Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial

Research output: Contribution to journalResearch articleContributedpeer-review


  • Andre Pittig - , Institute of Clinical Psychology and Psychotherapy, University of Würzburg (Author)
  • Ingmar Heinig - , Institute of Clinical Psychology and Psychotherapy (Author)
  • Stephan Goerigk - , Institute of Clinical Psychology and Psychotherapy, Ludwig Maximilian University of Munich (Author)
  • Freya Thiel - , Institute of Clinical Psychology and Psychotherapy (Author)
  • Katrin Hummel - , Institute of Clinical Psychology and Psychotherapy (Author)
  • Lucie Scholl - , Institute of Clinical Psychology and Psychotherapy (Author)
  • Jürgen Deckert - , University of Würzburg (Author)
  • Paul Pauli - , University of Würzburg (Author)
  • Katharina Domschke - , University of Würzburg, University of Freiburg (Author)
  • Ulrike Lueken - , University of Würzburg, Humboldt University of Berlin (Author)
  • Thomas Fydrich - , Humboldt University of Berlin (Author)
  • Lydia Fehm - , Humboldt University of Berlin (Author)
  • Jens Plag - , Charité – Universitätsmedizin Berlin (Author)
  • Andreas Ströhle - , Charité – Universitätsmedizin Berlin (Author)
  • Tilo Kircher - , University of Marburg (Author)
  • Benjamin Straube - , University of Marburg (Author)
  • Winfried Rief - , University of Marburg (Author)
  • Katja Koelkebeck - , University of Münster (Author)
  • Volker Arolt - , University of Münster (Author)
  • Udo Dannlowski - , University of Münster (Author)
  • Jürgen Margraf - , Ruhr University Bochum (Author)
  • Christina Totzeck - , Ruhr University Bochum (Author)
  • Silvia Schneider - , Ruhr University Bochum (Author)
  • Peter Neudeck - , TUD Dresden University of Technology, Protect-AD Study Site Cologne (Author)
  • Michelle G. Craske - , University of California at Los Angeles (Author)
  • Maike Hollandt - , University of Greifswald (Author)
  • Jan Richter - , University of Greifswald (Author)
  • Alfons Hamm - , University of Greifswald (Author)
  • Hans Ulrich Wittchen - , Institute of Clinical Psychology and Psychotherapy, Ludwig Maximilian University of Munich (Author)


Background: The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. Methods: This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. Results: Both treatments resulted in substantial improvements at post (PeEx-I: dwithin = 1.50, PeEx-S: dwithin = 1.78) and follow-up (PeEx-I: dwithin = 2.34; PeEx-S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TRPeEx-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. Conclusions: Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.


Original languageEnglish
Pages (from-to)1169-1181
Number of pages13
Journal Depression and anxiety
Issue number11
Publication statusPublished - Nov 2021

External IDs

PubMed 34293223
ORCID /0000-0002-7762-4327/work/141543448


Sustainable Development Goals


  • anxiety disorders, exposure therapy, intensified treatment, public health, randomized controlled trial