Contextual modulation of fear extinction as predictor of exposure therapy effectiveness
Abstract
Exposure therapy is an effective treatment for disorders characterized by fear and anxiety, but not all patients achieve symptom relief and many relapse outside of the original therapeutic context. Alterations in fear extinction – widely considered the central mechanism of exposure therapy – are observed in clinical populations, and have been linked to exposure treatment outcomes. However, extinction learning deficits alone cannot explain why fear returns when contextual conditions change. It is therefore pivotal to investigate the predictive value of contextual modulation of extinction learning for long-term exposure success. In this study, we examined whether contextual modulation of fear and safety learning in a Pavlovian fear-conditioning paradigm predicted intensive exposure treatment outcomes in patients with PTSD, OCD, and panic disorder (n = 109). We hypothesised that better contextual modulation would predict more favourable treatment outcomes across patient groups. Before treatment, participants completed fear acquisition and extinction in two different contexts, and three test phases assessing conditioned responses in the extinction and acquisition context, and a novel context. Fear responses were indexed by US expectancies and distress ratings. Symptom improvements were assessed using disorder-specific clinician-rated and self-report measures, as well as a transdiagnostic index of symptom distress. Our findings show that greater extinction context retention predicted more symptom reduction post-treatment, although effects were not consistent across outcome measures. These findings offer new insights into mechanisms that may underlie exposure success and highlight the translational value of contextual retention of extinction learning in fear-conditioning paradigms.
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BibTeX
@misc{stemerding2026contextual,
title = {{Contextual modulation of fear extinction as predictor of exposure therapy effectiveness}},
author = {Lotte Stemerding and Mirjam Kampman and Agnes van Minnen and Gert-Jan Hendriks and Vanessa van Ast and Rianne de Kleine},
howpublished = {PsyArXiv},
year = {2026},
month = sep,
doi = {10.31234/osf.io/6acs2_v2},
url = {https://osf.io/preprints/psyarxiv/6acs2_v2/},
note = {CC0},
}
RIS
TY - UNPB
TI - Contextual modulation of fear extinction as predictor of exposure therapy effectiveness
AU - Lotte Stemerding
AU - Mirjam Kampman
AU - Agnes van Minnen
AU - Gert-Jan Hendriks
AU - Vanessa van Ast
AU - Rianne de Kleine
PY - 2026
DA - 2026/09/01
PB - PsyArXiv
DO - 10.31234/osf.io/6acs2_v2
UR - https://osf.io/preprints/psyarxiv/6acs2_v2/
AB - Exposure therapy is an effective treatment for disorders characterized by fear and anxiety, but not all patients achieve symptom relief and many relapse outside of the original therapeutic context. Alterations in fear extinction – widely considered the central mechanism of exposure therapy – are observed in clinical populations, and have been linked to exposure treatment outcomes. However, extinction learning deficits alone cannot explain why fear returns when contextual conditions change. It is therefore pivotal to investigate the predictive value of contextual modulation of extinction learning for long-term exposure success. In this study, we examined whether contextual modulation of fear and safety learning in a Pavlovian fear-conditioning paradigm predicted intensive exposure treatment outcomes in patients with PTSD, OCD, and panic disorder (n = 109). We hypothesised that better contextual modulation would predict more favourable treatment outcomes across patient groups. Before treatment, participants completed fear acquisition and extinction in two different contexts, and three test phases assessing conditioned responses in the extinction and acquisition context, and a novel context. Fear responses were indexed by US expectancies and distress ratings. Symptom improvements were assessed using disorder-specific clinician-rated and self-report measures, as well as a transdiagnostic index of symptom distress. Our findings show that greater extinction context retention predicted more symptom reduction post-treatment, although effects were not consistent across outcome measures. These findings offer new insights into mechanisms that may underlie exposure success and highlight the translational value of contextual retention of extinction learning in fear-conditioning paradigms.
ER -