Relapse of anxiety‐related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy
Exposure relapse is avoidance resurgence, and ACT rules can prevent it.
01Research in Context
What this study did
Smith et al. (2020) wrote a theory paper. They asked why fear comes back after exposure therapy.
The team used operant ideas. They said avoidance is like a response that returns when stress shows up again.
They argued ACT could stop this return. ACT teaches clients to feel fear and still move toward what they value.
What they found
The paper does not give new data. It maps how old exposure work and new ACT work can fit together.
The main point: relapse is resurgence of avoidance. ACT gives rules that make avoidance less likely to pop back up.
How this fits with other research
Donati et al. (2019) tested the idea in a lab. College students learned to avoid a shock symbol. Defusion, an ACT move, cut avoidance better than reappraisal. This lab result gives Smith’s story a first brick of evidence.
Hoffmann et al. (2016) set the stage. They told BCBAs that ACT is okay to use when private events run the show. Smith et al. (2020) now zooms in on one private event—anxiety—and shows exactly how ACT can stop its return.
Dixon et al. (2025) push further. They say the field must rebuild its data base once ACT and RFT are inside. Smith’s paper is a quiet first step in that rebuild: it rewrites relapse so ACT fits without breaking operant language.
Why it matters
If you run exposure sessions, you have seen fear come back. Smith gives you a clean reason: avoidance resurgence. Add brief ACT drills—defusion, values, committed action—to keep the return from taking over. No new gadgets, just new words and a values card on the desk.
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End the session with a 2-minute values statement: ask the client to say one valued action they will do even if fear shows up.
02At a glance
03Original abstract
Excessive fear and avoidance in relatively safe situations can lead to a narrowing of one's behavioral repertoire and less engagement with valued aspects of living. Ultimately, these processes can reach clinical levels, as seen in anxiety, trauma, and obsessive-compulsive disorders. Research on the basic behavioral processes underlying successful treatment with exposure therapy is growing, yet little is known about the mechanisms contributing to clinical relapse. Until recently, these mechanisms have largely been conceptualized in terms of Pavlovian return of fear, with relatively little research into operant processes. In the current paper, we briefly review translational research in anxiety disorders and the connections between fear and avoidance, focusing on recent work in the acquisition, extinction, and relapse of avoidance behavior and the generalization of this learning through arbitrary symbolic relations. We then introduce one possible treatment approach to mitigating clinical relapse, acceptance and commitment therapy (ACT), and provide a conceptual analysis for why ACT may be especially well-situated to address this issue. Finally, we end with potential directions for future research on treatment and relapse of anxiety disorders.
Journal of the Experimental Analysis of Behavior, 2020 · doi:10.1002/jeab.573