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The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear

Published online by Cambridge University Press:  13 July 2018

Melissa M. Norberg Open the ORCID record for Melissa M. Norberg [Opens in a new window] ,
Amie R. Newins ,
Yan Jiang ,
Jianqiu Xu ,
Eduard Forcadell ,
Cristina Alberich  and
Brett J. Deacon
Melissa M. Norberg*
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
Amie R. Newins
Affiliation:
Department of Psychology, University of Central Florida, Orlando, FL, USA
Yan Jiang
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
Jianqiu Xu
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
Eduard Forcadell
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
Cristina Alberich
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
Brett J. Deacon
Affiliation:
Illawarra Anxiety Clinic, Mount Pleasant, NSW, Australia
*
*Correspondence to Melissa M. Norberg, Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. E-mail: melissa.norberg@mq.edu.au
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Abstract

Background: While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases. Aims: This study aimed to test the potential benefit of increasing the intensity of exposure therapy by adding an extra step that challenged uncontrollability (Step 15: allowing a spider to walk freely over one's body) to the standard fear hierarchy. Method: Fifty-one participants who had a severe fear of spiders completed two 60-min exposure sessions 1 week apart in a context that was either the same or different from the baseline and follow-up assessment context. Participants were categorized into groups based on the last hierarchy step they completed during treatment (Step 14 or fewer, or Step 15). Results: Those who completed Step 15 had greater reductions in fear and beliefs about the probability of harm from baseline to post-treatment than those who completed fewer steps. Although completing Step 15 did not prevent fear from returning after a context change, it allowed people to maintain their ability to tolerate their fear, which earlier steps did not. Despite some fear returning after a context change, individuals who completed Step 15 tended to report greater reductions in fear from baseline to the follow-up assessment than participants who completed 14 or fewer steps. Conclusions: Overall, these results suggest that more intensive exposure that directly challenges harm beliefs may lead to greater changes in fear and fear beliefs than less intensive exposure.

Keywords

exposure therapyspider phobiareturn of fearrenewalprediction errorsinhibitory learninganxiety
Type
Brief Clinical Report
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 6 , November 2018 , pp. 754 - 760
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

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