The role of positive linguistic sentiment in extinction learning through exposure therapy

Exposure therapy is derived from extinction learning principles. Evidence suggests that reward processes, including positive affect, may influence extinction learning. Few studies have explored the role of reward and positive affect in exposure. This study sought to address gaps by examining whether linguistic markers of positive affect expressed during exposure predicted learning and clinical outcomes. Adults (N = 47) with social anxiety or panic disorder completed nine sessions of exposure therapy. Participants rated expected likelihood of feared outcome occurrence before and after each exposure, and the difference (expectancy change) was calculated as a measure of learning. Natural language processing was used to analyze sentiment in written and spoken language during consolidation of extinction learning immediately after exposure, resulting in a score that reflected tendency towards positive over negative affect. Anxiety symptoms were assessed weekly at each exposure session and at end of treatment. Higher positive sentiment was associated with greater expectancy change at the between-person level for written and within-person level for spoken sentiment. Higher within-person positive sentiment predicted lower next-session anxiety for spoken sentiment only. Sentiment did not predict overall clinical outcomes. This is the first study to test the role of linguistic sentiment in exposure learning mechanisms and outcomes. More positive sentiment during exposure consolidation may support greater learning and reduced next-session symptoms, but may be insufficient in affecting overall clinical outcomes. It is possible that exposure learning may be maximized by directing attention towards more positive exposure elements; further study is needed to test this.