Ecological momentary assessment models trajectories of expectancy following exposure: A proof-of-concept pilot study

Background and objectives: The Inhibitory Retrieval Approach to exposure therapy for fears and anxiety emphasizes prediction error as one of several strategies for improving outcomes. Prediction error depends on disconfirmation of expectancies for the feared outcome, and thus exposure strategies that derive from inhibitory retrieval approaches emphasize expectancy violation during exposure. However, research studies examining expectancy violation in exposure therapy have treated expectancy as a stable characteristic, assuming that expectancy following an exposure exercise remains constant over time. This brief report outlines two different uses of a methodology for using ecological momentary assessment (EMA) to assess between-session expectancy following exposure during treatment for anxiety, and reports on pilot trial results.

Methods: Adults with social anxiety disorder (N = 12) and spider phobia (N = 31) taking part in larger trials investigating exposure therapy completed EMA questionnaires assessing expectancy for their feared outcome for 2-4 days following each of two exposure sessions.

Results: Expectancy ratings decreased from pre-to post-exposure and remained stable for 2-4 days following exposure.

Limitations: This pilot study used a very limited sample size and should be replicated in a larger sample.

Conclusions: Expectancy for feared outcome may be assessed using EMA following exposure sessions. Pilot results suggest that expectancy decreases immediately following exposures and remains stable afterwards.