Pub Date : 2025-12-01Epub Date: 2025-10-02DOI: 10.1016/j.brat.2025.104878
Gayle Maloney , Arnoud Arntz , Christopher Pittenger
Obsessive-Compulsive Disorder (OCD) is a debilitating psychological condition that remains resistant to treatment in a significant proportion of clients, even following completion of first-line psychological and pharmacological treatments. This paper describes a sequenced treatment protocol combining Exposure and Response Prevention (ERP) with Imagery Rescripting for OCD (ImRs-OCD) as an adjunctive intervention for individuals with treatment-resistant OCD. The ImRs-OCD protocol has undergone multiple rounds of refinement over the past 10 years through iterative protocol development, based on clinician and client feedback. We describe the evolution of the protocol, key adaptations for OCD, illustrative case examples, and preliminary evidence supporting its efficacy. A standardised 10-step ImRs-OCD protocol is presented, along with guidelines for implementation and a set of standard rescripting questions and handouts. This work aims to provide guidance to clinicians and to encourage further research into imagery rescripting as a comprehensive treatment approach for treatment-resistant OCD.
{"title":"The imagery rescripting protocol for obsessive-compulsive disorder (ImRs-OCD): A decade of iterative refinement in treatment sequencing following ERP","authors":"Gayle Maloney , Arnoud Arntz , Christopher Pittenger","doi":"10.1016/j.brat.2025.104878","DOIUrl":"10.1016/j.brat.2025.104878","url":null,"abstract":"<div><div>Obsessive-Compulsive Disorder (OCD) is a debilitating psychological condition that remains resistant to treatment in a significant proportion of clients, even following completion of first-line psychological and pharmacological treatments. This paper describes a sequenced treatment protocol combining Exposure and Response Prevention (ERP) with Imagery Rescripting for OCD (ImRs-OCD) as an adjunctive intervention for individuals with treatment-resistant OCD. The ImRs-OCD protocol has undergone multiple rounds of refinement over the past 10 years through iterative protocol development, based on clinician and client feedback. We describe the evolution of the protocol, key adaptations for OCD, illustrative case examples, and preliminary evidence supporting its efficacy. A standardised 10-step ImRs-OCD protocol is presented, along with guidelines for implementation and a set of standard rescripting questions and handouts. This work aims to provide guidance to clinicians and to encourage further research into imagery rescripting as a comprehensive treatment approach for treatment-resistant OCD.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104878"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-24DOI: 10.1016/j.brat.2025.104900
Maximilian Blomberg , Rachel Schaper , Anahita Bonabi , Johanna Sophie Oppermann , Hilmar Zech , Wally Wünsch-Leiteritz , Timo Brockmeyer
Background
Effective treatments for anorexia nervosa (AN) are available, yet many patients do not respond to treatment or experience relapse. Cognitive bias modification aims to ameliorate cognitive biases that are assumed to contribute to the development and maintenance of AN. This study examines the efficacy of a novel mobile approach-avoidance bias modification training (ABMT) with food cues for AN.
Method
In this RCT, 90 inpatients with AN received six sessions of active or sham ABMT with food cues or no training, alongside treatment-as-usual. Primary outcome was self-reported eating disorder psychopathology; secondary outcomes included food-related approach-avoidance bias, fear of food, and BMI. Outcomes were assessed at baseline, end-of-training and at 6-month follow-up.
Results
Active ABMT did not result in greater reductions in eating disorder psychopathology. Similarly, treatment conditions did not differ regarding in change in BMI, approach-avoidance bias or fear of food, neither in the short term nor in the long term. Changes in approach-avoidance bias did not mediate training effects on any outcomes.
Conclusions
This first RCT on ABMT for AN found no superiority of active ABMT over sham or no ABMT in reducing eating disorder psychopathology. ABMT also appeared insufficient to alter food-related approach bias. Mobile ABMT with food cues in its current form does not seem to be an efficacious adjunct treatment to inpatient TAU for patients with AN. Further research may explore whether modified training protocols and personalized approaches are more promising in this regard.
Trial registration
This study's design was registered at the German Clinical Trials Register [https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00022078]
{"title":"Smartphone-based approach-avoidance bias modification training for anorexia nervosa - A randomized clinical trial","authors":"Maximilian Blomberg , Rachel Schaper , Anahita Bonabi , Johanna Sophie Oppermann , Hilmar Zech , Wally Wünsch-Leiteritz , Timo Brockmeyer","doi":"10.1016/j.brat.2025.104900","DOIUrl":"10.1016/j.brat.2025.104900","url":null,"abstract":"<div><h3>Background</h3><div>Effective treatments for anorexia nervosa (AN) are available, yet many patients do not respond to treatment or experience relapse. Cognitive bias modification aims to ameliorate cognitive biases that are assumed to contribute to the development and maintenance of AN. This study examines the efficacy of a novel mobile approach-avoidance bias modification training (ABMT) with food cues for AN.</div></div><div><h3>Method</h3><div>In this RCT, 90 inpatients with AN received six sessions of active or sham ABMT with food cues or no training, alongside treatment-as-usual. Primary outcome was self-reported eating disorder psychopathology; secondary outcomes included food-related approach-avoidance bias, fear of food, and BMI. Outcomes were assessed at baseline, end-of-training and at 6-month follow-up.</div></div><div><h3>Results</h3><div>Active ABMT did not result in greater reductions in eating disorder psychopathology. Similarly, treatment conditions did not differ regarding in change in BMI, approach-avoidance bias or fear of food, neither in the short term nor in the long term. Changes in approach-avoidance bias did not mediate training effects on any outcomes.</div></div><div><h3>Conclusions</h3><div>This first RCT on ABMT for AN found no superiority of active ABMT over sham or no ABMT in reducing eating disorder psychopathology. ABMT also appeared insufficient to alter food-related approach bias. Mobile ABMT with food cues in its current form does not seem to be an efficacious adjunct treatment to inpatient TAU for patients with AN. Further research may explore whether modified training protocols and personalized approaches are more promising in this regard.</div></div><div><h3>Trial registration</h3><div>This study's design was registered at the German Clinical Trials Register [<span><span>https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00022078</span><svg><path></path></svg></span>]</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104900"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-30DOI: 10.1016/j.brat.2025.104882
Olivier T. de Vries , Sascha B. Duken , Nadža Džinalija , Merel Kindt , Vanessa A. van Ast
The powerful ways future behavior and cognition can be affected by emotional events are typically studied either by means of Pavlovian conditioning or episodic memory paradigms, which both rest on the idea that associations are formed between distinct stimuli experienced closely together in space or time. However, due to their incompatible methods, little is known about how physiological read-outs of Pavlovian conditioning and episodic memory work in concert to affect behavior and other cognitive processes, how they relate to each other, or whether they reflect the activity of distinct associative processes in the first place. To shed light on such questions, a paradigm is needed that can assess both conditioned psychophysiology and episodic memory. We reasoned that multimodal stimuli, consisting of congruent image-sound combinations, have the potential to serve as potent unconditioned stimuli in a paradigm where participants encode a large number ‘mini-conditioning events’. Measuring both pupil dilation and facial electromyography, we found that psychophysiological responses to 20 unique aversive USs – but not positive USs - transferred to arbitrary predictors already after a single paired presentation in this novel paradigm. Real-life emotional aversive and stressful events are likely to involve both Pavlovian conditioning and episodic memory processes. The ‘Episodic Threat Conditioning’ paradigm enables their simultaneous assessment, thereby providing an opportunity to gain more holistic insight into how different expressions of memory interact in mental health and disease.
{"title":"‘Episodic Threat Conditioning’: a novel approach to simultaneously measure Pavlovian threat conditioning and episodic memory","authors":"Olivier T. de Vries , Sascha B. Duken , Nadža Džinalija , Merel Kindt , Vanessa A. van Ast","doi":"10.1016/j.brat.2025.104882","DOIUrl":"10.1016/j.brat.2025.104882","url":null,"abstract":"<div><div>The powerful ways future behavior and cognition can be affected by emotional events are typically studied either by means of Pavlovian conditioning or episodic memory paradigms, which both rest on the idea that associations are formed between distinct stimuli experienced closely together in space or time. However, due to their incompatible methods, little is known about how physiological read-outs of Pavlovian conditioning and episodic memory work in concert to affect behavior and other cognitive processes, how they relate to each other, or whether they reflect the activity of distinct associative processes in the first place. To shed light on such questions, a paradigm is needed that can assess both conditioned psychophysiology and episodic memory. We reasoned that multimodal stimuli, consisting of congruent image-sound combinations, have the potential to serve as potent unconditioned stimuli in a paradigm where participants encode a large number ‘mini-conditioning events’. Measuring both pupil dilation and facial electromyography, we found that psychophysiological responses to 20 unique aversive USs – but not positive USs - transferred to arbitrary predictors already after a single paired presentation in this novel paradigm. Real-life emotional aversive and stressful events are likely to involve both Pavlovian conditioning and episodic memory processes. The ‘Episodic Threat Conditioning’ paradigm enables their simultaneous assessment, thereby providing an opportunity to gain more holistic insight into how different expressions of memory interact in mental health and disease.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104882"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-12DOI: 10.1016/j.brat.2025.104914
Halaina R. Winter , Alice R. Norton , Bethany M. Wootton
Imagery rescripting (ImR) has demonstrated efficacy in reducing symptoms of social anxiety disorder (SAD). However, there are many logistical and psychological barriers that prevent individuals with SAD from accessing treatment. The efficacy of remote treatment methodologies, such as internet videoconferencing, has recently been demonstrated across a range of mental disorders. However, the efficacy of videoconferencing-delivered ImR (vImR) has not yet been examined. The present study aims to examine the efficacy and acceptability of vImR for SAD in a multiple baseline trial utilising the waitlist control group from a larger randomised controlled trial (RCT). 35 participants (Mage = 37.86; SD = 12.90) received no intervention for 8-weeks, then received an 8-session manualised vImR treatment protocol. Within-group analyses indicated negligible effect sizes from baseline to pre-treatment (SIAS-6: d = 0.22; 95 % CI: 0.25 – 0.69; SPS-6: d = −0.03; 95 % CI: 0.49 – 0.44). Large effect sizes were found from pre-treatment to post-treatment (SIAS-6: d = 0.81; 95 % CI: 0.32–1.29; SPS-6: d = 0.80; 95 % CI: 0.30–1.27) and pre-treatment to 3-month follow-up (SIAS-6: d = 0.85; 95 % CI: 0.36–1.33; SPS-6: d = 0.90; 95 % CI: 0.40–1.38). At post-treatment, 66 % of participants no longer met criteria for SAD (74 % at 3-month follow-up). Benchmarking analyses indicated similar treatment effect sizes to in-person ImR for SAD. Participants rated the program as highly acceptable. The results indicate that the mechanisms of ImR appear to be transferable to vImR and therefore this may be a viable remote treatment option for individuals with SAD who do not respond to first-line treatments.
意象处方（ImR）在减轻社交焦虑障碍（SAD）症状方面已被证明有效。然而，有许多后勤和心理障碍阻碍了SAD患者获得治疗。网络视频会议等远程治疗方法的有效性最近已在一系列精神疾病中得到证实。然而，视频会议提供的ImR （vImR）的有效性尚未得到检验。本研究旨在检验vImR治疗SAD的有效性和可接受性，该试验采用多基线试验，利用来自更大的随机对照试验（RCT）的等待名单对照组。35名参与者（Mage = 37.86; SD = 12.90）在8周内不接受干预，然后接受8个疗程的手动vImR治疗方案。组内分析表明，从基线到预处理的效应大小可以忽略不计（SIAS-6: d = 0.22; 95% CI: 0.25 - 0.69; SPS-6: d = -0.03; 95% CI: 0.49 - 0.44）。从治疗前到治疗后（SIAS-6: d = 0.81; 95% CI: 0.32-1.29; SPS-6: d = 0.80; 95% CI: 0.30-1.27）和治疗前到3个月的随访（SIAS-6: d = 0.85; 95% CI: 0.36-1.33; SPS-6: d = 0.90; 95% CI: 0.40-1.38）均发现了较大的效应量。在治疗后，66%的参与者不再符合SAD的标准（3个月随访时为74%）。基准分析表明，SAD的治疗效果与现场ImR相似。参与者对这个项目的评价是高度可接受的。结果表明，ImR的机制似乎可以转移到vImR，因此对于对一线治疗无效的SAD患者来说，这可能是一个可行的远程治疗选择。
{"title":"Imagery rescripting for social anxiety disorder via internet videoconferencing: An open trial","authors":"Halaina R. Winter , Alice R. Norton , Bethany M. Wootton","doi":"10.1016/j.brat.2025.104914","DOIUrl":"10.1016/j.brat.2025.104914","url":null,"abstract":"<div><div>Imagery rescripting (ImR) has demonstrated efficacy in reducing symptoms of social anxiety disorder (SAD). However, there are many logistical and psychological barriers that prevent individuals with SAD from accessing treatment. The efficacy of remote treatment methodologies, such as internet videoconferencing, has recently been demonstrated across a range of mental disorders. However, the efficacy of videoconferencing-delivered ImR (vImR) has not yet been examined. The present study aims to examine the efficacy and acceptability of vImR for SAD in a multiple baseline trial utilising the waitlist control group from a larger randomised controlled trial (RCT). 35 participants (<em>M</em><sub>age</sub> = 37.86; <em>SD</em> = 12.90) received no intervention for 8-weeks, then received an 8-session manualised vImR treatment protocol. Within-group analyses indicated negligible effect sizes from baseline to pre-treatment (SIAS-6: <em>d</em> = 0.22; 95 % CI: 0.25 – 0.69; SPS-6: <em>d</em> = −0.03; 95 % CI: 0.49 – 0.44). Large effect sizes were found from pre-treatment to post-treatment (SIAS-6: <em>d</em> = 0.81; 95 % CI: 0.32–1.29; SPS-6: <em>d</em> = 0.80; 95 % CI: 0.30–1.27) and pre-treatment to 3-month follow-up (SIAS-6: <em>d</em> = 0.85; 95 % CI: 0.36–1.33; SPS-6: <em>d</em> = 0.90; 95 % CI: 0.40–1.38). At post-treatment, 66 % of participants no longer met criteria for SAD (74 % at 3-month follow-up). Benchmarking analyses indicated similar treatment effect sizes to in-person ImR for SAD. Participants rated the program as highly acceptable. The results indicate that the mechanisms of ImR appear to be transferable to vImR and therefore this may be a viable remote treatment option for individuals with SAD who do not respond to first-line treatments.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104914"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-01DOI: 10.1016/j.brat.2025.104903
Eliza M. Ferguson, David D.J. Cooper, Jessica R. Grisham
Emerging evidence suggests that rescripting aversive memories related to obsessive-compulsive disorder (OCD) may improve symptoms and OCD-relevant cognitive and affective outcomes. We aimed to validate an online, audio-guided imagery rescripting protocol by comparing it with a focused, thought-listing control. A sample of Prolific online workers (n = 112) with high OCD symptoms identified a memory associated with OCD-related experiences, then were randomly assigned to complete either the rescripting or control task. Select outcomes were re-assessed one-week post-experiment. Feared self-perceptions improved for the rescripting, but not the control condition; these improvements were maintained for idiosyncratic and state feared-self beliefs, but not trait fear-of-self. Participants in the rescripting condition also reported significantly greater reductions in state anxiety and urge to neutralise, compared to controls. No changes were observed in obsessional beliefs for either condition. There were no between-condition differences in engagement in behavioural neutralisation post-experiment. A small but significant increase in reporting OCD symptoms was found at follow-up; this did not differ between conditions and was consistent with heightened awareness of symptoms. These findings provide preliminary evidence that imagery rescripting in a standardised audio-guided format may be an effective adjunctive treatment for OCD to facilitate cognitive and affective change.
{"title":"Evaluation of a brief, online imagery rescripting intervention targeting fear-of-self in high obsessive-compulsive participants","authors":"Eliza M. Ferguson, David D.J. Cooper, Jessica R. Grisham","doi":"10.1016/j.brat.2025.104903","DOIUrl":"10.1016/j.brat.2025.104903","url":null,"abstract":"<div><div>Emerging evidence suggests that rescripting aversive memories related to obsessive-compulsive disorder (OCD) may improve symptoms and OCD-relevant cognitive and affective outcomes. We aimed to validate an online, audio-guided imagery rescripting protocol by comparing it with a focused, thought-listing control. A sample of Prolific online workers (<em>n</em> = 112) with high OCD symptoms identified a memory associated with OCD-related experiences, then were randomly assigned to complete either the rescripting or control task. Select outcomes were re-assessed one-week post-experiment. Feared self-perceptions improved for the rescripting, but not the control condition; these improvements were maintained for idiosyncratic and state feared-self beliefs, but not trait fear-of-self. Participants in the rescripting condition also reported significantly greater reductions in state anxiety and urge to neutralise, compared to controls. No changes were observed in obsessional beliefs for either condition. There were no between-condition differences in engagement in behavioural neutralisation post-experiment. A small but significant increase in reporting OCD symptoms was found at follow-up; this did not differ between conditions and was consistent with heightened awareness of symptoms. These findings provide preliminary evidence that imagery rescripting in a standardised audio-guided format may be an effective adjunctive treatment for OCD to facilitate cognitive and affective change.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104903"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-25DOI: 10.1016/j.brat.2025.104898
Julie L. Ji , Sonia Baee , Diheng Zhang , Claudia Calicho-Mamani , M. Joseph Meyers , Daniel Funk , Samuel Portnow , Laura Barnes , Bethany A. Teachman
{"title":"Corrigendum to “Multi-session online interpretation bias training for anxiety in a community sample” [Behaviour Research and Therapy, 142 (2021), 1–15 / 103864]","authors":"Julie L. Ji , Sonia Baee , Diheng Zhang , Claudia Calicho-Mamani , M. Joseph Meyers , Daniel Funk , Samuel Portnow , Laura Barnes , Bethany A. Teachman","doi":"10.1016/j.brat.2025.104898","DOIUrl":"10.1016/j.brat.2025.104898","url":null,"abstract":"","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104898"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-31DOI: 10.1016/j.brat.2025.104907
Anton Regorius , Jule Lepper , Christiane A. Melzig , Christoph Benke
Objective
Exposure therapy is a first-line treatment for social anxiety, yet many individuals show limited response or relapse after treatment. Deficits in reward processes have been linked to impaired extinction learning and may undermine exposure efficacy. This study investigated whether supplementing in-vivo exposure with reward-enhancing strategies can improve outcomes for public speaking anxiety, particularly in individuals with elevated anhedonia.
Method
This preregistered study (ClinicalTrials: NCT06258889) randomized 40 adults with public speaking anxiety to: in-vivo exposure paired with reward-focused (EXP + RF) or cognitive restructuring (EXP + CR) techniques. Participants completed a preparatory and exposure session. Outcomes were assessed at baseline, intermediate and post-treatment. Primary outcomes included public speaking anxiety, assessed via Personal Report of Public Speaking Anxiety (PRPSA), and mean fear ratings during a behavioral approach test (BAT; standardized 3-min speech). Baseline anhedonia, assessed via Temporal Experience of Pleasure Scale (TEPS), was examined as a moderator.
Results
Both groups improved significantly in public speaking anxiety and fear during BAT from baseline to post-treatment, with no between-group differences. Exploratory analyses revealed that treatment efficacy in public speaking anxiety differed between treatment groups as a function of individuals’ levels of anhedonia. In individuals with high anhedonia, EXP + RF led to greater reduction in public speaking anxiety than EXP + CR (d = 1.43, p = .04). No differences emerged for low or medium anhedonia. Anhedonia did not moderate other outcomes.
Conclusion
Individuals with elevated anhedonia derived greater benefit from exposure therapy for social anxiety when augmented with reward-enhancing strategies, highlighting treatment optimization in this subgroup and stratified treatment planning.
{"title":"Augmenting in vivo exposure with reward-focused strategies: A randomized controlled trial providing preliminary evidence for improved outcomes in individuals with elevated anhedonia","authors":"Anton Regorius , Jule Lepper , Christiane A. Melzig , Christoph Benke","doi":"10.1016/j.brat.2025.104907","DOIUrl":"10.1016/j.brat.2025.104907","url":null,"abstract":"<div><h3>Objective</h3><div>Exposure therapy is a first-line treatment for social anxiety, yet many individuals show limited response or relapse after treatment. Deficits in reward processes have been linked to impaired extinction learning and may undermine exposure efficacy. This study investigated whether supplementing in-vivo exposure with reward-enhancing strategies can improve outcomes for public speaking anxiety, particularly in individuals with elevated anhedonia.</div></div><div><h3>Method</h3><div>This preregistered study (ClinicalTrials: NCT06258889) randomized 40 adults with public speaking anxiety to: in-vivo exposure paired with reward-focused (EXP + RF) or cognitive restructuring (EXP + CR) techniques. Participants completed a preparatory and exposure session. Outcomes were assessed at baseline, intermediate and post-treatment. Primary outcomes included public speaking anxiety, assessed via <em>Personal Report of Public Speaking Anxiety</em> (PRPSA), and mean fear ratings during a behavioral approach test (BAT; standardized 3-min speech). Baseline anhedonia, assessed via <em>Temporal Experience of Pleasure Scale</em> (TEPS), was examined as a moderator.</div></div><div><h3>Results</h3><div>Both groups improved significantly in public speaking anxiety and fear during BAT from baseline to post-treatment, with no between-group differences. Exploratory analyses revealed that treatment efficacy in public speaking anxiety differed between treatment groups as a function of individuals’ levels of anhedonia. In individuals with high anhedonia, EXP + RF led to greater reduction in public speaking anxiety than EXP + CR (<em>d</em> = 1.43, <em>p</em> = .04). No differences emerged for low or medium anhedonia. Anhedonia did not moderate other outcomes.</div></div><div><h3>Conclusion</h3><div>Individuals with elevated anhedonia derived greater benefit from exposure therapy for social anxiety when augmented with reward-enhancing strategies, highlighting treatment optimization in this subgroup and stratified treatment planning.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104907"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-04DOI: 10.1016/j.brat.2025.104909
Amelia Reynolds, Colin MacLeod, Ben Grafton
The present study examined whether people with high trait anxiety volitionally access proportionately more negative (than positive) information when interrogating available information concerning an approaching potential stressor during a period of expectancy updating. The present study also examined the role this negative interrogation bias plays in shaping trait anxiety-linked negative expectancy bias and elevated negative state affect. Participants low and high in trait anxiety (N = 311) were informed at the outset of the testing session that they may later view a potentially stressful film. Participants then completed a procedure designed to induce initial expectancies concerning the film viewing stressor. Subsequently, participants were provided the opportunity to update their initial expectancies by interrogating negative and positive information concerning the film viewing stressor. The proportion of negative information selected by each participant was taken as a measure of their negative interrogation bias. Measures of expectancies and state affect were taken before and after the induction of initial expectancies, and before and after the subsequent expectancy updating period. The results indicated that, during the expectancy updating period, participants high in trait anxiety displayed greater negative interrogation bias than participants low in trait anxiety. The results also revealed an indirect association between trait anxiety and elevation of negative state affect concurrent to expectancy updating period, which was serially mediated by negative interrogation bias during this period, and by concurrent elevation of negative expectancy bias. Findings are discussed with regards to potential implications for cognitive behavioural interventions for anxiety which seek to drive therapeutic change through the modification of expectancies.
{"title":"Trait anxiety-linked bias in expectancy updating: Examining the contributions of negative interrogation bias and negatively biased expectancy updating to elevated negative state affect when approaching potential stressors","authors":"Amelia Reynolds, Colin MacLeod, Ben Grafton","doi":"10.1016/j.brat.2025.104909","DOIUrl":"10.1016/j.brat.2025.104909","url":null,"abstract":"<div><div>The present study examined whether people with high trait anxiety volitionally access proportionately more negative (than positive) information when interrogating available information concerning an approaching potential stressor during a period of expectancy updating. The present study also examined the role this <em>negative interrogation bias</em> plays in shaping trait anxiety-linked negative expectancy bias and elevated negative state affect. Participants low and high in trait anxiety (<em>N</em> = 311) were informed at the outset of the testing session that they may later view a potentially stressful film. Participants then completed a procedure designed to induce initial expectancies concerning the film viewing stressor. Subsequently, participants were provided the opportunity to update their initial expectancies by interrogating negative and positive information concerning the film viewing stressor. The proportion of negative information selected by each participant was taken as a measure of their negative interrogation bias. Measures of expectancies and state affect were taken before and after the induction of initial expectancies, and before and after the subsequent expectancy updating period. The results indicated that, during the expectancy updating period, participants high in trait anxiety displayed greater negative interrogation bias than participants low in trait anxiety. The results also revealed an indirect association between trait anxiety and elevation of negative state affect concurrent to expectancy updating period, which was serially mediated by negative interrogation bias during this period, and by concurrent elevation of negative expectancy bias. Findings are discussed with regards to potential implications for cognitive behavioural interventions for anxiety which seek to drive therapeutic change through the modification of expectancies.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104909"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-04DOI: 10.1016/j.brat.2025.104881
Alex H.K. Wong , Jonas Zaman , Steven Verheyen
Fear generalization refers to the spread of fear to novel stimuli. Recent evidence suggests that fear generalization is linked with inductive reasoning. In the inductive reasoning literature, inferences are stronger to taxonomically related stimuli that share conceptual features with the target stimulus (e.g., duck and swan), compared to thematically related stimuli that often co-occur with the target stimulus (e.g., duck and pond). Preliminary evidence also shows greater fear generalization to taxonomically related stimuli compared to thematically related stimuli in a fear conditioning framework. The current study aimed to extend this pattern to safety behavior, a behavioral response that minimizes the onset of an expected threat. In a fear and avoidance conditioning framework, participants (N = 74) first acquired stronger safety behaviors to a threat predicting conditioned stimulus (CS+) than to a safety predicting conditioned stimulus (CS-). In a following generalization test, participants showed stronger generalized safety behaviors to novel generalization stimuli (GSs) that were taxonomically related to the CS + compared to those thematically related to the CS+. Low distress tolerance, a risk factor for clinical anxiety, was associated with less differentiated generalized safety behaviors to the GSs. The findings suggest that taxonomic generalization of safety behaviors is stronger than thematic generalization of safety behaviors.
{"title":"Taxonomic and thematic generalization of safety behaviors","authors":"Alex H.K. Wong , Jonas Zaman , Steven Verheyen","doi":"10.1016/j.brat.2025.104881","DOIUrl":"10.1016/j.brat.2025.104881","url":null,"abstract":"<div><div>Fear generalization refers to the spread of fear to novel stimuli. Recent evidence suggests that fear generalization is linked with inductive reasoning. In the inductive reasoning literature, inferences are stronger to taxonomically related stimuli that share conceptual features with the target stimulus (e.g., duck and swan), compared to thematically related stimuli that often co-occur with the target stimulus (e.g., duck and pond). Preliminary evidence also shows greater fear generalization to taxonomically related stimuli compared to thematically related stimuli in a fear conditioning framework. The current study aimed to extend this pattern to safety behavior, a behavioral response that minimizes the onset of an expected threat. In a fear and avoidance conditioning framework, participants (N = 74) first acquired stronger safety behaviors to a threat predicting conditioned stimulus (CS+) than to a safety predicting conditioned stimulus (CS-). In a following generalization test, participants showed stronger generalized safety behaviors to novel generalization stimuli (GSs) that were taxonomically related to the CS + compared to those thematically related to the CS+. Low distress tolerance, a risk factor for clinical anxiety, was associated with less differentiated generalized safety behaviors to the GSs. The findings suggest that taxonomic generalization of safety behaviors is stronger than thematic generalization of safety behaviors.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104881"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-11DOI: 10.1016/j.brat.2025.104918
Wencke Donath , Ernst H.W. Koster , Rafaële J.C. Huntjens , Matt Field , Peter J. de Jong
Clinically derived theoretical models of dissociative identity disorder (DID) suggest that these individuals experience shifts in cognitive functioning between identity states. While prior research has found no objective inter-identity differences in memory, the present study investigated whether such differences are evident in a related cognitive domain: attentional processing. It was hypothesized that individuals with DID would exhibit differences in their attentional bias (AB) toward concern-related stimuli. They were compared to individuals with PTSD who experienced interpersonal childhood trauma, simulators enacting different identity states, and non-clinical adults. Based on cognitive models in anxiety, individuals with PTSD were expected to show a vigilance-avoidance AB pattern for concern-related stimuli. Non-clinical comparisons were expected to show a weaker AB effect than the clinical groups. Participants (n = 95) completed a visual spatial dot-probe task with both short (200 ms) and long (1250 ms) exposure conditions, displaying angry (i.e., concern-related stimuli) and happy facial expressions (i.e., control stimuli). In addition, participants completed post-task measures of state anxiety and state dissociation. The results did not reveal significant AB differences between identity states in individuals with DID, although differences were observed between identity states in the simulator group. Moreover, no significant AB differences were found between individuals with DID, PTSD, and non-clinical groups. State anxiety and state dissociation scores were not significantly related to AB scores. Findings provided no support for shifts in attentional processing between identity states in DID. Furthermore, we found no evidence for a hypervigilant-avoidant AB pattern for concern-related stimuli in PTSD.
{"title":"Attentional processing of concern-related stimuli in dissociative identity disorder: No evidence for inter-identity differences","authors":"Wencke Donath , Ernst H.W. Koster , Rafaële J.C. Huntjens , Matt Field , Peter J. de Jong","doi":"10.1016/j.brat.2025.104918","DOIUrl":"10.1016/j.brat.2025.104918","url":null,"abstract":"<div><div>Clinically derived theoretical models of dissociative identity disorder (DID) suggest that these individuals experience shifts in cognitive functioning between identity states. While prior research has found no objective inter-identity differences in memory, the present study investigated whether such differences are evident in a related cognitive domain: attentional processing. It was hypothesized that individuals with DID would exhibit differences in their attentional bias (AB) toward concern-related stimuli. They were compared to individuals with PTSD who experienced interpersonal childhood trauma, simulators enacting different identity states, and non-clinical adults. Based on cognitive models in anxiety, individuals with PTSD were expected to show a vigilance-avoidance AB pattern for concern-related stimuli. Non-clinical comparisons were expected to show a weaker AB effect than the clinical groups. Participants (<em>n</em> = 95) completed a visual spatial dot-probe task with both short (200 ms) and long (1250 ms) exposure conditions, displaying angry (i.e., concern-related stimuli) and happy facial expressions (i.e., control stimuli). In addition, participants completed post-task measures of state anxiety and state dissociation. The results did not reveal significant AB differences between identity states in individuals with DID, although differences were observed between identity states in the simulator group. Moreover, no significant AB differences were found between individuals with DID, PTSD, and non-clinical groups. State anxiety and state dissociation scores were not significantly related to AB scores. Findings provided no support for shifts in attentional processing between identity states in DID. Furthermore, we found no evidence for a hypervigilant-avoidant AB pattern for concern-related stimuli in PTSD.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104918"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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