Values- versus monetary reward-enhanced exposure therapy for the treatment of social anxiety in emerging adulthood

Exposure therapy represents the gold-standard treatment for social anxiety, yet evidence indicates the need for improvement. One promising avenue involves linking exposures to a motivator. The current study examined the impact of intrinsically-rewarding, personal values-enhanced versus extrinsically-rewarding, monetary-enhanced exposure on short-term social anxiety fear and avoidance outcomes, and evaluated impacted initial treatment motivation and exposure generalization.Methods: Sixty emerging adults ages 17-26 with significantly elevated social and public speaking anxiety were randomized to receive values-enhanced exposure, monetary reward-enhanced exposure, or exposure alone. They completed a laboratory session with a brief intervention and speech exposure, one-week follow-up with novel exposure, and online follow-up two weeks later. Subjective and behavioral anxiety measures were collected.Results: Linking exposures to values decreased self-reported anxiety following the speech exposure retest, which generalized to anticipatory anxiety prior to a novel speech task. Linking exposures to money temporarily increased speech length, but this difference did not remain during the novel task. Conditions showed similar improvements on other outcomes.Conclusion: Extrinsic motivators can temporarily motivate exposure engagement, whereas a brief values intervention can enhance exposure learning and decrease subjective anxiety across feared situations compared to monetary enhancement. If replicated, this has pragmatic implications for exposure framing within social anxiety treatment.