Facilitating emotional processing in depression: the application of exposure principles

• Principles of exposure and emotional processing might facilitate new learning in depression.
• Unproductive processing, maladaptive inhibitory control, and processing of positive emotions must be addressed.
• New learning can be strengthened across contexts to reduce risk for relapse.

Even with the best psychosocial and pharmacological treatments for unipolar depression, relapse is a serious problem. One path to improve treatments for depression is to target fundamental processes that go awry in depression and to enhance new learning by adapting principles and strategies from exposure-based treatments for anxiety and fear-related disorders. I describe basic principles of exposure and emotional processing and illustrate with Exposure-based Cognitive Therapy (EBCT) for depression, how these principles can be applied, with some adaptation, to address the therapeutic targets of depression. Clinical trial data of EBCT suggest that this application might be fruitful and that the process of change might be similar to that in exposure-based treatments for anxiety and trauma-related disorders.