Anxiety-control strategies: Is there room for neutralization in successful exposure treatment?
Abstract
Cognitive-behavioral theory suggests that anxiety-control strategies such as neutralization, distraction and various forms of safety behavior have the potential to diminish the effectiveness of and/or interfere with exposure treatment. Yet, it is common practice when treating individuals with anxiety disorders to employ various anxiety-control strategies as a means of assisting clients/patients with difficult exposure situations. Questions surrounding the issue of which anxiety-control strategies help vs. hinder exposure-based treatments (and under which circumstances) have been a topic of much investigation and continue to be a focus of theoretical debate. The present article reviews several key studies which collectively shed some light on this debate. The evidence suggests that clients' anxiety-control strategies may be less likely to become counter-productive when: (i) they promote increases in self-efficacy, (ii) they do not demand excessive attentional resources, (iii) they enable greater approach behavior and integration of corrective information (via 'disconfirmatory experiences'), and (iv) they do not promote misattributions of safety. Theoretical and clinical implications of these findings are discussed, and future directions for research in this area are suggested.
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Previous experimental and clinical findings demonstrate that patients adopting distraction, rituals, suppression, or just getting through exposures have reduced extinction learning, thereby interfering with treatment outcome.
“Previous experimental and clinical findings demonstrate that patients adopting these approaches have reduced extinction learning, thereby interfering with treatment outcome (for review, see Parrish, Radomsky, & Dugas, 2008).”
From How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder (2017) · cites this paper as Parrish, Radomsky, & Dugas, 2008
The review reports that some demanding distractions can hinder exposure, but it rejects the claim that anxiety-control strategies generally impair treatment. In “Distraction vs. Focused Attention During Exposure” (page unavailable), it reports lasting treatment gains with conversational distraction; the Discussion (page unavailable) says some strategies may improve outcomes and treats their effects on extinction learning as speculative. (LLM, conf=0.86)
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- Authors
- Parrish, C. L., Radomsky, A. S., & Dugas, M. J.
- Affiliations
- Concordia University (CA)
- Corresponding author
- Radomsky, Adam S.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 28
- Issue
- 8
- Pages
- 1400-1412
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2032140365
- Cited by
- 73
- References
- 89
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 1 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 6 · 2013: 7 · 2012: 8
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Spectrum Research Repository (Concordia University) (acceptedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- neutralization, exposure therapy, anxiety disorders, safety behavior, distraction, self-efficacy, attentional resources, approach behavior
- MeSH terms
- Adaptation, Psychological, Anxiety Disorders, Arousal, Attention, Culture, Humans, Implosive Therapy, Internal-External Control, Phobic Disorders, Reality Testing, Cognitive Behavioral Therapy, Panic Disorder, Self Efficacy
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