Positive and negative affect influence learning during exposure therapy: Secondary analysis from a randomized controlled trial.

OBJECTIVE: The Inhibitory Retrieval model of exposure therapy emphasizes expectancy change as a core mechanism of treatment. Evidence suggests important roles for both positive and negative affect during exposure therapy. The current study assesses the extent to which positive and negative affect moderate expectancy change during exposure therapy.

METHOD: N = 77 adults with either social anxiety disorder or panic disorder completed a nine-session exposure therapy protocol: n = 41 were randomized to exposure therapy based on principles of extinction learning (Inhibitory Retrieval condition), during which they rated expectancy of an aversive outcome before and after each exposure; and n = 36 participants were randomized to exposure focused on fear reduction (Habituation condition), during which they rated subjective experiences of fear before and after each exposure. The Positive and Negative Affect Schedule (past month) was collected at baseline, mid-treatment and post-treatment.

RESULTS: In the Inhibitory Retrieval condition, positive and negative affect each moderated the relationship between pre- and post-expectancy. Specifically, individuals with low positive affect relative to their own mean (p = .029) or high negative affect relative to other individuals (p < .001) reduced expectancies less when pre-expectancy was high. In the Habituation condition, neither positive nor negative affect moderated the relationship between pre- and post-exposure fear.

CONCLUSIONS: Affect moderates expectancy change during exposure therapy modeled using Inhibitory Retrieval, such that higher negative affect and lower positive affect are associated with less expectancy change. Considering the historical emphasis on reducing negative affect, models of exposure therapy may additionally incorporate strategies to increase positive affect to maximize expectancy change.