Rethinking Exposure: Inhibitory Learning as an Alternative to Habituation

Exposure therapy has long been a cornerstone in the treatment of anxiety-related conditions. Traditionally, its effectiveness has been understood through the lens of habituation—the idea that with repeated exposure to a feared stimulus, anxiety will gradually decrease.

While this model has proven clinically useful, recent developments in the science of learning suggest a need to revisit and expand our understanding. In particular, Inhibitory Learning Theory (ILT) offers an alternative perspective that shifts the focus from reducing distress to facilitating new, more adaptive learning.

This post outlines the key distinctions between habituation and ILT, and discusses why ILT may offer particular advantages in working with complex and treatment-resistant cases.

The Habituation Model: Strengths and Limitations

Habituation refers to a decrease in anxiety or arousal following repeated exposure to a feared stimulus. The traditional view is that as clients stay in contact with a feared situation—without avoiding or escaping—it gradually becomes less distressing.

This model provides a simple and intuitive rationale for exposure-based interventions and has been influential in shaping treatment protocols across anxiety disorders. However, it also presents some clinical limitations:

• Progress is often measured by reduction in distress, which can lead clients (and therapists) to interpret persisting anxiety as failure.

• Clients may drop out if relief is not experienced quickly, or if distress returns between sessions.

• Contextual dependency can limit generalisation—exposure may work in one setting but not in others.

• Complex presentations, such as moral injury or intrusive shame-based cognitions, may not involve fear in the traditional sense, making habituation a less relevant mechanism.

Inhibitory Learning Theory: A Different Conceptual Frame

Inhibitory Learning Theory does not reject exposure therapy—it reframes how we understand what makes it effective.

Rather than aiming to reduce fear or distress, ILT views exposure as a process that creates new, inhibitory associations. These compete with the original fear-based associations but do not erase them. The goal is not directly to feel less afraid, but to learn that the feared outcome either does not occur or is more manageable than expected.

This is referred to as expectancy violation, and research suggests that it plays a central role in effective exposure outcomes. The aim of exposure here is to both develop new learning in the context of a distressing stimulus and to reinforce it so that it takes precedence over (i.e., inhibits) the existing learning.

Key Concepts in ILT-Based Exposure

1. Expectancy Violation

The primary driver of learning is the mismatch between what the client expects to happen and what actually occurs. Exposures are more effective when they disconfirm the client’s predictions.

Example: A client who believes “If I speak about this memory, I will lose control” is encouraged to engage in imaginal exposure. When the feared outcome does not occur, a new association is formed: “This memory is distressing, but I can remain grounded.”

2. Distress Tolerance, Not Distress Reduction

While habituation targets a reduction in distress across or within sessions, ILT accepts that distress may remain high—and may even fluctuate unpredictably. The emphasis is on remaining in contact with the feared experience long enough for new learning to take place, not on reducing emotional discomfort.

This reframing can be particularly helpful when working with clients who interpret ongoing anxiety or distress as evidence of failure.

3. Generalisation Through Variability

ILT encourages the use of exposure tasks across a range of settings, emotional states, and contexts. This reduces the risk that new learning is tied too narrowly to a single environment and increases the likelihood that it will generalise to real-world situations.

4. Eliminating Subtle Safety Behaviours

Safety behaviours (e.g., distraction, “just-in-case” planning) may interfere with learning by preventing clients from fully experiencing the feared outcome—or the absence of it. ILT-informed practice encourages identifying and, where appropriate, removing these behaviours to enhance learning.

5. Using Retrieval Cues

Stimuli present during exposure (e.g., specific phrases, objects, or bodily postures) can later serve as retrieval cues, helping clients access new (inhibitory) learning when facing feared situations outside therapy.

Practical Implications for Clinicians

An ILT-informed approach involves more than a shift in technique—it involves a shift in therapeutic stance. Rather than focusing on symptom reduction as the benchmark of success, therapists guide clients to approach feared situations as opportunities to test predictions and develop greater flexibility.

This approach may be especially relevant in presentations involving:

• Persistent or treatment-resistant anxiety

• Internalised moral evaluations (e.g., in moral injury)

• Complex rule-based beliefs (“If I feel this, it means I’m weak/wrong”)

• Recurrent relapse triggered by context shifts

By prioritising learning over relief, ILT may create conditions for durable, generalisable change.

Concluding Thoughts

Both habituation and inhibitory learning offer valuable perspectives on the change processes underpinning exposure therapy. Habituation may still have heuristic and motivational value—particularly in early-stage treatment or with more straightforward phobias.

However, where habituation falls short, ILT provides a compelling, research-informed alternative. It offers a more flexible framework for understanding the learning processes that support behaviour change—especially in the presence of persistent fear, shame, or distress.

For clinicians looking to deepen their conceptual grasp of exposure, ILT provides a useful lens—one that prioritises what is learned, not just what is felt.

Christian Hughes is a Psychotherapist, Clinical Supervisor, and Clinical Trainer, specialising in Acceptance and Commitment Therapy, with expertise in Trauma, PTSD, and a spec

ial interest in Moral Injury. If you would like to know more, or to discuss working with Christian, please get in touch

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