Cognitive restructuring before exposure therapy or behavioral experiments? How the timing of expectancy violation and magnitude of expectancy change influence exposure therapy outcomes.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of consulting and clinical psychology Pub Date : 2025-05-01 DOI:10.1037/ccp0000953

Carly J Johnco, Melissa Norberg, Viviana M Wuthrich, Ronald M Rapee

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引用次数: 0

Abstract

Objective: Inhibitory learning models emphasize the central role of threat expectancy violation during exposure therapy. However, exposure is often implemented alongside cognitive restructuring, which reduces threat expectancies before exposure, reducing the potential for expectancy violation. This study examined whether the timing of expectancy violation (before/during exposure) and magnitude of expectancy change impact the efficacy of exposure therapy.

Method: A total of 249 adults (range 18-59 years old, M = 21.19, SD = 6.89) with elevated public speaking anxiety completed an intensive exposure session. Participants were randomly allocated to receive exposure based on (a) behavioral experiments (BE; i.e., maximizing expectancy violation and emphasizing prediction error following exposure); (b) cognitive restructuring before exposure (CR + EXP; i.e., threat expectancies reduced before exposure, thus reducing expectancy violation during exposure tasks); or (c) exposure without explicit processing of threat expectancies or expectancy violation. Change in symptoms was assessed pre-post exposure session and at 1-week follow-up.

Results: The BE and CR + EXP groups showed superior anxiety reduction (primary outcome) and threat expectancy change (secondary outcome) compared to exposure without explicit processing of threat expectancies or expectancy violation. There was a nonsignificant small effect size difference in anxiety reduction favoring BE over CR + EXP. There was greater expectancy change in the BE group compared to the CR + EXP group and shorter treatment duration. Greater threat expectancy change during exposure tasks was associated with greater anxiety reduction.

Conclusions: Threat expectancy change facilitates anxiety reduction during exposure therapy, and there may be modest advantages to challenging threat expectancies after exposure (BE) compared to before exposure (CR + EXP). (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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暴露疗法或行为实验前的认知重构？期望违反的时间和期望变化的幅度如何影响暴露治疗的结果。

目的：抑制性学习模型强调威胁期望违反在暴露治疗中的核心作用。然而，暴露通常与认知重组一起实施，这降低了暴露前的威胁预期，减少了违反预期的可能性。本研究考察了期望违反的时间（暴露前/暴露中）和期望变化的幅度是否影响暴露治疗的效果。方法：对249名公共演讲焦虑升高的成年人（年龄18-59岁，M = 21.19, SD = 6.89）进行强化暴露。参与者被随机分配接受基于(a)行为实验(BE；即，最大化期望违反并强调暴露后的预测误差)；(b)暴露前认知重构（CR + EXP）；即，在暴露前降低威胁期望，从而减少暴露任务期间的期望违反)；或(c)未明确处理威胁期望或期望违反的暴露。在接触前后和1周随访时评估症状的变化。结果：BE组和CR + EXP组在焦虑减少（主要结果）和威胁期望改变（次要结果）方面优于未显式处理威胁期望或违反期望的暴露。与CR + EXP相比，BE组在减轻焦虑方面存在不显著的小效应值差异。与CR + EXP组相比，BE组的预期变化更大，治疗时间更短。在暴露任务中，更大的威胁预期变化与更大的焦虑减少有关。结论：威胁期望的改变有助于暴露治疗期间焦虑的减少，并且与暴露前（CR + EXP）相比，暴露后挑战威胁期望（be）可能有一定的优势。（PsycInfo Database Record (c) 2025 APA，版权所有）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.