The efficacy of exposure-based cognitive behavioral therapy (eCBT) for panic disorder and agoraphobia (PD/AG) is well established, but the mechanisms of action are still under debate. Here we investigated whether increased fear activation (by provoking additional bodily symptoms using interoceptive challenges) during exposure to agoraphobic situations would improve therapy outcome. Individuals diagnosed with PD/AG (N = 124) were randomized to one of the two variants of eCBT, with (exposure plus fear activation; E + FA) and without (exposure alone; E) guided evocation of unpleasant body symptoms (using additional interoceptive exposure exercises) and/or threat cognitions (expectations of potential threats that might occur during exposure). Primary outcome measures were assessed at baseline, post treatment, and at four-month follow-up. Reported fear and perceived likelihood of expected threat were assessed as moderators prior to, during, and after exposure sessions using ecological momentary assessment. Post treatment, E + FA was inferior to E in two of four primary outcome measures. At the follow-up assessment, both treatment variants were equally effective in all outcomes. In conclusion, increasing fear activation by explicitly activating the response units of the fear network did not result in better treatment outcome, questioning popular recommendations to maximize patient fear during eCBT - at least for patients with PD/AG.
Keywords: Agoraphobia, Emotional processing theory, Exposure based cognitive behavioral therapy, Inhibitory learning, Interoceptive exposure, Panic disorder
Behaviour research and therapy
Journal Article
English
41539132
Guideline Central and select third party use “cookies” on this website to enhance the user experience.
This technology helps us gather statistical and analytical information to optimize the relevant content for you.
The user also has the option to opt-out which may have an effect on the browsing experience.