The scarier the better: maximizing exposure therapy outcomes for spider fear

Melissa M. Norberg*, Amie R. Newins, Yan Jiang, Jianqiu Xu, Eduard Forcadell, Cristina Alberich, Brett J. Deacon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Background: While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases. Aims: This study aimed to test the potential benefit of increasing the intensity of exposure therapy by adding an extra step that challenged uncontrollability (Step 15: allowing a spider to walk freely over one's body) to the standard fear hierarchy. Method: Fifty-one participants who had a severe fear of spiders completed two 60-min exposure sessions 1 week apart in a context that was either the same or different from the baseline and follow-up assessment context. Participants were categorized into groups based on the last hierarchy step they completed during treatment (Step 14 or fewer, or Step 15). Results: Those who completed Step 15 had greater reductions in fear and beliefs about the probability of harm from baseline to post-treatment than those who completed fewer steps. Although completing Step 15 did not prevent fear from returning after a context change, it allowed people to maintain their ability to tolerate their fear, which earlier steps did not. Despite some fear returning after a context change, individuals who completed Step 15 tended to report greater reductions in fear from baseline to the follow-up assessment than participants who completed 14 or fewer steps. Conclusions: Overall, these results suggest that more intensive exposure that directly challenges harm beliefs may lead to greater changes in fear and fear beliefs than less intensive exposure.

Original languageEnglish
Pages (from-to)754-760
Number of pages7
JournalBehavioural and Cognitive Psychotherapy
Issue number6
Early online date13 Jul 2018
Publication statusPublished - Nov 2018


  • exposure therapy
  • spider phobia
  • return of fear
  • renewal
  • prediction errors
  • inhibitory learning
  • anxiety


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