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

Research output: Contribution to journalResearch articleContributedpeer-review


  • Andre Pittig - , University of Würzburg, Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Ingmar Heinig - , Chair of Clinical Psychology an Behavioral Neuroscience, Dresden University of Technology (Author)
  • Stephan Goerigk - , Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Technical University of Munich (Author)
  • Jan Richter - , University of Greifswald, University of Hildesheim (Author)
  • Maike Hollandt - , University of Greifswald (Author)
  • Ulrike Lueken - , University of Würzburg, Humboldt University of Berlin (Author)
  • Paul Pauli - , University of Würzburg (Author)
  • Jurgen Deckert - , University of Würzburg (Author)
  • Tilo Kircher - , University of Marburg (Author)
  • Benjamin Straube - , University of Marburg (Author)
  • Peter Neudeck - (Author)
  • Katja Koelkebeck - , Munster Technological University (Author)
  • Udo Dannlowski - , Munster Technological University (Author)
  • Volker Arolt - , Munster Technological University (Author)
  • Thomas Fydrich - , Humboldt University of Berlin (Author)
  • Lydia Fehm - , Humboldt University of Berlin (Author)
  • Andreas Strohle - , Free University of Berlin (Author)
  • Christina Totzeck - , Ruhr University Bochum (Author)
  • Jurgen Margraf - , Ruhr University Bochum (Author)
  • Silvia Schneider - , Ruhr University Bochum (Author)
  • Jurgen Hoyer - , Chair of Behavioral Psychotherapy, Dresden University of Technology (Author)
  • Winfried Rief - , University of Marburg (Author)
  • Michelle G. Craske - , University of California at Irvine (Author)
  • Alfons O. Hamm - , University of Greifswald (Author)
  • Hans-Ulrich Wittchen - , Chair of Clinical Psychology and Psychotherapy, Dresden University of Technology, Technical University of Munich (Author)


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 rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low 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.


Original languageEnglish
Number of pages19
JournalClinical psychological science
Early online dateOct 2022
Publication statusPublished - 4 Oct 2022

External IDs

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


ASJC Scopus subject areas


  • Anxiety disorders, Expectancy violation, Exposure therapy, Mechanisms of change, Prediction error, Treatment outcome, expectancy violation, anxiety disorders, exposure therapy, prediction error, mechanisms of change, treatment outcome