Improved exposure therapy key to overcoming fears and phobias, psychologist says

A new approach to programs to combat fears and phobias will increase their effectiveness over the long term, according to research being presented at the 47th Australian Psychological Society Annual Conference in Perth.

Repeated controlled exposure to the source of a fear, known as exposure therapy, is best-practice treatment for anxiety disorders; yet 50 per cent of people won’t respond. 

Elimination of fear relies on people’s ability to lay down new “safety” memories, which override old fear memories, thus inhibiting the emotional response to the source of their fear.

Michelle G. Craske, Professor of Psychology and of Psychiatry and Biobehavioural Sciences, and Director of the Anxiety Disorders Research Centre at the University of California, Los Angeles (UCLA), says people with anxiety disorders have trouble retaining new, more positive experiences relating to  the source of their fear.

“If someone feared a spider, you could help them to overcome their fear by showing them the spider a number of times, and realising that it didn’t harm them during these exposures would reduce their fear,” Professor Craske says. 

“But we now know that while some people might respond well to that exposure, for many their fear would arise again later because they have difficulty laying down new safety memories and retaining that knowledge that the spider isn’t harmful.”

She said therefore that approaches to exposure therapy must be modified.

She said: “Current emphases are on how we teach people to be less afraid in the moment. But our research has shown that the amount by which fear decreases in the moment is not an indicator of how fear will decrease in the longer term.”

Professor Craske will provide the latest evidence from UCLA’s Anxiety Disorders Research Centre for a number of strategies to improve inhibitory, safety learning during exposure therapy, including: continuing in a feared situation beyond the point of expected tolerance, exposure to multiple feared cues separately and then simultaneously, variability in the feared stimulus during exposure tasks, and affect labelling or verbalisation of current emotional experiences.

These strategies depart from traditional exposure therapy models of repeated, sustained exposure to feared stimuli until fear is lessened.  “The focus is on enhancing safety learning, independent of fear reduction, to achieve better long-term results,” says Professor Craske. “Strategies such as varying exposure exercises may make the experience more difficult, but research has found that with greater variability in learning, there is greater retention in the long run.”

These strategies suggest a significant shift away from fear reduction through exposure therapy as the primary measure of successful outcomes, to enhancement of safety learning independent of fear reduction.

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Professor Michelle G. Craske is Professor of Psychology and of Psychiatry and Biobehavioural Sciences, and Director of the Anxiety Research Centre, at UCLA.  She has published extensively in the area of fear and anxiety disorders, including over 300 scientific articles, four books on the topics of aetiology and treatment of anxiety disorders, gender differences in anxiety, translation from the basic science of fear learning to treating phobias and anxiety disorder, and principles of practice of cognitive behavioural therapy, as well as several self-help books and therapist guides.

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