavior and practicing it, the client gains coping skills and self-efficacy, which is likely to increase future approach behavior and decrease fear (Bandura, 1977).”
Analysis of self-efficacy theory of behavioral change
Bandura, A., & Adams, N. E. (1977) · Cognitive Therapy and Research · doi:10.1007/bf01663995 · Cited by 1,338 · cited 1× · see citing works
“After observing appropriately modeled approach behavior and practicing it, the client gains coping skills and self-efficacy, which is likely to increase future approach behavior and decrease fear (Bandura, 1977).”
Myers, K. M., & Davis, M. (2007) · Molecular Psychiatry · doi:10.1038/sj.mp.4001939 · Cited by 1,277 · see citing works
Into the unknown: A review and synthesis of contemporary models involving uncertainty
Carleton, R. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.007 · Cited by 1,104 · see citing works
Memory and Metamemory Considerations in the Training of Human Beings
Bjork, R. A. (1994) · Metacognition · doi:10.7551/mitpress/4561.003.0011 · Cited by 1,084 · see citing works
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., et al. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.1.151 · Cited by 1,048 · see citing works
A meta-analytic review of prolonged exposure for posttraumatic stress disorder
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.04.007 · Cited by 1,005 · see citing works
Medial prefrontal cortex as an action-outcome predictor
Alexander, W. H., & Brown, J. W. (2011) · Nature Neuroscience · doi:10.1038/nn.2921 · Cited by 1,000 · see citing works
Cognitive processes mediating behavioral change.
Bandura, A., Adams, N. E., & Beyer, J. (1977) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.35.3.125 · Cited by 957 · see citing works
Metacognition: Knowing about Knowing
Allen, B. (1995) · Information Processing & Management · doi:10.1016/0306-4573(95)80050-4 · Cited by 877 · see citing works
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010) · Psychological Bulletin · doi:10.1037/a0019712 · Cited by 868 · see citing works
Imagery in therapy: an information processing analysis of fear
Lang, P. J. (1977) · Behavior Therapy · doi:10.1016/s0005-7894(77)80157-3 · Cited by 792 · cited 2× · see citing works
“Emotional processing theory drew upon Lang’s bioinformational model of fear (Lang, 1977, 1979), which notes the importance of changes in physiology (e.g., heart rate) in response to emotional stimuli as an indicator of improvement during systematic desensitization (Lang, Melamed, & Hart, 1970).”
BackgroundIncreasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. G. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.01.011 · Cited by 775 · see citing works
Fear Extinction and Relapse: State of the Art
Vervliet, B., Craske, M. G., & Hermans, D. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185542 · Cited by 671 · see citing works
Rachman, S. (1980) · Behaviour Research and Therapy · doi:10.1016/0005-7967(80)90069-8 · Cited by 657 · cited 2× · see citing works
“A revised theory of exposure therapy, emotional processing, took hold in the 1980s (Foa & Kozak, 1986; Rachman, 1980).”
BackgroundHofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012) · Depression and Anxiety · doi:10.1002/da.21888 · Cited by 630 · see citing works
Behavioral treatment of panic disorder
Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989) · Behavior Therapy · doi:10.1016/s0005-7894(89)80073-5 · Cited by 627 · see citing works
Bandura, A., Blanchard, E. B., & Ritter, B. (1969) · Journal of Personality and Social Psychology · doi:10.1037/h0028276 · Cited by 583 · see citing works
Treatment of specific phobia in adults
Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.10.002 · Cited by 573 · see citing works
Progress in behavior modification
de Silva, P. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90073-r · Cited by 542 · see citing works
A meta-analysis of treatment outcome for panic disorder
Gould, R. A., Ott, M. W., & Pollack, M. H. (1995) · Clinical Psychology Review · doi:10.1016/0272-7358(95)00048-8 · Cited by 520 · see citing works
One-session treatment for specific phobias
Öst, L.-G. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90113-7 · Cited by 498 · see citing works
Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80096-6 · Cited by 496 · see citing works
Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21965 · Cited by 495 · see citing works
Intolerance of uncertainty in obsessive-compulsive disorder
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(02)00182-2 · Cited by 494 · see citing works
Abramowitz, J. S. (1997) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.65.1.44 · Cited by 490 · cited 1× · see citing works
“A large body of evidence supports the efficacy of exposure in the treatment of obsessive-compulsive disorder (OCD; Abramowitz, 1996, 1997; Abramowitz, Franklin, & Foa, 2002; Foa & McLean, 2016; Gava et al., 2009; Rosa-Alcázar, Sánchez-Meca, GómezConesa, & Marín-Martínez, 2008), posttraumatic stress…”
Background(1992) · Cited by 464 · see citing works
A psychophysiological analysis of fear modification using an automated desensitization procedure
Lang, P. J., Melamed, B. G., & Hart, J. (1970) · Journal of Abnormal Psychology · doi:10.1037/h0029875 · Cited by 463 · see citing works
Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.6.957 · Cited by 446 · see citing works
Psychological treatment of obsessive–compulsive disorder: A meta-analysis
Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.07.001 · Cited by 444 · see citing works
Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.
Gould, R. A., Buckminster, S., Pollack, M. H., Otto, M. W., & Yap, L. (1997) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.1997.tb00123.x · Cited by 427 · see citing works
The treatment of social anxiety disorder
Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.07.007 · Cited by 424 · see citing works
McEvoy, P. M., & Mahoney, A. E. J. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.08.010 · Cited by 412 · see citing works
Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2005.01.002 · Cited by 399 · see citing works
Exposure Therapy for Anxiety: Principles and Practice
Davis, M. L., & Powers, M. B. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.609655 · Cited by 383 · see citing works
Factors determining vicarious extinction of avoidance behavior through symbolic modeling
Bandura, A., & Menlove, F. L. (1968) · Journal of Personality and Social Psychology · doi:10.1037/h0025260 · Cited by 379 · see citing works
Meta-analysis of cognitive-behavioral treatments for social phobia
Taylor, S. J. (1996) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(95)00058-5 · Cited by 365 · cited 1× · see citing works
“…(Choy, Fyer, & Lipsitz, 2007; Grös & Antony, 2006), social anxiety disorder (Gould, Buckminster, Pollack, Otto, & Yap, 1997; Rodebaugh, Holaway, &Heimberg, 2004; Taylor, 1996), and panic disorder (Barlow, Craske, Cerny, & Klosko, 1989; Craske, Brown, &Barlow, 1991; Gould, Otto, & Pollack, 1995).”
Foa, E. B., & McLean, C. P. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093533 · Cited by 360 · see citing works
Abramowitz, J. S. (1996) · Behavior Therapy · doi:10.1016/s0005-7894(96)80045-1 · Cited by 357 · cited 1× · see citing works
“A large body of evidence supports the efficacy of exposure in the treatment of obsessive-compulsive disorder (OCD; Abramowitz, 1996, 1997; Abramowitz, Franklin, & Foa, 2002; Foa & McLean, 2016; Gava et al., 2009; Rosa-Alcázar, Sánchez-Meca, GómezConesa, & Marín-Martínez, 2008), posttraumatic stress…”
BackgroundTHE SYSTEMATIC DESENSITIZATION TREATMENT OF NEUROSES
Wolpe, J. (1961) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-196103000-00001 · Cited by 333 · cited 1× · see citing works
“The earliest approach to exposure therapy was systematic desensitization (Wolpe, 1958, 1961).”
BackgroundVicarious extinction of avoidance behavior.
Bandura, A., Grusec, J. E., & Menlove, F. L. (1967) · Journal of Personality and Social Psychology · doi:10.1037/h0024182 · Cited by 319 · see citing works
Ollendick, T. H., Öst, L.-G., Reuterskiöld, L., Costa, N., Cederlund, R., Sirbu, C., Davis, T. E., & Jarrett, M. A. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0015158 · Cited by 310 · see citing works
One-session treatment of specific phobias in youths: A randomized clinical trial.
Öst, L.-G., Svensson, L., Hellström, K., & Lindwall, R. (2001) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.69.5.814 · Cited by 281 · see citing works
(2010) · Cited by 262 · see citing works
Success and failure in the behavioral treatment of obsessive-compulsives.
Foa, E. B., Grayson, J. B., Steketee, G. S., Doppelt, H., Turner, R. M., & Latimer, P. R. (1983) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.51.2.287 · Cited by 258 · see citing works
Behavioral treatment of panic disorder: A two-year follow-up
Craske, M. G., Brown, T. A., & Barlow, D. H. (1991) · Behavior Therapy · doi:10.1016/s0005-7894(05)80367-3 · Cited by 258 · see citing works
Examination of model characteristics in reducing avoidance behavior.
Meichenbaum, D. H. (1971) · Journal of Personality and Social Psychology · doi:10.1037/h0030593 · Cited by 258 · cited 1× · see citing works
“Modeling has been shown to be more effective than systematic desensitization for the treatment of multiple phobias (Bandura et al., 1969; Shaw & Thoresen, 1974) and is especially effective when the model shares characteristics like age and gender with the client (Kazdin, 1974; Meichenbaum, 1971).”
BackgroundThe Long Shadow of Temperament
Kagan, J., & Snidman, N. C. (2009) · Harvard University Press eBooks · doi:10.2307/j.ctv2jfvczc · Cited by 256 · see citing works
Five-Year Course of Obsessive-Compulsive Disorder: Predictors of Remission and Relapse [CME]
Eisen, J. L., Sibrava, N. J., Boisseau, C. L., Mancebo, M. C., Stout, R. L., Pinto, A., & Rasmussen, S. A. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12m07657 · Cited by 248 · see citing works
Statistical theory of distributional phenomena in learning
Estes, W. K. (1955) · Psychological Review · doi:10.1037/h0046888 · Cited by 246 · see citing works
Einstein, D. A. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12077 · Cited by 223 · see citing works
Effects of varied-stimulus exposure training on fear reduction and return of fear
Rowe, M. K., & Craske, M. G. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10017-1 · Cited by 202 · see citing works
Success and failure in the behavioral treatment of obsessive-compulsives.
Foa, E. B., Grayson, J. B., Steketee, G. S., et al. (1983) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.51.2.287 · Cited by 202 · see citing works
Covert modeling, model similarity, and reduction of avoidance behavior
Kazdin, A. E. (1974) · Behavior Therapy · doi:10.1016/s0005-7894(74)80002-x · Cited by 196 · cited 1× · see citing works
“Modeling has been shown to be more effective than systematic desensitization for the treatment of multiple phobias (Bandura et al., 1969; Shaw & Thoresen, 1974) and is especially effective when the model shares characteristics like age and gender with the client (Kazdin, 1974; Meichenbaum, 1971).”
BackgroundSpecific and Non-specific Factors in Behaviour Therapy
Gelder, M., Bancroft, J., Gath, D. H., Johnston, D. W., Mathews, A., & Shaw, P. (1973) · The British Journal of Psychiatry · doi:10.1192/bjp.123.4.445 · Cited by 189 · see citing works
Jacoby, R. J., & Abramowitz, J. S. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.07.001 · Cited by 188 · see citing works
Ritter, B. (1968) · Behaviour Research and Therapy · doi:10.1016/0005-7967(68)90033-8 · Cited by 180 · cited 1× · see citing works
“…colleagues suggested that individuals with phobias could learn approach behavior and experience reduced fear throughmodeling, or observing others approach a feared object or situation without negative consequences (Bandura, Blanchard, & Ritter, 1969; Bandura, Grusec, & Menlove, 1967; Ritter, 1968).”
BackgroundPossible mechanisms for why desensitization and exposure therapy work
Tryon, W. W. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.08.005 · Cited by 180 · cited 1× · see citing works
“In 1975, Marks published an extensive literature review on systematic desensitization and determined that the active ingredient in this treatment was the exposure to feared stimuli, not relaxation (Marks, 1975; Tryon, 2005).”
BackgroundThe effects of changing contexts on return of fear following exposure therapy for spider fear.
Mineka, S., Mystkowski, J. L., Hladek, D., & Rodriguez, B. I. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.4.599 · Cited by 177 · see citing works
Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.06.006 · Cited by 176 · see citing works
Davis, T. E., & Ollendick, T. (2006) · Clinical Psychology Science and Practice · doi:10.1093/clipsy.bpi018 · Cited by 167 · see citing works
One versus five sessions of exposure in the treatment of injection phobia
Öst, L.-G., Hellström, K., & Kåver, A. (1992) · Behavior Therapy · doi:10.1016/s0005-7894(05)80385-5 · Cited by 165 · see citing works
Effect of multiple context exposure on renewal in spider phobia
Shiban, Y., Pauli, P., & Mühlberger, A. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.10.007 · Cited by 162 · see citing works
Kozak, M. J., Foa, E. B., & Steketee, G. (1988) · Behavior Therapy · doi:10.1016/s0005-7894(88)80039-x · Cited by 162 · see citing works
Kamphuis, J. H., & Telch, M. J. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00147-3 · Cited by 158 · see citing works
The treatment of chronic obsessive-compulsive neurosis: Follow-up and further findings
HODGSON, R. J., Rachman, S., & Marks, I. M. (1972) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(72)80012-3 · Cited by 156 · see citing works
McEvoy, P. M., & Erceg-Hurn, D. M. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.002 · Cited by 155 · see citing works
March, J. S. (1995) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199501000-00008 · Cited by 153 · see citing works
Context-specificity of relapse: effects of therapist and environmental context on return of fear.
Rodriguez, B. I., Craske, M., Mineka, S., & Hladek, D. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00106-5 · Cited by 152 · see citing works
Treating disgust reactions in contamination-based obsessive-compulsive disorder
McKay, D. (2006) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2005.09.005 · Cited by 152 · see citing works
Nothing is safe: Intolerance of uncertainty is associated with compromised fear extinction learning
Morriss, J., Christakou, A., & van Reekum, C. M. (2016) · Biological Psychology · doi:10.1016/j.biopsycho.2016.05.001 · Cited by 152 · see citing works
Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD)
Gava, I., Barbui, C., Aguglia, E., Carlino, D., Churchill, R., De Vanna, M., & McGuire, H. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005333.pub2 · Cited by 151 · see citing works
Manipulations of exposure-based therapy to reduce return of fear: a replication
Lang, A. J., & Craske, M. G. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00031-5 · Cited by 149 · see citing works
McLean, C. P., & Foa, E. B. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.94 · Cited by 148 · see citing works
One versus five sessions of exposure in the treatment of flying phobia
Öst, L.-G., Brandberg, M., & Alm, T. (1997) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)00077-6 · Cited by 146 · see citing works
An examination of the decline in fear and disgust during exposure-based treatment
Smits, J. A. J., Telch, M. J., & Randall, P. K. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00094-8 · Cited by 142 · see citing works
Pitman, R. K., Orr, S. P., Altman, B., Longpre, R. E., Poiré, R. E., Macklin, M. L., Michaels, M. J., & Steketee, G. S. (1996) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(96)90024-3 · Cited by 141 · see citing works
Kircanski, K., Mortazavi, A., Castriotta, N., Baker, A. S., Mystkowski, J. L., Yi, R., & Craske, M. G. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.10.010 · Cited by 140 · see citing works
Fear and learning: from basic processes to clinical implications
(2007) · Choice Reviews Online · doi:10.5860/choice.44-4146 · Cited by 140 · see citing works
Öst, L.-G., Alm, T., Brandberg, M., & Breitholtz, E. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00176-x · Cited by 138 · see citing works
Tsao, J. C. I., & Craske, M. G. (2000) · Behavior Therapy · doi:10.1016/s0005-7894(00)80026-x · Cited by 131 · see citing works
Flooding versus Desensitization in the Treatment of Phobic Patients: A Crossover Study
Marks, I. M., Boulougouris, J. C., & Marset, P. (1971) · The British Journal of Psychiatry · doi:10.1192/bjp.119.551.353 · Cited by 129 · see citing works
Comparative effectiveness of guided mastery and exposure treatments for intractable phobias.
Williams, S. L., Dooseman, G., & Kleifield, E. I. (1984) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.52.4.505 · Cited by 126 · see citing works
Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks
Carleton, R. N., Fetzner, M. G., Hackl, J. L., & McEvoy, P. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.792100 · Cited by 126 · see citing works
Imagery vividness and perceived anxious arousal in prolonged exposure treatment for PTSD
Rauch, S. A. M., Foa, E. B., Furr, J. M., & Filip, J. C. (2004) · Journal of Traumatic Stress · doi:10.1007/s10960-004-5794-8 · Cited by 122 · see citing works
Handbook of Exposure Therapies
Richard, D. C. S., & Lauterbach, D. (2007) · Elsevier eBooks · doi:10.1016/b978-0-12-587421-2.x5000-5 · Cited by 118 · see citing works
“But it might be a heart attack”: Intolerance of uncertainty and panic disorder symptoms
Carleton, R. N., Duranceau, S., Freeston, M. H., Boelen, P. A., McCabe, R. E., & Antony, M. M. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.04.006 · Cited by 118 · see citing works
Guided mastery and performance desensitization treatments for severe acrophobia.
Williams, S. L., Turner, S. M., & Peer, D. F. (1985) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.53.2.237 · Cited by 114 · see citing works
Common pitfalls in exposure and response prevention (EX/RP) for OCD
Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2012.05.002 · Cited by 114 · see citing works
Does escape behavior strengthen agoraphobic avoidance? A replication
Rachman, S., Craske, M. G., Tallman, K., & Solyom, C. A. E. (1986) · Behavior Therapy · doi:10.1016/s0005-7894(86)80069-7 · Cited by 113 · see citing works
Behavioral Treatments of Phobic and Obsessive-Compulsive Disorders: A Critical Appraisal
Marks, I. M. (1975) · Progress in behavior modification · doi:10.1016/b978-0-12-535601-5.50010-x · Cited by 110 · cited 1× · see citing works
“In 1975, Marks published an extensive literature review on systematic desensitization and determined that the active ingredient in this treatment was the exposure to feared stimuli, not relaxation (Marks, 1975; Tryon, 2005).”
BackgroundMemory and society psychological perspectives
Nilsson, L. (2006) · Cited by 109 · see citing works
Superiority of flooding (implosion) to desensitisation for reducing pathological fear
Boulougouris, J. C., MARKS, I., & Marset, P. (1971) · Behaviour Research and Therapy · doi:10.1016/0005-7967(71)90030-1 · Cited by 109 · see citing works
EMOTION REGULATION PREDICTS ANXIETY OVER A FIVE-YEAR INTERVAL: A CROSS-LAGGED PANEL ANALYSIS
Wirtz, C. M., Hofmann, S. G., Riper, H. M., & Berking, M. (2013) · Depression and Anxiety · doi:10.1002/da.22198 · Cited by 109 · see citing works
Oglesby, M. E., Boffa, J. W., Short, N. A., Raines, A. M., & Schmidt, N. B. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.01.005 · Cited by 109 · see citing works
Emotional variability and sustained arousal during exposure
Culver, N. C., Stoyanova, M., & Craske, M. G. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.10.009 · Cited by 106 · see citing works
Morriss, J., Christakou, A., & van Reekum, C. M. (2015) · Biology of Mood & Anxiety Disorders · doi:10.1186/s13587-015-0019-8 · Cited by 106 · see citing works
Cognition and exposure in vivo in the treatment of agoraphobia: Short-term and delayed effects
Emmelkamp, P. M. G., & Mersch, P. P. A. (1982) · Cognitive Therapy and Research · doi:10.1007/bf01185728 · Cited by 105 · see citing works
Jacoby, R. J., Fabricant, L. E., Leonard, R. C., Riemann, B. C., & Abramowitz, J. S. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.07.008 · Cited by 102 · see citing works
Abramowitz, J. S., Franklin, M. E., & Foa, E. B. (2002) · Cited by 100 · see citing works
What Is Going On Around Here? Intolerance of Uncertainty Predicts Threat Generalization
Morriss, J., Macdonald, B., & van Reekum, C. M. (2016) · PLOS ONE · doi:10.1371/journal.pone.0154494 · Cited by 94 · see citing works
Generalization of therapeutic changes in agoraphobia: The role of perceived self-efficacy.
Williams, S. L., Kinney, P. J., & Falbo, J. (1989) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.57.3.436 · Cited by 93 · see citing works
Beckham, J. C., Vrana, S. R., May, J. G., Gustafson, D. J., & Smith, G. R. (1990) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(90)90002-3 · Cited by 86 · see citing works
Holland, P. C., & Gallagher, M. (2006) · Journal of Neuroscience · doi:10.1523/jneurosci.0390-06.2006 · Cited by 85 · see citing works
Guided mastery and performance desensitization treatments for severe acrophobia.
Williams, S. L., Turner, S. M., & Peer, D. F. (1985) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.53.2.237 · Cited by 83 · see citing works
Ollendick, T. H., Öst, L., Reuterskiöld, L., & Costa, N. M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.024 · Cited by 80 · see citing works
Optimizing Treatment and Instruction: Implications of a New Theory of Disuse
Bjork, R. A., & Bjork, E. L. (2013) · Psychology Press eBooks · doi:10.4324/9780203086254-13 · Cited by 79 · see citing works
Boelen, P. A., Reijntjes, A., & Smid, G. E. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.004 · Cited by 76 · see citing works
Watts, F. (1971) · Behaviour Research and Therapy · doi:10.1016/0005-7967(71)90006-4 · Cited by 75 · see citing works
Fear activation and distraction during the emotional processing of claustrophobic fear
Telch, M. J., Valentiner, D. P., Ilai, D., Young, P. R., Powers, M. B., & Smits, J. A. J. (2004) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2004.03.004 · Cited by 71 · see citing works
Forsyth, J. P., Eifert, G. H., & Barrios, V. (2007) · Fear and learning: From basic processes to clinical implications. · doi:10.1037/11474-007 · Cited by 71 · see citing works
Rachman, S. (1967) · Psychological Bulletin · doi:10.1037/h0024212 · Cited by 71 · see citing works
Clinical relevance of retrieval cues for attenuating context renewal of fear
Culver, N. C., Stoyanova, M., & Craske, M. G. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.10.002 · Cited by 70 · see citing works
Imagery in Therapy: An Information Processing Analysis of Fear – Republished Article
Lang, P. J. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.08.011 · Cited by 68 · see citing works
Generalization of therapeutic changes in agoraphobia: The role of perceived self-efficacy.
Williams, S. L., Kinney, P. J., & Falbo, J. (1989) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.57.3.436 · Cited by 68 · see citing works
McGuire, J. F., Orr, S. P., Essoe, J. K.-Y., McCracken, J. T., Storch, E. A., & Piacentini, J. (2016) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2016.1199276 · Cited by 67 · see citing works
Implosive therapy and flooding procedures: A critical review.
Morganstern, K. P. (1973) · Psychological Bulletin · doi:10.1037/h0034571 · Cited by 65 · cited 3× · see citing works
“…and Behavioral Practice (2018), https://doi.org/10.1016/j.cbpra.2017.12.001 Available online at www.sciencedirect.com ScienceDirect Cognitive and Behavioral Practice xx (2018) xxx-xxx www.elsevier.com/locate/cabp extreme and unrealistic stimuli (Morganstern, 1973; Smith, Dickson, & Sheppard, 1973).”
BackgroundMethodResultInfluentialEffects of modeling and desensitization in reducing dentist phobia.
Shaw, D. W., & Thoresen, C. E. (1974) · Journal of Counseling Psychology · doi:10.1037/h0037102 · Cited by 57 · see citing works
The assessment and treatment of specific phobias: a review
Grös, D. F., & Antony, M. M. (2006) · Current Psychiatry Reports · doi:10.1007/s11920-006-0066-3 · Cited by 55 · see citing works
McGuire, J. F., Orr, S. P., Wu, M. S., Lewin, A. B., Small, B. J., Phares, V., Murphy, T. K., Wilhelm, S., Pine, D. S., Geller, D., et al. (2016) · Depression and Anxiety · doi:10.1002/da.22468 · Cited by 54 · see citing works
Guided mastery treatment of agoraphobia: beyond stimulus exposure.
Sl, W. (1990) · PubMed · Cited by 52 · see citing works
Standard criteria for relapse are needed in obsessive-compulsive disorder
Simpson, H. B., Franklin, M. E., Cheng, J., Foa, E. B., & Liebowitz, M. R. (2005) · Depression and Anxiety · doi:10.1002/da.20052 · Cited by 50 · see citing works
Bandarian-Balooch, S., Neumann, D. L., & Boschen, M. J. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.12.006 · Cited by 44 · see citing works
Surprise! A unifying model of dorsal anterior cingulate function?
Egner, T. (2011) · Nature Neuroscience · doi:10.1038/nn.2932 · Cited by 44 · see citing works
Translational research perspectives on maximizing the effectiveness of exposure therapy
Powers, M. B., Smits, J. A. J., Leyro, T. M., & Otto, M. W. (2007) · Elsevier eBooks · doi:10.1016/b978-012587421-2/50005-3 · Cited by 40 · see citing works
Return of fear: Underlearning and overlearning
Rachman, S., & Lopatka, C. (1988) · Behaviour Research and Therapy · doi:10.1016/0005-7967(88)90108-8 · Cited by 33 · see citing works
Is incomplete fear-reduction followed by a return of fear?
Rachman, S., Robinson, S. L., & Lopatka, C. (1987) · Behaviour Research and Therapy · doi:10.1016/0005-7967(87)90116-1 · Cited by 32 · see citing works
Context effects on habituation to disgust-relevant stimuli
Viar-Paxton, M. A., & Olatunji, B. O. (2012) · Behavior Modification · doi:10.1177/0145445512446189 · Cited by 28 · see citing works
Self-citationAcceptability of fear reduction procedures with children
King, N. J., & Gullone, E. (1990) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(90)90042-j · Cited by 27 · see citing works
Flooding therapy: Effectiveness, stimulus characteristics, and the value of brief in vivo exposure
Marshall, W. L., Gauthier, J. G., Christie, M. M., Currie, D. W., & Gordon, A. (1977) · Behaviour Research and Therapy · doi:10.1016/0005-7967(77)90090-0 · Cited by 26 · see citing works
Surprise beyond prediction error
Chumbley, J. R., Burke, C. J., Stephan, K. E., Friston, K. J., Tobler, P. N., & Fehr, E. (2014) · Human Brain Mapping · doi:10.1002/hbm.22513 · Cited by 23 · see citing works
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 · see citing works
Self-citationDavis, T. E. (2005) · Clinical Psychology Science and Practice · doi:10.1093/clipsy/bpi018 · Cited by 23 · see citing works
Riley, W. T., McCormick, M. G. F., Simon, E. M., Stack, K., Pushkin, Y., Overstreet, M. M., Carmona, J. J., & Magakian, C. (1995) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(95)00003-7 · Cited by 21 · see citing works
Marks, I. M. (1972) · PubMed · Cited by 17 · see citing works
Moulds, M. L., & Nixon, R. D. V. (2005) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2005.05.005 · Cited by 14 · see citing works
Review of Flooding Procedures (Implosion) in Animals and Man
Smith, R. D., Dickson, A. L., & Sheppard, L. (1973) · Perceptual and Motor Skills · doi:10.2466/pms.1973.37.2.351 · Cited by 10 · see citing works
Social Psychology’s Contribution to a Sustainable Future
Myers, D. G. (2013) · Journal of Management for Global Sustainability · doi:10.13185/jm2013.01102 · Cited by 7 · see citing works
The Long Shadow of Temperament
Denham, R., & Martin, A. (2005) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000179051.23925.a8
Flagged first, then by citations
11 of the 172 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Foa, 1996, Mechanisms of change in exposure therapy, Current Controversies in the Anxiety Disorders, 329
Cited by
Sorted by citations
Morriss, J., Zuj, D. V., & Mertens, G. (2021) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2021.05.011 · Cited by 108 · see citing works
“…the reinforcement rate in prior threat acquisition training (partial vs. continuous) or the reinforcement rate in threat extinction training itself (Knowles and Olatunji, 2018; Lipp et al., 2020; Thompson et al., 2018) (i.e., complete omission of the US, compared to partial omission or unpaired…”
Backgroundvan Minnen, A., Hendriks, L., de Kleine, R. A., Hendriks, G., Verhagen, M., & de Jongh, A. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1492836 · Cited by 65 · see citing works
“…of view, this therapist rotation model provides a good opportunity for patients to learn new associations in a variety of therapeutic contexts, i.e. different therapists and different therapy rooms, which may strengthen these learning experiences (Craske et al., 2008; Knowles & Olatunji, 2018).”
BackgroundMorriss, J., Wake, S., Elizabeth, C., & van Reekum, C. M. (2021) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2021.05.011 · Cited by 52 · see citing works
“, prolonged exposure-based therapy) to these treatments (25,52) are needed to target IU-related biases in a particular disorder or within a broader set of disorders (26).”
BackgroundMorriss, J., & van Reekum, C. M. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.03.004 · Cited by 46 · see citing works
Baerg, L., & Bruchmann, K. (2022) · Acta Psychologica · doi:10.1016/j.actpsy.2022.103534 · Cited by 46 · see citing works
Inhibitory Learning for Anxiety-Related Disorders
Tolin, D. F. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.07.008 · Cited by 35 · see citing works
Morriss, J., Wake, S., Lindner, M., McSorley, E., & Dodd, H. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.04.012 · Cited by 33 · see citing works
de Baets, L., Meulders, A., Damme, S. V., Caneiro, J., & Matheve, T. (2023) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2023.11420 · Cited by 26 · see citing works
The Impact of Intolerance of Uncertainty and Cognitive Behavioural Instructions on Safety Learning
Wake, S., van Reekum, C. M., Dodd, H., & Morriss, J. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10113-4 · Cited by 20 · see citing works
Siegel, 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 · see citing works
Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors
van der Hoeven, M. L., Assink, M., Stams, G. J. J. M., Daams, J. G., Lindauer, R., & Hein, I. M. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00500-2 · Cited by 12 · see citing works
“This vulnerability may be explained by the inhibitory learning model stating that, through exposure, children learn that what is feared might actually not happen (expectancy disconfirmation) (Craske et al., 2008, 2014; Knowles & Olatunji, 2019).”
BackgroundHartmann, A. S., Naumann, E., Vocks, S., Svaldi, J., & Werthmann, J. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.3813 · Cited by 13 · see citing works
“More recent studies in the area of anxiety disorders ad vocate for variability in the exposure hierarchy in order to maximize inhibitory learning (e.g., Knowles & Olatunji, 2019).”
BackgroundCO2 reactivity as a biomarker of exposure-based therapy non-response: study protocol
Smits, J. A. J., Monfils, M., Otto, M. W., Telch, M. J., Shumake, J., Feinstein, J. S., Khalsa, S. S., Cobb, A. R., Parsons, E. M., Long, L. J., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04478-x · Cited by 12 · see citing works
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 · see citing works
Scheveneels, S., Boddez, Y., Vervliet, B., & Hermans, D. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.03.001 · Cited by 12 · see citing works
“In a study by Lang and Craske (2000), participants fearful of heights had one hour of exposure divided into twelve 5-minute exercises.”
BackgroundKennedy, S. M., & Hawks, J. L. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.09.011 · Cited by 11 · see citing works
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 11 · see citing works
Woolf‐King, S. E., Sheinfil, A. Z., Babowitch, J. D., Siedle‐Khan, B., Loitsch, A., & Maisto, S. A. (2018) · Alcoholism Treatment Quarterly · doi:10.1080/07347324.2018.1539630 · Cited by 10 · see citing works
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 · see citing works
“29,30 Thus, XTics introduces a variety of tic-triggering events.”
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 8 · see citing works
Jessup, S. C., & Olatunji, B. O. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101747 · Cited by 9 · see citing works
Self-citationDo Exposure Therapy Processes Impact the Efficacy of Deep Tms for Obsessive-Compulsive Disorder?
Guzick, A. G., Schweissing, E. J., Tendler, A., Sheth, S. A., Goodman, W. K., & Storch, E. A. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100756 · Cited by 10 · see citing works
The regulatory role of attention in PTSD from an information processing perspective
Bardeen, J. R. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816022-0.00011-9 · Cited by 10 · see citing works
Macdonald, C. (2024) · Frontiers Virtual Real. · doi:10.3389/frvir.2024.1506938 · Cited by 7 · see citing works
Cognitive Behavioral Therapy for Child and Adolescent Anxiety: CBT in a Nutshell
Badin, E., Alvarez, E., & Chu, B. C. (2020) · Neuromethods · doi:10.1007/978-1-0716-0700-8_3 · Cited by 6 · see citing works
Sánchez, C. G., Díaz‐Ferrer, S., Aristizabal, J. A., Mata, J. L., & Ruiz, S. R. (2022) · Psychotherapy Research · doi:10.1080/10503307.2021.2021310 · Cited by 6 · see citing works
“Exposure to one’s own body has been shown to be effective in reducing body dissatisfaction (Knowles & Olatunji, 2019), as well as the negative emotions and feelings derived from it, in adolescents with obesity (Jansen et al., 2008) and ED risk (Díaz Ferrer et al., 2015; 2017).”
BackgroundMorriss, J., Wake, S. J., elizabeth, C., & van Reekum, C. M. (2021) · doi:10.31234/osf.io/nrqv6 · Cited by 7 · see citing works
Wong, A. H. K. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102580 · Cited by 6 · see citing works
Opdensteinen, K. D., Rach, H., Gruszka, P., Schaan, L., Adolph, D., Pané‐Farré, C. A., Benke, C., Dierolf, A. M., Schneider, S., & Hechler, T. (2023) · Pain · doi:10.1097/j.pain.0000000000003041 · Cited by 5 · see citing works
Samantaray, N. N., Mishra, A., Singh, A. R., Sudhir, P. M., & Singh, P. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.12.085 · Cited by 5 · see citing works
Graded-Modelle – eine Einführung
Matheve, T., de Baets, L., Moog, M., Hasenbring, M., & Levenig, C. (2023) · MSK – Muskuloskelettale Physiotherapie · doi:10.1055/a-2013-4773 · Cited by 6 · see citing works
“Vor diesem Hintergrund wurden Patient*innen erst dann mit einer stärker angstbe - setzten Aktivität konfrontiert, wenn sich Habituation an eine weniger angstbesetzte Aktivität eingestellt hatte [9].”
BackgroundKühne, F., Hobrecker, L. K., Heinze, P. E., Meißner, C., & Weck, F. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1328850 · Cited by 4 · see citing works
“During the last few years, case vignettes for the implementation of IL in ERP were published for the treatment of OCD patients (Craske et al., 2014; Knowles and Olatunji, 2019).”
BackgroundIntroduction to the Special Series: Clinical Applications of the Inhibitory Learning Model
Frank, B. E., & McKay, D. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.12.002 · Cited by 4 · see citing works
The impact of intolerance of uncertainty and cognitive behavioural instructions on safety learningPreprint
Wake, S. J., van Reekum, C. M., Dodd, H. F., et al. (2020) · doi:10.31234/osf.io/z5vbn · Cited by 4 · see citing works
Sauer, K. S., Bailer, J., Jungmann, S. M., & Witthöft, M. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.08.001 · Cited by 3 · see citing works
Sánchez, C. G., Cabello, J. M. J., Rodríguez‐Ruiz, S., et al. (2024) · Healthcare · doi:10.3390/healthcare12060624 · Cited by 3 · see citing works
“Self-exposure to the body has been shown to be effective in reducing BD [27] alongside the treatment of the negative emotions and feelings present derived from this exposure in people with obesity [28] or EDs [19].”
BackgroundNishikawa, Y., Fracalanza, K., Rector, N. A., & Laposa, J. M. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10322-z · Cited by 2 · see citing works
“Further, IU may interfere with treatment response (Frank & Mckay, 2019; Knowles & Olatunji, 2019; Wake et al., 2020) in a variety of ways.”
BackgroundPérez, I. M. M., Castillo, D. A. P., de la Fuente, C. P. R., & Pérez, S. E. M. (2025) · Therapeutics · doi:10.3390/therapeutics2030013 · Cited by 2 · see citing works
Mitchell, B. J., Braley, E. I., Jagannathan, N., Goodman, W. K., Storch, E. A., & Wiese, A. D. (2025) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2025-0033 · Cited by 2 · see citing works
Pimentel, S. S., & DeLapp, R. C. T. (2022) · Springer eBooks · doi:10.1007/978-3-030-99669-7_9 · Cited by 4 · see citing works
Distress variability during exposure therapy and its relationship with PTSD symptom decline
Kooistra, M. J., Hoeboer, C. M., Oprel, D. A. C., Schoorl, M., van der Does, W. A. J., van Minnen, A., & de Kleine, R. A. (2024) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2024.101983 · Cited by 2 · see citing works
A Conceptual and Empirical Review of Acceptance and Commitment Therapy for Hoarding
Krafft, J., & Ong, C. W. (2025) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2025.02.010 · Cited by 4 · see citing works
Knowles, K. A., Jessup, S. C., & Olatunji, B. O. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100777 · Cited by 2 · see citing works
Self-citationDo Exposure Therapy Processes Impact the Efficacy of Deep Tms for Obsessive-Compulsive Disorder?Preprint
Guzick, A. G., Schweissing, E. J., Tendler, A., et al. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4073316 · Cited by 2 · see citing works
Perspectives on a good death: A comparative study of veterans and civilians
Suntai, Z., Laha‐Walsh, K., & Albright, D. L. (2023) · Death Studies · doi:10.1080/07481187.2023.2219641 · Cited by 1 · see citing works
“Research suggests that such exposure may reduce the fear of death or death anxiety through a process known as “ habituation ” (Knowles & Olatunji, 2019).”
BackgroundFriedberg, R. D., Neelley, M., Lee, T., Chen, R., Xie, I. Y., Zucker, J., & Greenberger, A. (2024) · Current Psychiatry Research and Reviews · doi:10.2174/0126660822284733240229042550 · Cited by 1 · see citing works
Jessup, S. C., Mariaskin, A., & Olatunji, B. O. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23758 · Cited by 1 · see citing works
Self-citationAntifragility and Growth Through Adversity: A Scoping Review
Holton, N., Cottin, M., Wright, A., Michael, M., Antonio, D. S., & Bigliassi, M. (2026) · Psychological Reports · doi:10.1177/00332941261416041 · Cited by 4 · see citing works
Buccellato, K. H., Brown, H. N., Price, W. A., Straud, C. L., Blount, T. H., Foa, E. B., Brown, L. A., McLean, C. P., Schobitz, R. P., DeBeer, B. B., et al. (2026) · Journal of Behavioral Medicine · doi:10.1007/s10865-026-00666-2 · Cited by 1 · see citing works
Morriss, J., Rodriguez-Sobstel, C., & Steinman, S. A. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10491-z · Cited by 1 · see citing works
“…samples has important implications for understanding IU-related mechanisms and translation of experimental research to clinical therapies in general (Einstein, 2014; Shihata et al., 2016) and especially in relation to exposure-based therapies (Gee & Odriozola, 2021; Knowles & Olatunji, 2018).”
Liu, L. (2024) · Personalized Medicine in Psychiatry · doi:10.1016/j.pmip.2024.100127 · Cited by 1 · see citing works
The Role of Exposure Therapy in Accelerated Experiential Dynamic Psychotherapy: The Case of "Chris"
Yunusova, I. (2023) · Pragmatic Case Studies in Psychotherapy · doi:10.55818/pcsp.v19i2.2134 · Cited by 1 · see citing works
“Exposure-based treatments are most effective when stimuli utilized are varied and when implemented within a variety of contexts in order to facilitate generalization of learning (Blakey & Abramowitz, 2019; Craske et al., 2014; Knowles & Olatunji, 2019; Persons, 2008; Tolin, 2019).”
BackgroundA conceptual and empirical review of acceptance and commitment therapy for hoardingPreprint
Krafft, J., & Ong, C. W. (2024) · doi:10.31234/osf.io/ksz7d · Cited by 1 · see citing works
DEMİR, Ş., & BAŞ, Ö. (2022) · Batı anadolu eğitim bilimleri dergisi · doi:10.51460/baebd.1032795
Morriss, J., Rodriguez-Sobstel, C., & Steinman, S. A. (2022) · doi:10.31234/osf.io/fpjv7
Hinweise zur Arbeit am Symptom
Zarbock, G., Wilckens, P.-S., & Semmler, N. (2022) · Springer eBooks · doi:10.1007/978-3-662-62068-7_5
Approaches on Redesigning Entrepreneurship Education
Mallika Sankar, M., Sophan, A., & Kureethara, J. V. (2023) · Advances in human resources management and organizational development book series · doi:10.4018/978-1-6684-7578-2.ch004
Behavioral Conceptualizations of Obsessive-Compulsive and Related Disorders
Cassin, S. E., Regev, R., Fournier, S., & Rector, N. A. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190068752.013.10
Gamified closed-loop non-pharmacological intervention enhances tic suppression in childrenPreprint
Rotstein, M. S., Zimmerman‐Brenner, S., Davidovitch, S., Ben‐Haim, Y., Koryto, Y., Sion, R., Rubinstein, E., Djerassi, M., Lubiniaker, N., Peleg, T. P., et al. (2024) · medRxiv · doi:10.1101/2024.04.17.24303913
“Research indicates that varying the content, order of stimuli, and their context can boost exposure-based therapies 28,29 .”
BackgroundUsing Summer Camps as Opportunities to Provide Brief Interventions
Guastello, A. D., Barthle-Herrera, M. A., Downing, S. T., Mirhosseini, T., Valko, A., & McNamara, J. P. H. (2024) · CBT: science into practice · doi:10.1007/978-3-031-60746-2_8
Jamali, M., McEnroy, K., Gaudette, L. W., Baber, Z., & Stoddard, R. J. (2024) · JOSPT Cases · doi:10.2519/josptcases.2024.0034
Maternal Punitive Responses, Safety Behaviors, and Fear in Anxious Children
Conroy, H. E., Viana, A. G., Raines, E. M., Trent, E. S., Silva, K., Zvolensky, M. J., & Storch, E. A. (2024) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02915-x
“Researchers and clinicians employ SUDS ratings during exposure to measure in-the-moment distress reductions (i.e., fear downregulation) and gauge distress levels as the expectancy of negative feared outcomes shifts (Knowles & Olatunji, 2019).”
Understanding Musicians' Experience in a Virtual Reality Concert Hall Performance Simulation
Loveridge, B., Osborne, M. S., Glasser, S., & Genay, A. (2026) · Designing Interactive Systems Conference · doi:10.1145/3800645.3813039
“Such simulations support musicians to habituate to performance stress by challenging expectancies of negative evaluation and failure [14], develop mental focus, and practice recovery from mistakes in elevated pressure situations [18].”
Lewis-Fung, S. E., Geitz, V., Tchao, D., Inthiran, A., Malik, K., Gray, H. G., Gold, D. A., Bui, E., & Appel, L. (2026) · doi:10.2196/preprints.110718
- Authors
- Knowles, K. A., & Olatunji, B. O.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Knowles, Kelly A.
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 26
- Issue
- 1
- Pages
- 186-200
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC6884337
- OpenAlex
- W2789746080
- Cited by
- 60
- References
- 172
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 13 · 2023: 9 · 2022: 13 · 2021: 5 · 2020: 6 · 2019: 2 · 2018: 4
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognitive and Behavioral Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH018921)
- 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, exposure hierarchy, intolerance of uncertainty, anxiety disorders, return of fear, transdiagnostic mechanisms, fear extinction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
