Joy beyond fear: Positive emotions after exposure in patients with anxiety disorders and their link to threat expectancy and treatment outcome

Research output: Contribution to journal › Research article › Contributed › peer-review

Contributors

  • Thomas Borchert - , University of Göttingen (Author)
  • Ingmar Heinig - , Chair of Clinical Psychology and Behavioral Neuroscience (Author)
  • Volker Arolt - , University of Münster (Author)
  • Christina Bartnick - , Ruhr University Bochum (Author)
  • Udo Dannlowski - , University of Münster, Bielefeld University (Author)
  • Jürgen Deckert - , University of Würzburg (Author)
  • Katharina Domschke - , University Medical Center Freiburg, German Center for Mental Health (DZPG) (Author)
  • Thomas Fydrich - , Humboldt University of Berlin (Author)
  • Stephan Goerigk - , Ludwig Maximilian University of Munich, Fresenius University of Applied Sciences Idstein (Author)
  • Alfons O. Hamm - , University of Greifswald (Author)
  • Maike Hollandt - , University of Greifswald (Author)
  • Jürgen Hoyer - , Chair of Behavioral Psychotherapy (Author)
  • Tilo Kircher - , University of Marburg (Author)
  • Katja Koelkebeck - , Bielefeld University (Author)
  • Ulrike Lueken - , Humboldt University of Berlin, German Center for Mental Health (DZPG) (Author)
  • Jürgen Margraf - , Ruhr University Bochum (Author)
  • Peter Neudeck - , Prof. Dr. Peter Neudeck's Practice at the Volksgarten, Chemnitz University of Technology (Author)
  • Paul Pauli - , University of Würzburg (Author)
  • Jan Richter - , University of Greifswald, University of Hildesheim (Author)
  • Winfried Rief - , University of Marburg (Author)
  • Silvia Schneider - , Ruhr University Bochum (Author)
  • Benjamin Straube - , University of Marburg (Author)
  • Andreas Ströhle - , Charité – Universitätsmedizin Berlin (Author)
  • Hans Ulrich Wittchen - , Ludwig Maximilian University of Munich (Author)
  • Andre Pittig - , University of Göttingen (Author)

Abstract

Exposure-based CBT is effective in treating anxiety disorders, but individual responses vary substantially, underlining the need to identify and boost mechanisms underlying exposure. In this study, the role of positive emotions occurring after exposure was examined. In an analysis of 8416 exposure records of 648 anxiety patients undergoing exposure therapy, the degree of positive emotions hope and joy occurring after exposure exercises, their predictors, and their role regarding treatment success were investigated. Positive emotions after exposure were medium to high and increased slightly across repeated exposure exercises. They were associated with exposure-related learning indicators (i.e., expectancy violation and change as well as the prediction-error learning rate) and were mainly predicted by adjusted threat expectancy assessed after completing exposure, controlling for baseline depressive symptoms and affect. Higher positive emotions independently predicted better treatment outcome beyond learning indicators, and partially mediated the association between learning indicators and treatment outcome. These findings indicate that positive emotions are partly associated with successful learning during exposure but seem to have a unique contribution to overall treatment success, underlining the need to strengthen positive emotions via different possible means.

Details

Original languageEnglish
Article number104880
Journal Behaviour research and therapy
Volume195
Publication statusPublished - Dec 2025
Peer-reviewedYes

External IDs

PubMed 41086598
ORCID /0000-0002-1697-6732/work/219264972
ORCID /0000-0002-7762-4327/work/219266691

Keywords

Sustainable Development Goals

Keywords

  • Anxiety disorders, Expectancy violation, Exposure therapy, Hope, Joy, Positive emotions