The Scarier The Better: Maximizing Exposure Therapy Outcomes for Spider Fear
What was the aim of the research?
Exposure therapy is the gold-standard treatment for overcoming phobias, including a fear of spiders. Although exposure therapy effectively reduces anxiety, some individuals experience less benefit during treatment and others may experience a return in fear after treatment ceases.
The aim of this study was to test the Rescorla and Wagner (1972) model. This model assumes that greater discrepancies between what one thinks will occur and what actually occurs will lead to greater fear extinction. We did this by adding an extra, more challenging step to the fear hierarchy (a 15th step). This step involved allowing a spider to freely crawl all over one’s body.
How did we do it?
51 people who had a severe fear of spiders completed 2 x 60 minute exposure session with a Golden Orb spider 1 week apart. Prior to beginning the fear hierarchy, participants identified their worst-case scenario beliefs. These beliefs involved “freaking out,” “getting hurt,” or “dying” as a result of a spider crawling on them. Participants were then told that exposure to a spider would allow them to test out their “worst-case scenario” beliefs. During each step of the fear hierarchy, participants were advised to focus on their reaction to the spider and to reflect on whether they were tolerating these reactions. Participants moved on to the next most difficult step of the fear hierarchy once they reported that there was nothing else they could learn about their worst-case scenario beliefs from the particular step that they were currently completing.
What did we find?
By the end of the second exposure session, 17 of the 51 participants stopped at or before Step 14, whereas 34 of the 51 participants completed Step 15. As predicted, participants who completed Step 15 had greater reductions in their fear than those who terminated the fear hierarchy at an earlier step. Additionally, those who completed Step 15 also reported much greater reductions in the probability of their worst-case scenarios coming true if a spider were to crawl on them in the future.
Despite these impressive gains immediately post-treatment, completing Step 15 did not prevent individuals from experiencing a slight return of fear after treatment from moving into a new context. However, Step 15 did allow people to maintain their ability to tolerate their fear reactions after moving into a new context, whereas people who stopped exposure at Step 14 or earlier lost some of their ability to tolerate their negative reactions to the spider.
Therefore, the primary benefit of a completing exposure tasks that more directly challenge one’s fear beliefs appears to be in reducing harmful beliefs and in improving tolerance for difficult situations.
What does this mean in practice?
Many therapists do not deliver exposure therapy and other therapists will only deliver imaginal exposure (Hipol & Deacon, 2012). This is often due to not having been trained in how to deliver exposure and/or believing that clients cannot tolerate the experience (Deacon et al., 2013). This study shows that clients cannot only tolerate exposure therapy, but their ability to tolerate distress improves because of it. We recommend that anyone who feels uncomfortable delivering exposure therapy seek out training from a qualified specialist.
Citation: Norberg, M. M; Newins, A., Jiang, Y., Xu, J., Foracell, E., Alberich, C., & Deacon, B. (2018) The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear, Behavioural and Cognitive Psychotherapy, July, https://doi.org/10.1017/S1352465818000437
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Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R., & McGrath, P. B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27(8), 772-780. doi:10.1016/j.janxdis.2013.04.006
Hipol, L. J., & Deacon, B. J. (2012). Dissemination of evidence-based practices for anxiety disorders in Wyoming: A survey of practicing psychotherapists. Behavior Modification, 37, 170-188. doi:10.1177/0145445512458794
Rescorla, R. A., & Wagner, A. R. (1972). A theory of Pavlovian conditioning: Variations in the effectiveness of reinforcement and non-reinforcement. In A. H. Black & W. F. Prokasy (Eds.), Classical Conditioning II: Current Research and Theory. New York: Appleton-Century-Crofts.