Predicting return of fear following exposure therapy with an implicit measure of attitudes.

We sought to advance understanding of the processes underlying the efficacy of exposure therapy and particularly the phenomenon of return of fear (ROF) following treatment by drawing on a social psychological view of phobias as attitudes. Specifically, a dual process theory of attitude-related behavior predicts that a positive response to exposure therapy may reflect change in either the automatic (the attitude representation itself) or controlled (skills and confidence at coping with the fear) responses to the phobic stimulus, or both. However, if the attitude representation remains negative following treatment, ROF should be more likely. We tested this hypothesis in a clinical sample of individuals with public speaking phobia using a single-session exposure therapy protocol previously shown to be efficacious but also associated with some ROF. Consistent with predictions, a post-treatment implicit measure of attitudes toward public speaking (the Personalized Implicit Association Test [PIAT]) predicted ROF at 1-month follow-up. These results suggest that change in the automatically activated attitude toward the phobic stimulus is an important goal of exposure therapy and that an implicit measure like the PIAT can provide a useful measure of such change by which to gauge the adequacy of exposure treatment and predict its long-term efficacy.

It was as big as my head, I swear! Biased spider size estimation in spider phobia.

The current study tested the association between fear and perception in spider phobic individuals (n=57) within the context of a treatment outcome study. Participants completed 5 post-treatment Behavioral Approach Tasks (BATs) in which they encountered a live spider and were asked to provide spider size estimates. Consistent with predictions, results indicated that high levels of fear were associated with magnified perception of phobic stimuli. Specifically, we found a significant positive correlation between size estimates and self-reported fear while encountering spiders. Together with previous findings, these results further support the notion that fear is involved in the encoding and processing of perceptual information.