Pathways to change in one-session exposure with and without cognitive intervention: An exploratory study in spider phobia

Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: A systematic review.

“…Interestingly, 6 studies (24%) involved the manipulation of CBT in their design and analysis, but failed to demonstrate that CBT caused threat reappraisal (Hoffart, 1995; Hoffart, Borge, Sexton, H., & Clark, D. (2009); Hofmann et al, 2007; McManus, Clark, & Hackman, 2000; Meuret et al, 2010; Raes, Koster, Loeys, & DeRaedt, 2011). In each of these studies, threat appraisal did change with treatment but did not differ between CBT and a credible comparison condition (e.g., pharmacotherapy, stress management, interpersonal therapy, breathing retraining), thus making it impossible to rule the possibility that this change was due to time or some other third variable (not involving CBT or treatment).…”

Conquer your cravings

“…Our findings contrast the recommendations made by Craske et al (2014), who propose that exposure sessions aimed at violation of expectancies yield better treatment outcomes than exposure sessions aimed at habituation. However, the current findings do fit with an exposure study in spider phobics in which exposure explicitly aimed at the challenging of dysfunctional cognitions led to similar treatment effects and cognitive alterations compared to an exposure condition that was purely behavioral (Raes, Koster, Loeys, & De Raedt, 2011). Still, in the spider phobics study, cognitive change was a mediator for treatment outcome, whereas a change in expectancies was not associated with intake in the present study, though the absolute belief in the expectancies was (less belief associated with less intake).…”

“…The same was found in an experiment in spider phobics, in which explicitly targeting maladaptive cognition did not have added benefit as compared to a purely behavioural treatment (Raes, Koster, Loeys, & De Raedt, 2011). Interestingly, the change in maladaptive cognitions in both conditions was again found to mediate the improvement in self-related and spider-related fears (Raes et al, 2011). These latter findings are generally in line with the findings in this dissertation: the food cue exposure condition aimed at expectancy violation in chapter 6 did not lead to less intake than the food cue exposure condition aimed at habituation of eating desires, while reduction of expectancies after therapy was equally strong in both exposure conditions.…”

“…In addition to the similar effects in both conditions on behavioural and phobic symptoms, both conditions experienced an equal change in cognitions and needed an equal duration of exposure (i.e., the number of minutes required to achieve the behavioural target of contact with the animal) to achieve these effects (Koch et al, 2004). The same was found in an experiment in spider phobics, in which explicitly targeting maladaptive cognition did not have added benefit as compared to a purely behavioural treatment (Raes, Koster, Loeys, & De Raedt, 2011). Interestingly, the change in maladaptive cognitions in both conditions was again found to mediate the improvement in self-related and spider-related fears (Raes et al, 2011).…”

Cognitive Restructuring

“…A recent study of one session exposure versus CBT-based exposure for spider phobia revealed that change in maladaptive cognitions mediated posttreatment and follow-up reductions in self-report phobic symptoms (Raes, Koster, Loeys, & De Raedt, 2011). Finally, a systematic review of CBT studies of anxiety disorders concluded that change in threat reappraisal has a causal effect on reduction in anxious symptoms, although it was not possible to support the stronger position that threat reappraisal is responsible for the efficacy of CBT (Smits, Julian, Rosenfield, & Powers, 2012).…”