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What to Expect When it's Unexpected: A Multi-Theoretical Approach to Exposure Therapy

  • Author(s): Baker, Aaron S.
  • Advisor(s): Craske, Michelle G
  • et al.
Abstract

Cognitive Behavioral Therapy is the most widespread and effective intervention used for anxiety disorders. Our understanding of the underlying mechanisms is somewhat limited by divergent theories, as the most widespread theory, Emotional Processing Theory (Foa & Kozak, 1986), has not been empirically supported, and in fact, has been regularly refuted when tested. An alternative can be drawn from associative learning theory by employing the Rescorla-Wagner model (Rescorla & Wagner, 1972) to model change during exposure therapy. This model postulates that after a strong dose of exposure therapy to a target stimulus, the use of secondary exciter in conjunction with a target stimulus would allow additional learning to accrue to the target stimulus. Study 1 applied this model by treating specific phobia of spiders with a 40-minute prolonged exposure to two spiders on day one, then providing an additional day of exposure where the control group again received exposure to the two spiders, and the experimental group received exposure to one spider and worms concurrently. Results indicated that the intended manipulation was not effective at increasing expectancy due to the inclusion of worms; however, process analyses revealed a relationship of between session activation leading to better treatment outcomes. Study 2 again applied this model by inflating the outcome expectancy belief on a second day of exposure, by providing the experimental group with information about the spiders being more aggressive than usual. In a pilot sample the results were mixed as to whether the intervention was effective at increasing expectancy of an adverse event occurring, though it did provide important information about the feasibility of utilizing scripts to inflate outcome expectancy without risking inflated drop-out. While limited support was found for the model in these two studies, the large number of limitations warranted future work to be done with more acutely anxious samples. Further, future studies should look to employ more powerful forms of secondary exciters to reveal effects above and beyond the already powerful intervention.

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