Does the way exposure exercises are presented matter? Comparing fear reduction versus fear toleration models

Exposure therapy is considered to be a first line treatment for a variety of anxiety disorders as supported by several review studies. However, there is no clear understanding of how it works. The present study examined how framing exposure exercises impacted outcomes in socially anxious individuals. We conducted a brief two-session exposure-based intervention, including experiential exercises from each therapeutic rationale, with homework assigned between sessions. We were specifically interested in the efficacy of four brief skills interventions: (a) fear reduction, (b) psychological flexibility, (c) values rationale, and (d) control for reducing public speaking anxiety from first to second exposure session. By combining participants at Utah State University and the University of Colorado Boulder, 81 individuals were randomized to participate in the study. Consistent with our prediction, individuals receiving an active intervention improved to a greater extent on major outcome measures of social anxiety compared to the control group. No significant differences were found between active interventions. Results showed no significant group differences in SUDs change at session 1 or session 2. Additionally, at session 1 those who received an active intervention displayed more within-session exposure engagement than individuals in the control condition. Importantly, there was no difference in between-session exposure engagement (number of exposures attempted) between groups. Overall, the results from this study suggest that there may not be one right way to implement exposure. Furthermore, there may be an overarching mechanism by which exposure works.