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Cited by 237Memory and Neural MechanismsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPosttraumatic Stress Disorder Research

Role of inhibition in exposure therapy

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Craske, Michelle G., Liao, Betty, Brown, Lily, Vervliet, Bram·2012·Journal of Experimental Psychopathology
DOI 10.5127/jep.026511
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Abstract

While many researchers have largely focused on principles of systematic desensitization and habituation in explaining fear extinction, these processes have mixed evidence at best. In particular, these models do not account for spontaneous recovery or reinstatement of fear, nor do they explain the context dependency of extinction or rapid reacquisition. This may in part account for the significant number of patients who fail to respond to our available treatments which rely on these principles in designing exposure sessions. However, recent research is converging to suggest that an inhibitory model of fear reduction, in which the original feared association (CS-US) remains but is inhibited by a newly formed association (CS-noUS) representing safety, holds promise in explaining the long-term attenuation of fear and anxiety. This paper reviews research in a number of areas, including neuroimaging, psychophysiology, and psychopharmacology that all provide support for the inhibition model of anxiety. Limitations to this body of research are discussed, along with recommendations for future research and suggestions for improving exposure therapy for fear and anxiety disorders. Clinical implications discussed in this paper include incorporating random and variable practice in exposure sessions, multiple contexts, and pharmacological aides, among others.

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  • Variability in fear levels, which includes periods of elevated fear, is a positive predictor of outcome.

    “Although peak fear levels during exposure do not consistently predict outcomes (Craske et al., 2008), variability in fear levels, which includes periods of elevated fear, is a positive predictor of outcome (see Craske, Liao, Brown, & Vervliet, 2012; for a review).”

    From Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia (2013) · cites this paper as Craske, Liao, Brown, & Vervliet, 2012

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Authors
Craske, M. G., Liao, B., Brown, L., & Vervliet, B.
Affiliations
  • University of California, Los Angeles (US)
  • KU Leuven (BE)
ORCID
Venue
Journal of Experimental Psychopathology
Publisher
SAGE Publications
Published
2012-07
Volume
3
Issue
3
Pages
322-345
ISSN
2043-8087 (ISSN-L)
DOI
10.5127/jep.026511
OpenAlex
W2074846402
Cited by
237
References
168
Citations by year
2026: 14 · 2025: 14 · 2024: 17 · 2023: 15 · 2022: 19 · 2021: 36 · 2020: 15 · 2019: 18 · 2018: 17 · 2017: 13 · 2016: 14 · 2015: 19 · 2014: 12 · 2013: 10 · 2012: 4
FWCI
7.38
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Experimental Psychopathology (publishedVersion)
  • Lirias (submittedVersion)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
exposure therapy, fear extinction, inhibitory conditioning, safety signals, spontaneous recovery, context sensitivity, anxiety disorders, fear and anxiety, variable practice

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