Skip to main content Accessibility help

The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear

  • Melissa M. Norberg (a1), Amie R. Newins (a2), Yan Jiang (a1), Jianqiu Xu (a1), Eduard Forcadell (a1), Cristina Alberich (a1) and Brett J. Deacon (a3)...


Background: While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases. Aims: This study aimed to test the potential benefit of increasing the intensity of exposure therapy by adding an extra step that challenged uncontrollability (Step 15: allowing a spider to walk freely over one's body) to the standard fear hierarchy. Method: Fifty-one participants who had a severe fear of spiders completed two 60-min exposure sessions 1 week apart in a context that was either the same or different from the baseline and follow-up assessment context. Participants were categorized into groups based on the last hierarchy step they completed during treatment (Step 14 or fewer, or Step 15). Results: Those who completed Step 15 had greater reductions in fear and beliefs about the probability of harm from baseline to post-treatment than those who completed fewer steps. Although completing Step 15 did not prevent fear from returning after a context change, it allowed people to maintain their ability to tolerate their fear, which earlier steps did not. Despite some fear returning after a context change, individuals who completed Step 15 tended to report greater reductions in fear from baseline to the follow-up assessment than participants who completed 14 or fewer steps. Conclusions: Overall, these results suggest that more intensive exposure that directly challenges harm beliefs may lead to greater changes in fear and fear beliefs than less intensive exposure.


Corresponding author

*Correspondence to Melissa M. Norberg, Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. E-mail:


Hide All
Arntz, A., Lavy, E., Van den Berg, G. and Van Rijsoort, S. (1993). Negative beliefs of spider phobics: a psychometric evaluation of the spider phobia beliefs questionnaire. Advances in Behaviour Research and Therapy, 15, 257277. doi: 10.1016/0146-6402(93)90012-Q
Mystkowski, J. L., Craske, M. G. and Echiverri, A. M. (2002). Treatment context and return of fear in spider phobia. Behavior Therapy, 33, 399416. doi: 10.1016/S0005-7894(02)80035-1
Öst, L. G., Salkovskis, P. M. and Hellstrom, K. (1991). One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia. Behavior Therapy, 22, 407422. doi: 10.1016/S0005-7894(05)80374-0
Rescorla, R. A. and Wagner, A. R. (1972). A theory of Pavlovian conditioning: variations in the effectiveness of reinforcement and non-reinforcement. In Black, A. H. and Prokasy, W. F. (eds), Classical Conditioning II: Current Research and Theory. New York: Appleton-Century-Crofts.
Szymanski, J. and O'Donohue, W. (1995). The potential role of state-dependent learning in cognitive therapy with spider phobics. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 13, 131150. doi:10.1007/BF02354458
Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B. and Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: a meta-analysis. Clinical Psychology Review, 28, 10211037. doi: 10.1016/j.cpr.2008.02.007


Type Description Title
Supplementary materials

Norberg et al. supplementary material
Norberg et al. supplementary material 1

 Word (113 KB)
113 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear

  • Melissa M. Norberg (a1), Amie R. Newins (a2), Yan Jiang (a1), Jianqiu Xu (a1), Eduard Forcadell (a1), Cristina Alberich (a1) and Brett J. Deacon (a3)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *