Question 1

Should I focus on habituation or expectancy violation when doing exposure therapy?

Accepted Answer

Craske's inhibitory learning model (ILM) has largely supplanted the habituation model as the theoretical framework for exposure therapy. ILM holds that extinction does not erase the original fear memory but creates a competing safety memory — meaning within-session anxiety reduction is NOT the goal. Optimization strategies include maximizing expectancy violation, deepened extinction (combining multiple feared stimuli), variability across contexts, occasional reinforced extinction, removal of safety behaviors, and affect labeling. The safety behavior debate has evolved: Lancaster 2025 suggests judicious fading rather than strict prohibition, but the core principle remains that safety behaviors prevent full expectancy violation.

Question 2

What's the difference between Craske's inhibitory learning model and classical extinction?

Accepted Answer

Craske's inhibitory learning model (ILM) has largely supplanted the habituation model as the theoretical framework for exposure therapy. ILM holds that extinction does not erase the original fear memory but creates a competing safety memory — meaning within-session anxiety reduction is NOT the goal. Optimization strategies include maximizing expectancy violation, deepened extinction (combining multiple feared stimuli), variability across contexts, occasional reinforced extinction, removal of safety behaviors, and affect labeling. The safety behavior debate has evolved: Lancaster 2025 suggests judicious fading rather than strict prohibition, but the core principle remains that safety behaviors prevent full expectancy violation.

Question 3

Should I remove safety behaviors during exposure to maximize expectancy violation?

Accepted Answer

Craske's inhibitory learning model (ILM) has largely supplanted the habituation model as the theoretical framework for exposure therapy. ILM holds that extinction does not erase the original fear memory but creates a competing safety memory — meaning within-session anxiety reduction is NOT the goal. Optimization strategies include maximizing expectancy violation, deepened extinction (combining multiple feared stimuli), variability across contexts, occasional reinforced extinction, removal of safety behaviors, and affect labeling. The safety behavior debate has evolved: Lancaster 2025 suggests judicious fading rather than strict prohibition, but the core principle remains that safety behaviors prevent full expectancy violation.

Question 4

How do I explain to patients that anxiety reduction during a session isn't the goal?

Accepted Answer

Craske's inhibitory learning model (ILM) has largely supplanted the habituation model as the theoretical framework for exposure therapy. ILM holds that extinction does not erase the original fear memory but creates a competing safety memory — meaning within-session anxiety reduction is NOT the goal. Optimization strategies include maximizing expectancy violation, deepened extinction (combining multiple feared stimuli), variability across contexts, occasional reinforced extinction, removal of safety behaviors, and affect labeling. The safety behavior debate has evolved: Lancaster 2025 suggests judicious fading rather than strict prohibition, but the core principle remains that safety behaviors prevent full expectancy violation.

PsychHQ

Inhibitory Learning vs. Habituation: How to Structure Exposure for Maximum Effect