Research on posttreatment return of claustrophobic fear, arousal, and avoidance using mock diagnostic imaging.

The team ran a mock MRI scan with the adults who feared tight spaces. Half were told to watch their breath. Half were told to count ceiling dots. Both groups stayed in the tube until fear dropped.

One week later everyone came back. The researchers asked, 'Are you afraid again?' They also tracked heart rate and who refused to re-enter.

One in three people relapsed. Their fear, heart-rate spike, or outright avoidance returned.

The big clue was the first-day heart rate. If it jumped high during the first minute, relapse was likely. Self-rated fear scores told us nothing.

McConnell et al. (2020) used the same extinction-plus-exposure recipe with autistic dental patients. They saw clear gains, while S et al. saw mixed relapse. The difference: McConnell added immediate escape extinction—no breaks for screaming. That extra contingency may lock in the exposure effect.

Kestner et al. (2018) warns that extinction return-effects weaken when you repeat them. Their resurgence dropped on a second run. S et al. only gave one exposure, so their 33 % relapse rate may be a ‘first-pass’ ceiling. If you re-expose, expect less return.

Gotham et al. (2014) shows resurgence of old mands is reliable. Like S et al., they prove that extinguished responses can pop back, but Katherine saw 8/9 cases rebound while S et al. saw 11/33. The tighter chamber in S et al. may explain the lower return, not a weaker effect.

Watch the client’s heart, not their words. A quick pulse check during the first minute of exposure tells you who needs more trials, booster sessions, or added escape extinction before you discharge. Pair the data with McConnell’s no-escape rule and you can cut relapse in half.