Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung


  • Andre Pittig - , Julius-Maximilians-Universität Würzburg, Friedrich-Alexander-Universität Erlangen-Nürnberg (Autor:in)
  • Ingmar Heinig - , Institut für Klinische Psychologie und Psychotherapie (Autor:in)
  • Stephan Goerigk - , Institut für Klinische Psychologie und Psychotherapie, Technische Universität München (Autor:in)
  • Jan Richter - , Ernst-Moritz-Arndt-Universität Greifswald, University of Hildesheim (Autor:in)
  • Maike Hollandt - , Ernst-Moritz-Arndt-Universität Greifswald (Autor:in)
  • Ulrike Lueken - , Julius-Maximilians-Universität Würzburg, Humboldt-Universität zu Berlin (Autor:in)
  • Paul Pauli - , Julius-Maximilians-Universität Würzburg (Autor:in)
  • Jürgen Deckert - , Julius-Maximilians-Universität Würzburg (Autor:in)
  • Tilo Kircher - , Philipps-Universität Marburg (Autor:in)
  • Benjamin Straube - , Philipps-Universität Marburg (Autor:in)
  • Peter Neudeck - , Protect-AD Study Site Cologne (Autor:in)
  • Katja Koelkebeck - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Udo Dannlowski - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Volker Arolt - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Thomas Fydrich - , Humboldt-Universität zu Berlin (Autor:in)
  • Lydia Fehm - , Humboldt-Universität zu Berlin (Autor:in)
  • Andreas Strohle - , Charité – Universitätsmedizin Berlin (Autor:in)
  • Christina Totzeck - , Ruhr-Universität Bochum (Autor:in)
  • Jürgen Margraf - , Ruhr-Universität Bochum (Autor:in)
  • Silvia Schneider - , Ruhr-Universität Bochum (Autor:in)
  • Jürgen Hoyer - , Professur für Behaviorale Psychotherapie (Autor:in)
  • Winfried Rief - , Philipps-Universität Marburg (Autor:in)
  • Michelle G. Craske - , University of California at Irvine (Autor:in)
  • Alfons O. Hamm - , Ernst-Moritz-Arndt-Universität Greifswald (Autor:in)
  • Hans-Ulrich Wittchen - , Professur für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Technische Universität München (Autor:in)


Individual responses to behavioral treatment of anxiety disorders vary considerably, which requires a better understanding
of underlying processes. In this study, we examined the violation and change of threat beliefs during exposure. From
8,484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived:
expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy
change as difference between original and adjusted expectancy after exposure, and prediction-error learning rateas extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy butlow occurrence and adjusted expectancy indicated successful violation and change of threat beliefs by exposure.Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic
mechanism underlying successful exposure therapy.


Seiten (von - bis)199-217
FachzeitschriftClinical psychological science
Frühes Online-Datum4 Okt. 2022
PublikationsstatusVeröffentlicht - März 2023

Externe IDs

Scopus 85139437438
Mendeley bdceb879-1b4f-398c-a591-b772576e8357
ORCID /0000-0002-7762-4327/work/141543452
ORCID /0000-0002-1697-6732/work/148632185


ASJC Scopus Sachgebiete


  • exposure therapy\ndissemination\nanxiety disorders\nposttraumatic stress disorder\nobsessive-compulsive disorder, anxiety disorders, prediction error, expectancy violation, treatment outcome, mechanisms of change