Discussion
Raeder, reduction of fear and avoidance, De Quervain
We have investigated the effects of acute stress on one-session exposure outcome and generalization in women with fear of spiders and cockroaches. Acute stress, administered prior to exposure, had no overall effect on exposure-induced reduction in fear and avoidance for the treated stimuli (spiders). Likewise, participants’ approach behavior towards untreated stimuli (cockroaches) increased from the pre-stress and pre-exposure measurement to the follow-up measurement, but no effect of stress induction was found. Similar findings have been obtained for subjective and self-report measures. This pattern of results suggests no effect of stress on exposure efficacy and generalization in women. However, the exposure-induced reduction in subjective fear and self-report measures for treated stimuli was reduced in women using OC specifically after pre-exposure stress induction. These results underline the importance of sex hormones as potential modulators of the efficacy and outcome of an one-session exposure treatment.Our finding differs from previous exposure therapy augmentation studies showing that GC administration (that is associated with high cortisol levels) prior to exposure therapy leads to stronger symptom reduction as compared to a placebo condition (De Quervain et al. In contrast to these studies, the present results suggest that acute stress (and the accompanying physiological cortisol increase) does not promote exposure-induced reduction of fear and avoidance towards treated stimuli in women. More specifically, in The absence of beneficial effects of pre-exposure stress on exposure efficacy and generalization was not due to a failure to induce stress. A multi-factorial manipulation check demonstrated that the Stress groups showed increased blood pressure, salivary cortisol concentrations and stress ratings after stress induction as compared to a baseline measurement immediately before stress induction. More specifically, Another aim of this study was to investigate possible effects of stress on generalization of exposure therapy effects towards untreated stimuli (Preusser et al. Therapy generalization effects might be related to a generalized mastery experience or an increase in self-efficacy beliefs after exposure to the treated stimuli (Raeder et al. Nevertheless, stress did not influence the generalization of exposure-induced benefit across different fear stimuli. Basic research on the effects of stress on stimulus-based fear extinction is very limited (but see Hagedorn et al. Potential limitations of our study might be related to the relatively small sample size or individual differences in the amount of cortisol released following a lab stressor (van Eck et al. 