Investigating the role of affective valence and arousal in exposure therapy for anxiety and related disorders

Positive affect has been hypothesized to improve exposure learning outcomes. However, empirical studies of this hypothesis have yielded mixed findings and suggest that it is important to disentangle the relative contributions of both affective valence and arousal. The current study is a secondary analysis from a clinical trial investigating predictors of nonresponse to 12 weekly sessions of exposure-based CBT for individuals with anxiety disorders (N = 100). State affective valence and arousal ratings were assessed before and after exposure sessions. Lagged multilevel modeling revealed that greater positive affective valence and lower affective arousal before and after exposure sessions independently predicted lower anxiety severity the following week, evidencing small standardized effects. Standard multiple regression analyses indicated that both the average affective valence and arousal reported before exposure sessions significantly predicted week 12 anxiety severity, when controlling for week 1 anxiety severity, evidencing medium-to-large standardized effects. Findings support the hypothesis that state affective valence and arousal levels before and after exposure sessions are related to the outcome of exposure therapy for anxiety disorders. Results are discussed in the context of variable findings from previous studies. Future research should continue to elucidate the mechanisms governing the effect of positive affect on exposure learning.