Merging Our Understanding of Anxiety and Exposure: Using Inhibitory Learning to Target Anxiety Sensitivity in Exposure Therapy.
Add ILT twists—variety, surprise, deepened extinction—to exposure so clients learn that racing hearts and sweaty palms are safe.
01Research in Context
What this study did
Pettingell et al. (2022) wrote a narrative review. They pulled together two ideas: inhibitory learning theory (ILT) and anxiety sensitivity (AS).
ILT says exposure works when the brain learns new, safer rules. AS is the fear of harmless body cues like a racing heart.
The authors argue you should mix ILT tactics—variety, surprise, deepened extinction—into every exposure to shrink AS.
What they found
The paper is a map, not new data. It shows how to turn old habituation drills into ILT-rich sessions.
Key moves: switch cues, break expectancies, repeat across new places, and tag bodily sensations as safe.
How this fits with other research
Magnacca et al. (2022) and Laske et al. (2022) both used remote BST to teach new skills. Their work says you can train therapists online and still hit fidelity. L et al. extend that idea: once trained, you can deliver ILT-guided exposure the same way.
Harper et al. (2023) proved brief BST lifts clinician presentation skills. L et al. apply the same brief-training logic to exposure, giving you a short menu of ILT moves to add next session.
Bearss et al. (2022) redesigned RUBI for schools through stakeholder loops. L et al. mirror that iterative spirit: update exposure protocols step-by-step using ILT principles instead of one big overhaul.
Why it matters
If you run exposure for anxiety, this paper gives you a plug-and-play upgrade. Pick one ILT rule—vary the cue, deepen extinction, or create prediction error—and weave it into today’s exposure. No extra kit, no new credential. You keep the client, the setting, and the tech; you just swap in smarter trials that target fear of body sensations.
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02At a glance
03Original abstract
Exposure-based therapies are the gold standard treatment for anxiety disorders, and recent advancements in basic and clinical research point to the need to update the implementation of exposure. Recent research has highlighted the importance of transdiagnostic factors such as anxiety sensitivity (AS), or fear of anxiety-related sensations. Elevated AS is common among all anxiety disorders and contains three dimensions, or expectancies, that can be used to guide treatment. Recently, treatments directly targeting AS have shown potential in reducing symptoms of anxiety. In addition, inhibitory learning theory (ILT) provides an alternative explanation of exposure processes based on basic learning research. ILT extends the current framework by accounting for renewal of fear, which is important given the substantial number of individuals who experience a return of symptoms following treatment. The current paper will provide an overview of ILT and discuss several ILT techniques that can be used to target AS. These two converging bodies of research hold strong potential for optimizing treatment for anxiety.
Behavior modification, 2022 · doi:10.1177/01454455211005073