Great interest exists in maximizing exposure therapy efficacy in anxiety disorders. At the same time, reduced frequency and shortened duration of exposure sessions are required to meet the specific regularities in routine care settings. extinction has emerged as the key mechanism of exposure treatment in anxiety disorders. examining exposure treatment processes from the perspective of extinction learning might provide novel insights into variability in exposure treatment duration and outcome. the present study sought to examine the functional link between fear extinction, the ability to accomplish exposure in a predetermined time and exposure therapy outcome in specific phobia. treatment-seeking individuals (N = 53) with spider phobia underwent a context-dependent fear conditioning paradigm prior to a standardized exposure. Spider-phobic participants who were able to complete exposure within the pre-determined time (i.e., completers) showed a more pronounced shortand long-term exposure therapy benefit. In the fear conditioning task, a more pronounced decline in CS-US contingency ratings during extinction (retrieval) was found in completers relative to noncompleters. The failure to further extinguish US expectancy to the CSs in non-completers might offer a potential mechanistic explanation why non-completers have difficulties to accomplish all exposure steps in a fixed time and show less pronounced treatment gains. Our findings bear specific implications for the implementation of exposure treatment to routine care settings.Exposure is considered as the treatment of choice for anxiety disorders. Exposure therapy is aimed at helping patients to overcome their anxiety by creating a safe environment, in which they are repeatedly and systematically exposed to feared or avoided scenarios, leading to decreases of fear 1,2 . Despite its effectiveness, some patients show no or only a partial remission of symptoms or experience a recovery of symptoms after treatment 3 . Likewise, some patients exhibit a delayed therapeutic benefit, requiring an extended treatment duration and frequency 4 . This, however, is at odds with the organizational and economic demands in routine care, which requires efficient time schedules and reduction of treatment-associated costs 5 . The frequency and duration of exposure sessions thus needs to be adapted to the specific regularities in routine care settings (e.g. see 6 ). The identification of new pathways to improve exposure treatment efficacy while at the same time decreasing barriers to transfer exposure treatment to routine care would be highly desirable 7 . So far, only little is known about mechanisms contributing to treatment duration and short-and long-term treatment outcome.Extinction has emerged as a central candidate for the main process underlying exposure 8 . Consequently, research on the cognitive and neurobiological foundations of extinction as the laboratory analog of exposure might pave the way to understand and improve exposure treatment efficacy. Ultimately, by bridging the g...

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Perceived self-efficacy refers to a subject’s expectation about the outcomes his/her behavior will have in a challenging situation. Low self-efficacy has been implicated in the origins and maintenance of phobic behavior. Correlational studies suggest an association between perceived self-efficacy and learning. The experimental manipulation of perceived self-efficacy offers an interesting approach to examine the impact of self-efficacy beliefs on cognitive and emotional functions. Recently, a positive effect of an experimentally induced increased self-efficacy on associative learning has been demonstrated. Changes in associative learning constitute a central hallmark of pathological fear and anxiety. Such alterations in the acquisition and extinction of conditioned fear may be related to cognitive and neurobiological factors that predict a certain vulnerability to anxiety disorders. The present study builds on previous own work by investigating the effect of an experimentally induced low perceived self-efficacy on fear acquisition, extinction and extinction retrieval in a differential fear conditioning task. Our results suggest that a negative verbal feedback, which leads to a decreased self-efficacy, is associated with changes in the acquisition of conditioned fear. During fear acquisition, the negative verbal feedback group showed decreased discrimination of fear responses between the aversive and safe conditioned stimuli (CS) relative to a group receiving a neutral feedback. The effects of the negative verbal feedback on the acquisition of fear discrimination learning were indexed by an impaired ability to discriminate the probability of receiving a shock during acquisition upon presentation of the aversive (CS+) relative to the safe stimuli (CS−). However, the effects of low self-efficacy on discrimination learning were limited to fear acquisition. No differences between the groups were observed during extinction and extinction retrieval. Furthermore, analysis of other outcome measures, i.e., skin conductance responses and CS valence ratings, revealed no group differences during the different phases of fear conditioning. In conclusion, lower perceived self-efficacy alters cognitive/expectancy components of discrimination during fear learning but not evaluative components and physiological responding. The pattern of findings suggests a selective, detrimental role of low(er) self-efficacy on the subject’s ability to learn the association between ambiguous cues and threat/safety.

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