Free Expectancy Violation Worksheet: Testing Predictions in Exposure Therapy
Exposure · Inhibitory Learning · Research-supported
A worksheet that structures every exposure exercise around an explicit, gradable prediction, meaning what the client expects to happen and how strongly they believe it (0–100%), compared afterwards with what actually happened, so the size of the mismatch, not the drop in distress, is what the client and clinician track.
Underlying mechanism: Expectancy violation within the inhibitory learning model of exposure
What it helps with
- Forcing predictions into specific, testable form before an exposure begins, rather than a vague sense that "something bad" will happen.
- Making the prediction-outcome mismatch, and therefore the new learning, explicit and visible after each trial.
- Shifting the clinical conversation away from "did your anxiety go down?" toward "was your prediction accurate?".
- Building a belief-conviction record across trials that shows whether the feared belief is weakening over time.
How clinicians use it
- Used in every exposure session from session 4 onward, paired with the ERP Inhibitory Learning Log for between-session tracking.
- Completed before each exposure, with the prediction written down and rated for belief strength before the trial starts.
- Reviewed immediately after each trial while memory of the outcome is fresh and specific.
Clinical Implementation Guide
- Write the prediction as a specific, checkable sentence, ideally in the client's own words, before the exposure begins.
- Rate belief strength on the 0–100% scale before the trial, and again afterward, so the shift is quantified rather than described impressionistically.
- Debrief the mismatch explicitly and immediately, "how big was the gap between what you expected and what happened?", as the primary review question.
What the worksheet looks like
| Prediction | Belief Strength (0-100%) | What Actually Happened | Mismatch Size |
|---|---|---|---|
| "If I raise this in the meeting, my manager will criticise me in front of everyone." | 75% | Manager said "good point" and moved the discussion forward. | Large mismatch: prediction did not occur at all. |
| "If I don't reply to this text within an hour, my friend will assume I don't care." | 60% | Friend replied the next morning, no mention of the delay. | Large mismatch: no evidence the delay registered at all. |
Clinical cautions
Ensure predictions are specific and testable, not vague. Avoid exposures where the feared outcome has a non-trivial probability of actually occurring without clinical supervision.
References
- Craske, M. G., et al. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
Part of
Systematic Exposure Protocol
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