12 Chapter 1 analogue for exposure therapy, helps us understand the underlying mechanism contributing to the effects of exposure therapy (Bouton, Mineka, & Barlow, 2001; Craske et al., 2008; Vervliet, Craske, & Hermans, 2013). In this process a conditional stimulus (CS) that was previously paired with an aversive outcome (unconditional stimulus, US) is repeatedly presented without being followed by the US, leading to the loss of the fear response. According to inhibitory learning theory (ILT), a recent exposure model, inhibitory learning plays an important role in extinction learning (Craske et al., 2008; Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014a; Craske, Treanor, Zbozinek, & Vervliet, 2022; Lang, Craske, & Bjork, 1999). It is stated that the original CS – US association does not disappear during exposure, but a new association: US does not predict the US (no US), is learned in addition to the original association (Bouton & King, 1983). After extinction, the CS is associated with two meanings, the original fear association (lower pathway figure 1.1) and the inhibitory meaning (upper pathway figure 1.1). Figure 1.1 An illustration of an exposure model for Social Anxiety Disorder. Exposure treatment is characterized by repeated confrontation with the feared situation (e.g., the public speech, the CS) in absence of the feared outcome (No-US), reflected by the multiple arrows in the upper route. Within exposure, the individual learns a new association between the social situation and the absence of danger. Retrieval of this new association in a social situation results in feeling calmer. According to Inhibitory Learning Theory (ILT), both the original association (lower pathway) as well as the new association (upper pathway) remain. The new association competes for retrieval with the original association. Moreover, both the new association (CS – no US) and the original association (CS – US) compete for retrieval. Inhibitory learning can be maximized by expectancy violation in which the harm expectancies of the individual are altered. For example, Rose would be repeatedly exposed to her feared situation such as giving a public speech (CS) in order to test her explicitly stated harm expectancy: “people will laugh at me and reject me”
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