Match or mismatch? The impact of expected fear on experienced fear during exposure.

Abstract

Expectancies are assumed to play an essential role in the maintenance and treatment of anxiety disorders. The present review aimed to systematically summarize studies examining the effects of expectancies as suggested by the match-mismatch model of fear (Rachman, 1994). A total of 50 articles were included. The findings largely supported core assumptions of the match-mismatch theory. The majority of studies verified the existence of an overprediction bias in anxiety disorders and a reduction of both expected and actually experienced level of fear with repeated exposures. There was some evidence, that an increasingly accurate prediction of fear was associated with reductions in real fear. New research directions and clinical implications are proposed to further develop treatment strategies for anxiety disorders. Public Health Significance StatementExposure therapy is highly effective as a treatment of anxiety disorders. However, mechanisms of change remain unclear. Cognitive processes, such as expectancies, might be one important factor for treatment success. The manuscript summarizes findings on fear-related expectancies and their violation within the context of exposure therapy. Patients with anxiety disorders tend to overpredict fear in situations, and this overprediction subsides with repeated exposure. There is a possible connection between a more accurate prediction of fear and exposure therapy outcome. This manuscript underlines the importance of incorporating expectancies in the evaluation of the therapy process.

Unraveling Negative Expectations and Nocebo-Related Effects in Musculoskeletal Pain

“…Worth mentioning is that in the case of firmly rooted expectations (i.e., where the patient implements strategies such as cognitive immunization), patients might require more evidence before successfully updating their priors. In this situation, clinicians should consider offering a higher number of disconfirming trials (i.e., repeating violation strategies more times than usual or offering the patient more treatment sessions; Gatzounis et al, 2021 ; Hilleke et al, 2021 ).…”

Evaluating the influence of cognitive mechanisms on fear expectancies: A commentary on Hilleke et al. (2021).

“…These studies also have helped identify neural circuitry associated with excessive fear reactions and fear conditioning. This framework has been used to evaluate the hypotheses in Hilleke et al (2021). That is, the literature evaluating fear learning has informed how individuals with anxiety interpret and predict the occurrence of a threat.…”

“…This study therefore highlights how engaging in RNT can increase the likelihood of cognitive processes that maintain anxiety symptoms. In their article, Hilleke et al (2021) speculate that the increased focus on threatening stimuli characteristic of attentional processes of individuals with anxiety disorders may lead to increased overestimation of anxiety symptoms. Therefore, at least as assessed by evaluating anticipatory processing, it seems that fear predictions also may increase subsequent attentional processes, creating a cycle of biased cognitive processing.…”

“…However, modest effect sizes and less consistent results among more complex conditioning paradigms (e.g., discrimination studies that include threat stimuli and safety stimuli; contextual fear paradigms) suggest that third variables may moderate these results. To expand upon the findings of Hilleke et al (2021), we will discuss one broad vulnerability factor for the development and maintenance of anxiety disorders that may impact fear prediction as well as fear learning.…”

Taxonomy and nature of fear-related expectancies.

“…Moreover, whether expectancies are equally biased across different forms of anxiety disorders must be investigated, as well as whether there are individual differences. It is plausible to assume that continuous avoidance of fear-evoking situations will prevent the overlearning of such unrealistic expectancies, which possibly stabilizes fear (see Hilleke et al, 2021). Yet, because expectancies do not act in isolation and are not the only processes related to the individual fear response, it may be beneficial to in addition consider other domains of information processing.…”