Pathways to change in one-session exposure with and without cognitive intervention: An exploratory study in spider phobia

It is well established that exposure therapy is an effective treatment for anxiety disorders. It is less clear, however, which mechanisms are crucial in explaining its success. In previous studies, cognitive change has been identified as a mediating variable. Several theorists have argued that the addition of cognitive interventions will, therefore, result in enhanced treatment effects. We tested this hypothesis by examining cognitive mediation of treatment in a purely behavioral versus a cognitive–behavioral exposure format. Thirty-one spider phobics were randomly assigned to either behavioral exposure or to exposure as a test for maladaptive cognitions (i.e., behavioral experiments). Both treatment formats showed large treatment effects and strong cognitive mediation of these effects. This indicates that, even when cognitions are not explicitly targeted, exposure effects are cognitively mediated. This challenges the idea that cognitions have to be explicitly challenged to elicit cognitive change in exposure treatment.

► We examine cognitive mediation of treatment in two exposure formats in spider phobia.
► Purely behavioral exposure is compared with exposure as a test for maladaptive cognitions.
► Both versions of exposure are effective and effects are largely mediated by cognitive change.
► Even when cognitions are not challenged, exposure effects are cognitively mediated.