@phdthesis{Grossekathoefer2022,
  author    = {Großekath{\"o}fer, Jonas David},
  title     = {Virtually Valid? On the Importance of Ecological Validity and Virtual Reality for Social Attention Research},
  doi       = {10.25972/OPUS-26041},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260417},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Gazes are of central relevance for people. They are crucial for navigating the world and communicating with others. Nevertheless, research in recent years shows that many findings from experimental research on gaze behavior cannot be transferred from the laboratory to everyday behavior. For example, the frequency with which conspecifics are looked at is considerably higher in experimental contexts than what can be observed in daily behavior. In short: findings from laboratories cannot be generalized into general statements. This thesis is dedicated to this matter. The dissertation describes and documents the current state of research on social attention through a literature review, including a meta-analysis on the /gaze cueing/ paradigm and an empirical study on the robustness of gaze following behavior. In addition, virtual reality was used in one of the first studies in this research field. Virtual reality has the potential to significantly improve the transferability of experimental laboratory studies to everyday behavior. This is because the technology enables a high degree of experimental control in naturalistic research designs. As such, it has the potential to transform empirical research in the same way that the introduction of computers to psychological research did some 50 years ago. The general literature review on social attention is extended to the classic /gaze cueing/ paradigm through a systematic review of publications and a meta-analytic evaluation (Study 1). The cumulative evidence supported the findings of primary studies: Covert spatial attention is directed by faces. However, the experimental factors included do not explain the surprisingly large variance in the published results. Thus, there seem to be further, not well-understood variables influencing these social processes. Moreover, classic /gaze cueing/ studies have limited ecological validity. This is discussed as a central reason for the lack of generalisability. Ecological validity describes the correspondence between experimental factors and realistic situations. A stimulus or an experimental design can have high and low ecological validity on different dimensions and have different influences on behavior. Empirical research on gaze following behavior showed that the /gaze cueing/ effect also occurs with contextually embedded stimuli (Study 2). The contextual integration of the directional cue contrasted classical /gaze cueing/ studies, which usually show heads in isolation. The research results can thus be transferred /within/ laboratory studies to higher ecologically valid research paradigms. However, research shows that the lack of ecological validity in experimental designs significantly limits the transferability of experimental findings to complex situations /outside/ the laboratory. This seems to be particularly the case when social interactions and norms are investigated. However, ecological validity is also often limited in these studies for other factors, such as contextual embedding /of participants/, free exploration behavior (and, thus, attentional control), or multimodality. In a first study, such high ecological validity was achieved for these factors with virtual reality, which could not be achieved in the laboratory so far (Study 3). Notably, the observed fixation patterns showed differences even under /most similar/ conditions in the laboratory and natural environments. Interestingly, these were similar to findings also derived from comparisons of eye movement in the laboratory and field investigations. These findings, which previously came from hardly comparable groups, were thus confirmed by the present Study 3 (which did not have this limitation). Overall, /virtual reality/ is a new technical approach to contemporary social attention research that pushes the boundaries of previous experimental research. The traditional trade-off between ecological validity and experimental control thus becomes obsolete, and laboratory studies can closely inherit an excellent approximation of reality. Finally, the present work describes and discusses the possibilities of this technology and its practical implementation. Within this context, the extent to which this development can still guarantee a constructive classification of different laboratory tests in the future is examined.},
  subject      = {Aufmerksamkeit},
  language  = {en}
}
@phdthesis{Klinke2022,
  author    = {Klinke, Christopher Matthias},
  title     = {Experimental investigation of the effect of distal stress induction on threat conditioning in humans},
  doi       = {10.25972/OPUS-22556},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-225562},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Stress constitutes a major risk factor for the development of psychiatric disorders, such as PTSD and anxiety disorders, by shifting the brain into a state of sensitization and makes it more vulnerable when being exposed to further aversive events. This was experimentally in-vestigated in rodents by examining the effect of a distal stress induction on threat conditioning, where stress impaired extinction learning and caused spontaneous recovery. However, this effect has never been experimentally investigated in humans, so far. Thus, the aim of this dissertation was to investigate the effect of distal stress on threat conditioning in humans. Therefore, two subsequent studies were conducted. For both studies, the threat conditioning paradigm comprised threat acquisition, extinction learning, and re-extinction. In the threat acquisition phase, two geometrical shapes were used as conditioned stimulus (CS), from which one (CS+) was paired with a painful electric stimulus (unconditioned stimulus, US), but not the other one (CS-). During extinction learning 24 h later and re-extinction seventeen days later, CSs were again presented but without any US delivery. In Study 1, 69 participants underwent either a stress (socially evaluated cold pressor test; SECPT) or sham protocol 10 days prior to threat conditioning. Furthermore, context effects were examined by placing the stress protocol in the same context (context-A stress, and sham group) or a different context (context-B stress group) than conditioning. Results revealed that the context-A, but not context-B, stress group displayed impaired safety learning (i.e. potenti-ation towards CS-) for startle response during threat acquisition. Moreover, the same stress group showed impaired threat extinction, evident in sustained CS discrimination in valence and arousal ratings during extinction learning, and memory recall. In sum, distal stress on the one hand impaired safety learning during threat conditioning on a level of startle response. On the other hand, stress impaired threat extinction on a level of ratings. Noteworthy, the effect of distal stress was only found when the stressor was placed in the same context as later threat learning. Hence, suggesting that the combination of stressor and stressor-associated context exerted the effect on threat extinction. In Study 2, it was examined if distal stress induction could also have an impact on threat and extinction processes without the necessity of context association. Therefore, the same stress (n = 45) or sham protocol (n = 44) as in Study 1 was conducted in a different context than and 24 h prior to a threat conditioning paradigm. Similar to Study 1, weakened extinction learning was found in fear ratings for the stress (vs. sham) group, which was indicated by persistent CS+/CS- differentiation after the first block of extinction trials. Alterations in safety learning towards the CS- during threat acquisition were only supported by significant correlations between stress measures on the stress day and conditioned startle response of the CS- during acquisition. Taken together, in two subsequent studies this dissertation provided first evidence of impaired threat extinction after distal stress induction in humans. Furthermore, impairments in safety learning, as can be observed in PTSD, were additionally demonstrated. Interestingly, the effects were boosted and more profound when associating the stressor to the later learning context. These results have clinical implications as they can be translated to the notion that prior stress exposure makes an individual more vulnerable for later aversive events.},
  subject      = {Stress},
  language  = {en}
}
@article{Franz2022,
  author    = {Franz, David J.},
  title     = {Is Applied Ethics Morally Problematic?},
  series = {Journal of Academic Ethics},
  volume    = {20},
  journal   = {Journal of Academic Ethics},
  issn      = {1572-8544},
  doi       = {10.1007/s10805-021-09417-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-269095},
  pages     = {359-374},
  year      = {2022},
  abstract  = {This paper argues that applied ethics can itself be morally problematic. As illustrated by the case of Peter Singer's criticism of social practice, morally loaded communication by applied ethicists can lead to protests, backlashes, and aggression. By reviewing the psychological literature on self-image, collective identity, and motivated reasoning three categories of morally problematic consequences of ethical criticism by applied ethicists are identified: serious psychological discomfort, moral backfiring, and hostile conflict. The most worrisome is moral backfiring: psychological research suggests that ethical criticism of people's central moral convictions can reinforce exactly those attitudes. Therefore, applied ethicists unintentionally can contribute to a consolidation of precisely those social circumstances that they condemn to be unethical. Furthermore, I argue that the normative concerns raised in this paper are not dependent on the commitment to one specific paradigm in moral philosophy. Utilitarianism, Aristotelian virtue ethics, and Rawlsian contractarianism all provide sound reasons to take morally problematic consequences of ethical criticism seriously. Only the case of deontological ethics is less clear-cut. Finally, I point out that the issues raised in this paper provide an excellent opportunity for further interdisciplinary collaboration between applied ethics and social sciences. I also propose strategies for communicating ethics effectively.},
  language  = {en}
}
@article{BreilHuesteggeBoeckler2022,
  author    = {Breil, Christina and Huestegge, Lynn and B{\"o}ckler, Anne},
  title     = {From eye to arrow: Attention capture by direct gaze requires more than just the eyes},
  series = {Attention, Perception \& Psychophysics},
  volume    = {84},
  journal   = {Attention, Perception \& Psychophysics},
  number    = {1},
  issn      = {1943-393X},
  doi       = {10.3758/s13414-021-02382-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-273206},
  pages     = {64-75},
  year      = {2022},
  abstract  = {Human attention is strongly attracted by direct gaze and sudden onset motion. The sudden direct-gaze effect refers to the processing advantage for targets appearing on peripheral faces that suddenly establish eye contact. Here, we investigate the necessity of social information for attention capture by (sudden onset) ostensive cues. Six experiments involving 204 participants applied (1) naturalistic faces, (2) arrows, (3) schematic eyes, (4) naturalistic eyes, or schematic facial configurations (5) without or (6) with head turn to an attention-capture paradigm. Trials started with two stimuli oriented towards the observer and two stimuli pointing into the periphery. Simultaneous to target presentation, one direct stimulus changed to averted and one averted stimulus changed to direct, yielding a 2 × 2 factorial design with direction and motion cues being absent or present. We replicated the (sudden) direct-gaze effect for photographic faces, but found no corresponding effects in Experiments 2-6. Hence, a holistic and socially meaningful facial context seems vital for attention capture by direct gaze. STATEMENT OF SIGNIFICANCE: The present study highlights the significance of context information for social attention. Our findings demonstrate that the direct-gaze effect, that is, the prioritization of direct gaze over averted gaze, critically relies on the presentation of a meaningful holistic and naturalistic facial context. This pattern of results is evidence in favor of early effects of surrounding social information on attention capture by direct gaze.},
  language  = {en}
}
@article{WongPittig2022,
  author    = {Wong, Alex H. K. and Pittig, Andre},
  title     = {A dimensional measure of safety behavior: A non-dichotomous assessment of costly avoidance in human fear conditioning},
  series = {Psychological Research},
  volume    = {86},
  journal   = {Psychological Research},
  number    = {1},
  issn      = {1430-2772},
  doi       = {10.1007/s00426-021-01490-w},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-267688},
  pages     = {312-330},
  year      = {2022},
  abstract  = {Safety behavior prevents the occurrence of threat, thus it is typically considered adaptive. However, safety behavior in anxiety-related disorders is often costly, and persists even the situation does not entail realistic threat. Individuals can engage in safety behavior to varying extents, however, these behaviors are typically measured dichotomously (i.e., to execute or not). To better understand the nuances of safety behavior, this study developed a dimensional measure of safety behavior that had a negative linear relationship with the admission of an aversive outcome. In two experiments, a Reward group receiving fixed or individually calibrated incentives competing with safety behavior showed reduced safety behavior than a Control group receiving no incentives. This allowed extinction learning to a previously learnt warning signal in the Reward group (i.e., updating the belief that this stimulus no longer signals threat). Despite the Reward group exhibited extinction learning, both groups showed a similar increase in fear to the warning signal once safety behavior was no longer available. This null group difference was due to some participants in the Reward group not incentivized enough to disengage from safety behavior. Dimensional assessment revealed a dissociation between low fear but substantial safety behavior to a safety signal in the Control group. This suggests that low-cost safety behavior does not accurately reflect the fear-driven processes, but also other non-fear-driven processes, such as cost (i.e., engage in safety behavior merely because it bears little to no cost). Pinpointing both processes is important for furthering the understanding of safety behavior.},
  language  = {en}
}
@phdthesis{HartliebgebFaust2021,
  author    = {Hartlieb [geb. Faust], Verena},
  title     = {Die Bedeutung der phonologischen Bewusstheit f{\"u}r die Entwicklung mathematischer Kompetenzen bei Kindern mit und ohne Migrationshintergrund : Ergebnisse einer L{\"a}ngsschnittstudie vom Beginn des Vorschuljahres bis zum Ende der ersten Klasse},
  doi       = {10.25972/OPUS-24404},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-244047},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Die Entwicklung mathematischer Kompetenzen beginnt bereits vor Schuleintritt und wird durch viele Faktoren beeinflusst. In der vorliegenden Arbeit wird prim{\"a}r untersucht, ob die phonologische Bewusstheit als (meta-)sprachliche Kompetenz auch f{\"u}r die fr{\"u}he mathematische Kompetenzentwicklung bedeutsam ist und ob sich bei Kindern mit und ohne Migrationshintergrund vergleichbare Zusammenh{\"a}nge finden lassen. Ein weiterer Schwerpunkt bildet die {\"U}berpr{\"u}fung von differenziellen Effekten von ausgew{\"a}hlten, mathematischen Vorschultrainings sowie eines Trainings der phonologischen Bewusstheit auf die mathematischen Kompetenzen unter Ber{\"u}cksichtigung des Migrationshintergrundes. Die statistischen Analysen basieren auf einer Stichprobe von {\"u}ber 370 Kindern, die im Verlauf der L{\"a}ngsschnittstudie zu vier Messzeitpunkten, jeweils am Beginn und Ende des Vorschul- bzw. ersten Schuljahres, untersucht wurden. Durch Berechnung hierarchischer Regressionsanalysen ließ sich global kein zus{\"a}tzlicher Erkl{\"a}rungsbeitrag der phonologischen Bewusstheit neben den mathematischen Ausgangskompetenzen feststellen. Der Vergleich der beiden Migrationsgruppen ergab keine strukturellen Unterschiede. Die {\"U}berpr{\"u}fung von spezifischen Effekten durch mathematische Vorschulprogramme (Krajewski et al., 2007; Friedrich \& de Galg{\´o}czy, 2004; Preiß, 2004, 2005) und von unspezifischen Effekten durch ein Training der phonologischen Bewusstheit und der Buchstaben-Laut-Zuordnung (K{\"u}spert \& Schneider, 2008; Plume \& Schneider, 2004) auf die mathematischen Kompetenzen lieferte nur vereinzelt positive Effekte, die jedoch bei Ber{\"u}cksichtigung von individuellen und famili{\"a}ren Kontrollvariablen reduziert wurden. Die Generalisierbarkeit der Ergebnisse ist durch die komplexe Datenstruktur verbunden mit kleinen Stichprobengr{\"o}ßen in den jeweiligen Faktorenstufen limitiert. Insgesamt erm{\"o}glicht die vorliegende Arbeit eine differenzierte Betrachtung der mathematischen Kompetenzentwicklung bei Kindern mit und ohne Migrationshintergrund und liefert wichtige Implikationen f{\"u}r Forschung und Praxis.},
  subject      = {Mathematik},
  language  = {de}
}
@article{WeissHeinHewig2021,
  author    = {Weiß, Martin and Hein, Grit and Hewig, Johannes},
  title     = {Between joy and sympathy: Smiling and sad recipient faces increase prosocial behavior in the dictator game},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {18},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {11},
  doi       = {10.3390/ijerph18116172},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-241106},
  year      = {2021},
  abstract  = {In human interactions, the facial expression of a bargaining partner may contain relevant information that affects prosocial decisions. We were interested in whether facial expressions of the recipient in the dictator game influence dictators´ ehavior. To test this, we conducted an online study (n = 106) based on a modified version of a dictator game. The dictators allocated money between themselves and another person (recipient), who had no possibility to respond to the dictator. Importantly, before the allocation decision, the dictator was presented with the facial expression of the recipient (angry, disgusted, sad, smiling, or neutral). The results showed that dictators sent more money to recipients with sad or smiling facial expressions and less to recipients with angry or disgusted facial expressions compared with a neutral facial expression. Moreover, based on the sequential analysis of the decision and the interaction partner in the preceding trial, we found that decision-making depends upon previous interactions.},
  language  = {en}
}
@phdthesis{Gromer2021,
  author    = {Gromer, Daniel},
  title     = {Mechanisms Underlying Virtual Reality Exposure Therapy for Specific Phobias},
  doi       = {10.25972/OPUS-20733},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-207334},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Virtual reality exposure therapy (VRET) is an effective cognitive-behavioral treatment for anxiety disorders that comprises systematic confrontations to virtual representations of feared stimuli and situations. However, not all patients respond to VRET, and some patients relapse after successful treatment. One explanation for this limitation of VRET is that its underlying mechanisms are not yet fully understood, leaving room for further improvement. On these grounds, the present thesis aimed to investigate two major research questions: first, it explored how virtual stimuli induce fear responses in height-fearful participants, and second, it tested if VRET outcome could be improved by incorporating techniques derived from two different theories of exposure therapy. To this end, five studies in virtual reality (VR) were conducted. Study 1 (N = 99) established a virtual environment for height exposure using a Computer Automatic Virtual Environment (CAVE) and investigated the effects of tactile wind simulation in VR. Height-fearful and non-fearful participants climbed a virtual outlook, and half of the participants received wind simulation. Results revealed that height-fearful participants showed stronger fear responses, on both a subjective and behavioral level, and that wind simulation increased subjective fear. However, adding tactile wind simulation in VR did not affect presence, the user's sense of 'being there' in the virtual environment. Replicating previous studies, fear and presence in VR were correlated, and the correlation was higher in height-fearful compared to non-fearful participants. Study 2 (N = 43) sought to corroborate the findings of the first study, using a different VR system for exposure (a head-mounted display) and measuring physiological fear responses. In addition, the effects of a visual cognitive distractor on fear in VR were investigated. Participants' fear responses were evident on both a subjective and physiological level---although much more pronounced on skin conductance than on heart rate---but the virtual distractor did not affect the strength of fear responses. In Study 3 (N = 50), the effects of trait height-fearfulness and height level on fear responses were investigated in more detail. Self-rated level of acrophobia and five different height levels in VR (1 m--20 m) were used as linear predictors of subjective and physiological indices of fear. Results showed that subjective fear and skin conductance responses were a function of both trait height-fearfulness and height level, whereas no clear effects were visible for heart rate. Study 4 (N = 64 + N = 49) aimed to advance the understanding of the relationship between presence and fear in VR. Previous research indicates a positive correlation between both measures, but possible causal mechanisms have not yet been identified. The study was the first to experimentally manipulate both presence (via the visual and auditive realism of the virtual environment) and fear (by presenting both height and control situations). Results indicated a causal effect of fear on presence, i.e., experiencing fear in a virtual environment led to a stronger sense of `being there' in the virtual environment. However, conversely, presence increased by higher scene realism did not affect fear responses. Nonetheless, presence seemed to have some effects on fear responding via another pathway, as participants whose presence levels were highest in the first safe context were also those who had the strongest fear responses in a later height situation. This finding indicated the importance of immersive user characteristics in the emergence of presence and fear in VR. The findings of the first four studies were integrated into a model of fear in VR, extending previous models and highlighting factors that lead to the emergence of both fear and presence in VR. Results of the studies showed that fear responses towards virtual heights were affected by trait height-fearfulness, phobic elements in the virtual environment, and, at least to some degree, on presence. Presence, on the other hand, was affected by experiencing fear in VR, immersion---the characteristics of the VR system---and immersive user characteristics. Of note, the manipulations of immersion used in the present thesis, visual and auditory realism of the virtual environment and tactile wind simulation, were not particularly effective in manipulating presence. Finally, Study 5 (N = 34) compared two different implementations of VRET for acrophobia to investigate mechanisms underlying its efficacy. The first implementation followed the Emotional Processing Theory, assuming that fear reduction during exposure is crucial for positive treatment outcome. In this condition, patients were asked to focus on their fear responses and on the decline of fear (habituation) during exposures. The second implementation was based on the inhibitory learning model, assuming that expectancy violation is the primary mechanism underlying exposure therapy efficacy. In this condition, patients were asked to focus on the non-occurrence of feared outcomes (e.g., 'I could fall off') during exposure. Based on predictions of the inhibitory learning model, the hypothesis for the study was that expectancy-violation-based exposure would outperform habituation-based exposure. After two treatment sessions in VR, both treatment conditions effectively reduced the patients' fear of heights, but the two conditions did not differ in their efficacy. The study replicated previous studies by showing that VRET is an effective treatment for acrophobia; however, contrary to the assumption, explicitly targeting the violation of threat expectancies did not improve outcome. This finding adds to other studies failing to provide clear evidence for expectancy violation as the primary mechanism underlying exposure therapy. Possible explanations for this finding and clinical implications are discussed, along with suggestions for further research.},
  subject      = {Virtuelle Realit{\"a}t},
  language  = {en}
}
@article{BreilKanskePittigetal.2021,
  author    = {Breil, Christina and Kanske, Philipp and Pittig, Roxana and B{\"o}ckler, Anne},
  title     = {A revised instrument for the assessment of empathy and Theory of Mind in adolescents: Introducing the EmpaToM-Y},
  series = {Behavior Research Methods},
  volume    = {53},
  journal   = {Behavior Research Methods},
  doi       = {10.3758/s13428-021-01589-3},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-302877},
  pages     = {2487-2501},
  year      = {2021},
  abstract  = {Empathy and Theory of Mind (ToM) are two core components of social understanding. The EmpaToM is a validated social video task that allows for independent manipulation and assessment of the two capacities. First applications revealed that empathy and ToM are dissociable constructs on a neuronal as well as on a behavioral level. As the EmpaToM has been designed for the assessment of social understanding in adults, it has a high degree of complexity and comprises topics that are inadequate for minors. For this reason, we designed a new version of the EmpaToM that is especially suited to measure empathy and ToM in youths. In experiment 1, we successfully validated the EmpaToM-Y on the original EmpaToM in an adult sample (N = 61), revealing a similar pattern of results across tasks and strong correlations of all constructs. As intended, the performance measure for ToM and the control condition of the EmpaToM-Y showed reduced difficulty. In experiment 2, we tested the feasibility of the EmpaToM-Y in a group of teenagers (N = 36). Results indicate a reliable empathy induction and higher demands of ToM questions for adolescents. We provide a promising task for future research targeting inter-individual variability of socio-cognitive and socio-affective capacities as well as their precursors and outcomes in healthy minors and clinical populations.},
  language  = {en}
}
@article{PittigHeinigGoerigketal.2021,
  author    = {Pittig, Andre and Heinig, Ingmar and Goerigk, Stephan and Thiel, Freya and Hummel, Katrin and Scholl, Lucie and Deckert, J{\"u}rgen and Pauli, Paul and Domschke, Katharina and Lueken, Ulrike and Fydrich, Thomas and Fehm, Lydia and Plag, Jens and Str{\"o}hle, Andreas and Kircher, Tilo and Straube, Benjamin and Rief, Winfried and Koelkebeck, Katja and Arolt, Volker and Dannlowski, Udo and Margraf, J{\"u}rgen and Totzeck, Christina and Schneider, Silvia and Neudeck, Peter and Craske, Michelle G. and Hollandt, Maike and Richter, Jan and Hamm, Alfons and Wittchen, Hans-Ulrich},
  title     = {Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial},
  series = {Depression and Anxiety},
  volume    = {38},
  journal   = {Depression and Anxiety},
  number    = {11},
  doi       = {10.1002/da.23204},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-257331},
  pages     = {1169-1181},
  year      = {2021},
  abstract  = {Background The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. Methods This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. Results Both treatments resulted in substantial improvements at post (PeEx-I: d\(_{within}\) = 1.50, PeEx-S: d\(_{within}\) = 1.78) and follow-up (PeEx-I: d\(_{within}\) = 2.34; PeEx-S: d\(_{within}\) = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32\% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TR\(_{PeEx-I}\)-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. Conclusions Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.},
  language  = {en}
}