Efficacy of Expectancy Focused Exposure Therapy for Anxiety Disorders

Summary

This clinical trial evaluates whether an optimized exposure-based treatment improves long-term outcomes for adults with anxiety disorders. Specifically, it examines whether Expectancy Focused Exposure (EFE), based on the inhibitory learning model, is more effective than Anxiety Focused Exposure (AFE) in reducing anxiety symptoms and preventing the return of fear over time. The study includes adults aged 18 years and older diagnosed with an anxiety disorder, including social anxiety disorder, specific phobia, generalized anxiety disorder, and panic disorder with or without agoraphobia. Anxiety disorders are highly prevalent and can significantly interfere with daily functioning, work performance, and interpersonal relationships. Exposure therapy is a central component of cognitive behavioral treatment for anxiety disorders. Traditional exposure approaches often focus on reducing anxiety during exposure sessions, but many individuals experience a return of fear after treatment. New theoretical models suggest that exposure may be more effective when designed to violate threat expectations and strengthen inhibitory learning. Participants will be recruited in sequential cohorts and randomly assigned to immediate treatment or a brief waitlist before treatment begins. Those assigned to the waitlist will start treatment at the next study step. When treatment begins, participants will receive either EFE or AFE. Both treatments consist of approximately 10 weekly individual psychotherapy sessions delivered by trained therapists. Participants will complete clinical assessments before treatment, during treatment, immediately after treatment, and at 6, 12, and 18 months after treatment completion. In AFE, exposure exercises are organized along an anxiety hierarchy and focus on reducing anxiety responses through repeated confrontation with feared stimuli. In EFE, exposure focuses on identifying and testing threat expectations, and exercises are designed to maximize expectancy violation and strengthen inhibitory learning. Potential risks include temporary emotional discomfort during exposure exercises. All sessions will be conducted by trained clinicians who monitor participant safety throughout the study. The results may help improve exposure-based treatments for anxiety disorders by identifying strategies that enhance long-term outcomes and reduce relapse.

Conditions

• Anxiety Disorders
• Panic Disorder
• Social Anxiety Disorder (SAD)
• Generalised Anxiety Disorder
• Specific Phobia

Interventions

BEHAVIORAL

Expectancy Focused Exposure

Expectancy Focused Exposure is an exposure-based psychological treatment grounded in the inhibitory learning model of exposure therapy (Craske, 2022). The intervention emphasizes the identification and testing of explicit threat expectations associated with feared stimuli or situations. Exposure exercises are designed to maximize expectancy violation by confronting situations that strongly predict feared outcomes and by systematically testing whether these outcomes occur. The goal of the intervention is to strengthen inhibitory learning by disconfirming threat predictions rather than by reducing anxiety during exposure. Clinically, this approach guides how exposure exercises are designed and implemented. Therapists construct a comprehensive associative map of the feared situation in order to plan exposures that maximally challenge the patient's threat expectations. This associative map includes the feared element (conditioned stimulus; CS), the expected consequence (unconditioned stimu

BEHAVIORAL

Anxiety Focused Exposure

Anxiety Focused Exposure is a traditional exposure-based cognitive behavioral therapy approach in which exposure exercises are organized according to a graduated hierarchy of feared situations or stimuli. The primary goal of the intervention is to reduce anxiety responses through repeated confrontation with anxiety-provoking stimuli. Exposure sessions focus on gradual increases in exposure intensity while monitoring anxiety levels across repeated exposures. In this approach, the therapist and the participant collaboratively construct an exposure hierarchy that organizes feared situations from least to most anxiety-provoking. This hierarchy allows participants to approach feared situations progressively, beginning with stimuli that evoke lower levels of anxiety and gradually advancing toward more challenging situations. Exposure exercises are conducted following this hierarchical structure, with the aim of promoting reductions in anxiety as individuals repeatedly confront feared situati

Sponsors & Collaborators

• Universidad de los Andes, Chile

  collaborator OTHER

• University of Chile

  lead OTHER

Principal Investigators

• Vanetza E Quezada-Scholz, PhD · University of Chile

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

70 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-07-01

Primary Completion

2028-07-30

Completion

2029-03-31

Countries

• Chile

Study Locations