Great interest exists in maximizing exposure therapy efficacy in anxiety disorders. At the same time, reduced frequency and shortened duration of exposure sessions are required to meet the specific regularities in routine care settings. Extinction has emerged as the key mechanism of exposure treatment in anxiety disorders. Examining exposure treatment processes from the perspective of extinction learning might provide novel insights into variability in exposure treatment duration and outcome. The present study sought to examine the functional link between fear extinction, the ability to accomplish exposure in a predetermined time and exposure therapy outcome in specific phobia. Treatment-seeking individuals (N = 53) with spider phobia underwent a context-dependent fear conditioning paradigm prior to a standardized exposure. Spider-phobic participants who were able to complete exposure within the pre-determined time (i.e., completers) showed a more pronounced short- and long-term exposure therapy benefit. In the fear conditioning task, a more pronounced decline in CS-US contingency ratings during extinction (retrieval) was found in completers relative to non-completers. The failure to further extinguish US expectancy to the CSs in non-completers might offer a potential mechanistic explanation why non-completers have difficulties to accomplish all exposure steps in a fixed time and show less pronounced treatment gains. Our findings bear specific implications for the implementation of exposure treatment to routine care settings.

人们对最大限度地提高暴露疗法治疗焦虑症的疗效非常感兴趣。同时，需要减少暴露频率并缩短暴露时间，以满足日常护理环境中的特定规律。消退已成为焦虑症暴露治疗的关键机制。从消退学习的角度检查暴露治疗过程可能会为暴露治疗持续时间和结果的变异性提供新的见解。本研究旨在探讨恐惧消退、在预定时间内完成暴露的能力以及特定恐惧症的暴露治疗结果之间的功能联系。患有蜘蛛恐惧症的寻求治疗的个体（ N = 53）在标准化暴露之前接受了上下文相关的恐惧条件反射范式。能够在预定时间内完成暴露的蜘蛛恐惧症参与者（即完成者）表现出更明显的短期和长期暴露治疗益处。在恐惧调节任务中，相对于未完成者，完成者在灭绝（检索）期间的 CS-US 意外事件评级下降更为明显。未能进一步消除美国对未完成者中 CS 的期望可能会提供一个潜在的机械解释，解释为什么未完成者难以在固定时间内完成所有暴露步骤并显示出不太明显的治疗效果。我们的研究结果对于在常规护理环境中实施暴露治疗具有具体意义。