The Dynamics of Learning and Retention Following an Exposure Exercise for Fear of Public Speaking

Exposure-based CBT is an effective treatment for anxiety disorders. However, individual differences in response to exposure indicate that many patients do not fully benefit from therapy. Examining individual changes over time in threat expectancy likelihood, a theorized working mechanism of exposure as proposed by the Inhibitory Retrieval Theory, may help optimize individual treatment success. This study aimed to examine the dynamics of learning during one exposure exercise for fear of public speaking and the retention of learning in daily life. Participants with elevated fear of public speaking (70 women, M age = 23.10) completed an exposure exercise designed to violate an idiosyncratic threat expectancy. They gave two, three, or four presentations to at least halve threat expectancy likelihood. Ecological momentary assessments were used to measure threat expectancy likelihood eight times a day for four days before and four days after the exposure exercise. Results showed individual differences in how fast threat expectancy likelihood decreased during the exposure exercise. Furthermore, there were individual differences in how much this translated to a decrease in threat expectancy likelihood in daily life and how long participants retained the decrease. Additionally, after the exposure exercise, we found a decrease in threat expectancy severity, anticipatory anxiety, avoidance tendency, and an increase in willingness to give a presentation in daily life. Future research could examine whether individual differences in the dynamics of learning and retention in daily life following an exposure exercise are clinically relevant as predictor of overall treatment success.