An experimental study of exposure-based and emotion-focused interventions: Strange bedfellows, or a match made in heaven?
Exposure therapy is a considered to be the treatment of choice for anxiety disorders, but mechanisms of change underlying its effectiveness are currently being contested. Emotional processing theory postulates that habituation of fear is the primary predictor of change during exposure, while inhibitory learning theory challenges that and postulates that variability in the intensity of fear is the predictor of change. Moreover, recent evidence points towards verbalization of emotion as a predictor of change during exposure as well. The present study investigated these predictors using a sample of 41 college students in an analog experimental design in the context of an exposure task. The study found mixed support that verbalization of emotion plays a role in improving the behavioral outcomes after an exposure task. Habituation in fear, controlled for variability in the intensity of fear, predicted worse speech performance from before to after the experimental task, (β = -.63, p = .001), while variability in the intensity of fear, controlled for habituation, improved speech performance (β = .54, p = .008). At the same time, habituation in shame, when controlled for variability in the intensity of shame, predicted an improvement in state self-esteem from before to after the experimental task (β =.31, p = .009), while variability in the intensity of shame, when controlled for habituation in shame, predicted state self-esteem deterioration (β = -.35, p = .038). Physiological indices indicated that lower heart rate variability during the experimental task predicted worsening in self-esteem from before to after the task (β = -.18, p = .034), while habituation in fear (r(39) = .40, p = .014) and shame (r(39) = .56, p < .001) was positively correlated with parasympathetic nervous system activity when controlled for variability in these emotional states.
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