Does fear reactivity during exposure predict panic symptom reduction?
Open accessAbstract
OBJECTIVE: Fear reactivity during exposure is a commonly used indicator of learning and overall therapy outcome. The objective of this study was to assess the predictive value of fear reactivity during exposure using multimodal indicators and an advanced analytical design. We also investigated the degree to which treatment condition (cognitive training vs. respiratory skill training) moderated fear reactivity and therapeutic outcome. METHOD: Thirty-four patients with panic disorder and agoraphobia completed a total of 123 in-vivo exposure sessions, comprising 3 weekly sessions and a 4th session 2 months following therapy completion. Sessions varied in length and phobic stimuli. Cardiorespiratory physiology (heart rate, carbon dioxide partial pressure [PCO2], respiration rate) and experiential symptoms (panic symptoms and anxiety) were assessed repeatedly throughout exposure sessions, in addition to weekly assessments of panic cognitions, avoidance, and functioning. RESULTS: Panic symptomatology decreased substantially in both treatment conditions during therapy and follow-up. Significant cardiorespiratory and experiential reactivity was observed during all exposures, characterized by activation followed by reduction. Greater within-session activation of anxiety and panic symptoms was inversely related to improvement in panic symptoms severity, but neither physiological activation nor within- or between-session reduction of either physiological or experiential variables was predictive of outcome. No moderating effects of treatment condition were found. CONCLUSIONS: Fear activation and reduction during exposure are weak predictors of corrective learning and fear extinction. Clinical implications for exposure therapy and directions for future research are discussed.
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In a study of in vivo exposure for panic disorder and agoraphobia, neither within-session nor between-session habituation indicated better outcomes.
“A recent study by Meuret et al. (2012) examined both within- and between-session habituation during in vivo exposures for individuals with panic disorder and agoraphobia. Results showed that neither within-session or between-session habituation indicated better outcomes (Meuret, Seidel, Rosenfield, Hofmann, & Rosenfield, 2012).”
From Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD (2014) · cites this paper as Meuret et al. (2012)
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- Authors
- Meuret, A. E., Seidel, A., Rosenfield, B., Hofmann, S. G., & Rosenfield, D.
- Affiliations
- Southern Methodist University (US)
- University of Minnesota (US)
- Boston University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2012
- Volume
- 80
- Issue
- 5
- Pages
- 773-785
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3404244
- OpenAlex
- W2012297178
- Cited by
- 67
- References
- 79
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 2 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 7 · 2015: 4 · 2014: 7 · 2013: 5 · 2012: 1
- FWCI
- 7.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01HL089761-01A1)
- Beth and Russell Siegelman Foundation
- National Institute of Mental Health Health (MH079236)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- fear reactivity, exposure therapy, panic disorder, agoraphobia, treatment outcome prediction, fear extinction, cognitive training, panic symptoms, anxiety, avoidance, phobic stimuli
- MeSH terms
- Adult, Agoraphobia, Fear, Female, Humans, Implosive Therapy, Male, Middle Aged, Predictive Value of Tests, Panic Disorder, Treatment Outcome
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