Cognitive Restructuring Before Versus After Exposure: Effect on Expectancy and Outcome in Individuals With Claustrophobia

Kirstyn L Krause, Naomi Koerner, Martin M Antony, Kirstyn L Krause, Naomi Koerner, Martin M Antony

Abstract

Maximizing the discrepancy between expected and actual outcomes during exposure (i.e., expectancy violation) is thought to optimize inhibitory learning. The current study examined Craske et al.'s suggestion that engaging in cognitive restructuring (CR) before exposure prematurely reduces expectancy and mitigates outcomes. Participants (N = 93) with claustrophobia were randomly assigned to either 15 minutes of CR before exposure (CR Before) or 15 minutes of CR after exposure (CR After). Although the CR Before condition experienced greater expectancy reduction before exposure than the CR After condition, both groups experienced similar overall expectancy reduction by the end of the intervention. Groups experienced similar gains, with large significant improvement at posttreatment and follow-up. Results suggest that both cognitive therapy and exposure therapy lead to expectancy reduction, but that the order of these interventions does not impact outcome. Clinicaltrials.org registration #NCT03628105.

Keywords: cognitive behavior therapy; cognitive restructuring; expectancy; expectancy violation; exposure therapy; inhibitory learning model.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Martin Antony has published a number of books on cognitive and behavioral treatments for specific phobias and other anxiety related disorders, and regularly presents workshops on related topics. Kirstyn Krause and Naomi Koerner have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Participant flow. Note. CR = cognitive restructuring.
Figure 2.
Figure 2.
Visual representation of procedure. Note. DASS-21 = Depression Anxiety Stress Scales; CLQ = Claustrophobia Questionnaire; CGCQ = Claustrophobia General Cognition Questionnaire; BAT = Behavioral Approach Test; CR = cognitive restructuring.
Figure 3.
Figure 3.
Estimated marginal means for expected feared outcomes. Note. There were no significant differences between groups at Time 1 or Time 2. Asterisk indicates a significant difference between groups at Time 3. Error bars represent 95% Confidence Interval. Time represents expected feared outcome ratings: 1 = before psychoeducation, 2 = after psychoeducation/before the preexposure thought record versus filler task manipulation, 3 = after the preexposure thought record versus filler task manipulation. ANOVA = analysis of variance; CR = cognitive restructuring.
Figure 4.
Figure 4.
Estimated marginal means for treatment gains. Note. There were no significant differences between groups at pretreatment, posttreatment, or follow-up. Error bars represent 95% Confidence Interval. BAT = Behavioral Approach Test; CR = cognitive restructuring; ANOVA = analysis of variance.
Figure 5.
Figure 5.
Change in expected feared outcomes from Time 3 to Time 9. Note. Error bars represent 95% Confidence Interval. Individual data points are offset from each time to reduce overplotting. Time represents expected feared outcome ratings: 3 = after the preexposure thought record versus filler task manipulation/before the first exposure trial, 4–8 = before the remaining five exposure trials during the intervention appointment; 9 = before the exposure trial during the follow-up appointment. CR = cognitive restructuring.

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Source: PubMed

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