Same same but different: Threat expectancy change and fear reduction as readouts of exposure rationales are only weakly associated and contribute differentially to treatment outcome in anxiety disorders

Publikation: Beitrag in Fachzeitschrift › Forschungsartikel › Beigetragen › Begutachtung

Beitragende

  • Sophie Thaon de Saint André - , Georg-August-Universität Göttingen (Autor:in)
  • Ingmar Heinig - , Professur für Klinische Psychologie und Behaviorale Neurowissenschaft (Autor:in)
  • Volker Arolt - , Westfälische Wilhelms-Universität Münster (Autor:in)
  • Christina Bartnick - , Ruhr-Universität Bochum (Autor:in)
  • Udo Dannlowski - , Westfälische Wilhelms-Universität Münster, Universität Bielefeld (Autor:in)
  • Jürgen Deckert - , Julius-Maximilians-Universität Würzburg (Autor:in)
  • Katharina Domschke - , Universitätsklinikum Freiburg, Deutsches Zentrum für Psychische Gesundheit (DZPG) (Autor:in)
  • Thomas Fydrich - , Humboldt-Universität zu Berlin (Autor:in)
  • Stephan Goerigk - , Ludwig-Maximilians-Universität München (LMU), Hochschule Fresenius gGmbH Idstein (Autor:in)
  • Alfons O. Hamm - , Ernst-Moritz-Arndt-Universität Greifswald (Autor:in)
  • Maike Hollandt - , Ernst-Moritz-Arndt-Universität Greifswald (Autor:in)
  • Jürgen Hoyer - , Professur für Behaviorale Psychotherapie (Autor:in)
  • Tilo Kircher - , Philipps-Universität Marburg (Autor:in)
  • Katja Koelkebeck - , Universität Bielefeld (Autor:in)
  • Ulrike Lueken - , Deutsches Zentrum für Psychische Gesundheit (DZPG) , Humboldt-Universität zu Berlin (Autor:in)
  • Jürgen Margraf - , Ruhr-Universität Bochum (Autor:in)
  • Peter Neudeck - , Prof. Dr. Peter Neudeck - Praxis am Volksgarten, Technische Universität Chemnitz (Autor:in)
  • Paul Pauli - , Julius-Maximilians-Universität Würzburg (Autor:in)
  • Jan Richter - , Ernst-Moritz-Arndt-Universität Greifswald, Stiftung Universität Hildesheim (Autor:in)
  • Winfried Rief - , Philipps-Universität Marburg (Autor:in)
  • Silvia Schneider - , Ruhr-Universität Bochum (Autor:in)
  • Benjamin Straube - , Philipps-Universität Marburg (Autor:in)
  • Andreas Ströhle - , Charité – Universitätsmedizin Berlin (Autor:in)
  • Hans Ulrich Wittchen - , Ludwig-Maximilians-Universität München (LMU) (Autor:in)
  • Andre Pittig - , Georg-August-Universität Göttingen (Autor:in)

Abstract

Responses to exposure therapy vary across individuals, emphasizing the need for a deeper understanding of its underlying mechanisms. This study examined two key processes during exposure that serve as readouts of different clinical rationales: (1) within-session fear reduction (measured as the decline from peak to end fear within an exposure exercise) and (2) threat expectancy processes (assessed via expectancy violation, expectancy change, and learning rate). Data from 516 patients with anxiety disorders who completed at least 10 exposure exercises in a clinical trial were analyzed. Results showed that expectancy measures and fear reduction were only weakly correlated within exposure exercises. While no significant differences were found in their time courses, both readouts independently predicted treatment success. Specifically, a higher learning rate and greater relative fear reduction were associated with better outcomes. These findings highlight the clinical relevance of monitoring fear reduction and expectancy-related readouts as indicators of two distinct exposure rationales — the fear reduction rationale and the threat expectancy rationale. Although it remains unclear whether they reflect separate mechanisms of change or different aspects of a shared mechanism, addressing both rationales may help optimize and personalize exposure therapy.

Details

OriginalspracheEnglisch
Aufsatznummer104856
Fachzeitschrift Behaviour research and therapy
Jahrgang194
PublikationsstatusVeröffentlicht - Nov. 2025
Peer-Review-StatusJa

Externe IDs

PubMed 41067133
ORCID /0000-0002-1697-6732/work/219264975
ORCID /0000-0002-7762-4327/work/219266693

Schlagworte

Ziele für nachhaltige Entwicklung

ASJC Scopus Sachgebiete

Schlagwörter

  • Anxiety disorders, Expectancy change, Expectancy violation, Exposure rationale, Fear reduction