Relapse of successfully treated anxiety and fear: Theoretical issues and recommendations for clinical practice
Open accessAbstract
Despite the existence of effective interventions for anxiety disorders, relapse--or the return of fear--presents a significant problem for patients and clinicians in the longer term. The present paper draws on the experimental and clinical behavioural literature, reviewing the mechanisms by which the return of fear can occur. The aim of the paper was to generate a list of treatment recommendations for clinicians aimed at reducing relapse in successfully treated anxiety disorders. Clinical and experimental literature on the mechanisms of renewal, reinstatement, spontaneous recovery and reacquisition are reviewed. These are linked with the clinical and experimental literature on the return of fear in successfully treated anxiety. A list of recommendations to assist in reducing the probability of relapse in successfully treated anxiety is presented. This list includes methods for use in behavioural (exposure) treatment of anxiety disorders that aim to enhance clinical outcomes. Despite the significant problem of relapse in successfully treated anxiety, there are methods available to reduce the probability of relapse through return of fear. Clinicians engaging in treatment of anxiety disorders should be mindful of these methods to ensure optimal patient outcome.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Principles of associative threat and safety learning underscore modern therapies such as exposure therapy.
“Importantly, principles of associative threat and safety learning underscore modern therapies such as exposure therapy (9).”
From I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training (2021) · cites this paper as [9]
After exposure therapy completion, many patients experience a return of anxiety symptoms.
“However, after exposure therapy completion, many patients experience a return of anxiety symptoms (9,12).”
From I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training (2021) · cites this paper as [9]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 81 · Cited by 145
Research works printed but not linked: 12
- Andrews G, Creamer M, Crino R, Hunt C, Lampe L, Page A. The Treatment of Anxiety Disorders. 2nd ed. Cambridge: Cambridge University Press, 2003.
- Davey GCL. "Non-specific" rather than "non-associative" pathways to phobias: A commentary on Poulton & Menzies. Behav Res Ther 2002; 40:151-158.
- Pitman RL, Shalev AY, Orr SP. Posttraumatic stress disorder: emotion, conditioning, and memory. In: Gazzaniga MS, ed. The new cognitive neurosciences 2nd ed. Cambridge, MA: MIT Press, 2000: 1133-1147.
- Dawson ME, Schell AM. Information processing and human autonomic classical conditioning. Adv Psychophysiol 1985; 1:89-165.
- Barlow DH, Raffa SD, Cohen EM. Psychosocial treatments for panic disorders, phobias and generalized anxiety disorder. In: Nathan PE, Gorman JM, eds. A guide to treatments that work. 2nd ed. New York: Oxford University Press, 2002: 301-335.
- Franklin ME, Foa EB. Cognitive behavioural treatments for obsessive compulsive disorder. In Nathan PE, Gorman JM, eds. A guide to treatments that work. 2nd ed. New York: Oxford University Press, 2002: 367-386.
- Emmelkamp PMG. Behaviour therapy with adults. In Bergin AE, Garfield SL, eds. Handbook of psychotherapy and behaviour change, 5th ed. New York: Wiley, 2004: 393-446.
- Bouton ME. Context and behavioral processes in extinction. Learn Mem 2004; 11:485-494.
- Gunther LM, Denniston JC, Miller RR. Conducting exposure techniques in multiple settings can prevent relapse. Behav Res Ther 1998; 36:75-91.
- Pavlov I. Conditioned Reflexes. New York: Oxford University Press, 1927
- Agras S. An investigation of decrements of anxiety responses during systematic desensitization. Behav Res Ther 1965; 2:267-270.
- Dennitson JC, Chang RC, Miller RR. Massive extinction treatment attenuates the renewal effect. Learn Motiv 2003; 34:68-86.
- Authors
- Boschen, M. J., Neumann, D. L., & Waters, A. M.
- Affiliations
- Griffith University (AU)
- Corresponding author
- Boschen, Mark J.
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2009-01-01
- Volume
- 43
- Issue
- 2
- Pages
- 89-100
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W2120637420
- Cited by
- 145
- References
- 81
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 8 · 2023: 6 · 2022: 4 · 2021: 12 · 2020: 10 · 2019: 8 · 2018: 13 · 2017: 9 · 2016: 8 · 2015: 15 · 2014: 7 · 2013: 5 · 2012: 11
- FWCI
- 1.09
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- 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 › Psychological Treatments and Assessments
- Keywords
- relapse, anxiety disorders, return of fear, reinstatement, renewal, spontaneous recovery, reacquisition, exposure therapy, behavioral interventions, treatment guidelines, fear conditioning
- MeSH terms
- Anxiety Disorders, Fear, Humans, Practice Patterns, Physicians', Psychological Theory, Recurrence, Cognitive Behavioral Therapy, Treatment Outcome, Practice Guidelines as Topic
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.
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
