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Mechanisms of Action in Exposure Therapy

  • Anxiety Disorders (L Brown, Section Editor)
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Abstract

Purpose of Review

Exposure therapy is an effective treatment for anxiety-related disorders, but many individuals do not achieve full symptom relief, and return of fear is a common occurrence. Understanding how exposure therapy works enables further development of strategies to improve its effectiveness.

Recent Findings

Recent studies have examined mechanisms of exposure-based interventions across multiple levels of analysis, from cognitive and behavioral changes that occur during treatment to the neurobiological mechanisms underlying fear extinction.

Summary

Belief change and reductions in safety behaviors and avoidance mediate symptom improvements during exposure therapy, suggesting plausible cognitive and behavioral mechanisms. On the neural level, increased activation of prefrontal regions during extinction learning is a likely mechanism of exposure. Improved understanding of the biological mechanisms of exposure have led to exciting developments in clinical research, including pharmacological augmentation, though clinical translation of basic research has produced mixed results. Though still in development, such translational research is a promising future direction for exposure-based interventions.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA

    Kelly A. Knowles & David F. Tolin

  2. Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA

    David F. Tolin

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Knowles, K.A., Tolin, D.F. Mechanisms of Action in Exposure Therapy. Curr Psychiatry Rep 24, 861–869 (2022). https://doi.org/10.1007/s11920-022-01391-8

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