Data from the Master theses Hengen and Müller: Approaching feared stimuli: Behavioral, self-reported, and physiological changes after a spider approach task

Avoidance is one of the key symptoms of anxiety disorders and a contributing factor to their maintenance. Therefore, the reduction of avoidance behavior is a primary goal during exposure-based treatments. However, it is often difficult to motivate patients to start with exposure and there is a relatively high attrition rate. We modified a decision-making paradigm which we had previously established as a laboratory measure of avoidance tendencies in order to foster a self-selected approach. Spider fearful individuals (N = 50) were assigned to one of two conditions. Intervention group: individuals were differentially reinforced by hypothetical money for choosing a fear-relevant (spider picture) over a neutral stimulus (butterfly picture). Sham-control group: individuals were equally rewarded for selecting both stimuli. As expected, we observed a shift from avoidance to approach in the Intervention group but not in the Sham-control group. There were no group differences in self-reported fear of spiders, nor in arousal, fearfulness, and unpleasantness towards the fearful stimuli. Interestingly, the control compared to the Intervention group showed more electro dermal responses while looking at spider pictures. Outside of the test situation, there was no transfer of approaching behavior to a behavioral approach test (BAT) and no effects were found on psychophysiology in the BAT with a real spider. These findings suggest that incentives may be a useful tool to initiate self-selected exposure to aversive pictures but this may not be sufficient to change affective responses. Nevertheless, reinforcement may be an underused strategy to initiate effective treatment