Translational research perspectives on maximizing the effectiveness of exposure therapy

This chapter emphasizes on the importance of conceptualizing exposure-based treatment as an active process of new safety learning. This is in opposition to the notion that extinction represents a destruction or replacement of fear learning. Both fear and safety responses are maintained even after extinction, leaving them in competition whenever the conditioned stimulus (CS) is encountered again. Because studies suggest the importance of context in determining whether safety or fear responses are retrieved on subsequent exposure to the CS, the chapter discusses several strategies that tip the scales in favor of the safety learning. The chapter also discusses several simple principles underscoring the proposition that contexts can aid or impair recall of extinction depending on their meaning (association with fear or safety) and arguing that clinicians need to actively evaluate the context and nature of learning in exposure assignments.