{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:41:17Z","timestamp":1771605677836,"version":"3.50.1"},"reference-count":122,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,11]],"date-time":"2024-08-11T00:00:00Z","timestamp":1723334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["7R21MH101564\u201002"],"award-info":[{"award-number":["7R21MH101564\u201002"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acamh.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Child Psychology Psychiatry"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The real\u2010world effectiveness of exposure\u2010based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA\u2010based search yielded 20 controlled experiments based on three paradigms that tested if fear\u2010related responses could be reduced without conscious awareness in highly phobic, transition\u2010age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta\u2010analyses of outcomes where feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.51\u20130.95) and self\u2010reported fear (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.45\u20131.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.54\u20130.62) and concomitant physiological arousal (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.55\u20130.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20091.2\u20131.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.70); (5) evoked ERPs suggesting encoding of extinction memories (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20092.13); and (6) had these effects without inducing autonomic arousal or subjective fear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition\u2010age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpp.14037","type":"journal-article","created":{"date-parts":[[2024,8,11]],"date-time":"2024-08-11T20:39:18Z","timestamp":1723408758000},"page":"98-121","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Advancing the treatment of anxiety disorders in transition\u2010age youth: a review of the therapeutic effects of unconscious exposure"],"prefix":"10.1111","volume":"66","author":[{"given":"Paul","family":"Siegel","sequence":"first","affiliation":[{"name":"Department of Psychology Purchase College, State University of New York  Purchase NY USA"},{"name":"Department of Psychiatry Keck School of Medicine, University of Southern California  Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley S.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Keck School of Medicine, University of Southern California  Los Angeles CA USA"},{"name":"Department of Psychiatry Children's Hospital Los Angeles, Institute for the Developing Mind  Los Angeles CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0019927"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2010.02251.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.06.029"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(96)00069-1"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029585"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000265"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.114.1.80"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/1528-3542.4.4.340"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03202793"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2006.10.002"},{"key":"e_1_2_7_13_1","volume-title":"Statistical power analysis for the behavioral sciences","author":"Cohen J.","year":"1988"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2014.04.006"},{"key":"e_1_2_7_15_1","unstructured":"Critical Appraisal Skills Programme. (2021).CASP Randomised Controlled Trial Checklist. Available from:https:\/\/casp\u2010uk.net\/images\/checklist\/documents\/CASP\u2010Randomised\u2010Controlled\u2010Trial\u2010Checklist\/CASP\u2010RCT\u2010Checklist\u2010PDF\u2010Fillable\u2010Form.pdf"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-050718-095608"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2007.03.004"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2008.06.029"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30169-X"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8986.1994.tb02446.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2007.07030504"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.99.1.20"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291701004056"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.654170"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2010.09.047"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cbpra.2015.04.003"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2014.03.030"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.11.001"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2012.711770"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2010.07.021"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2011.10.005"},{"key":"e_1_2_7_32_1","first-page":"257","article-title":"Emotion regulation in spider phobia: Role of the medial prefrontal cortex","volume":"4","author":"Hermann A.","year":"2009","journal-title":"SCAN"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2007.04.009"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.2174\/138161212803530916"},{"key":"e_1_2_7_35_1","first-page":"5","article-title":"Risks associated with untreated PTSD in combat veterans: Implications for improving mental health care engagement and treatment","volume":"30","author":"Hoge C.W.","year":"2013","journal-title":"Federal Practitioner"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03194980"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.13m08361"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0033164"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9280.00368"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.6.593"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-016-0006"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.15-10-06846.1995"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2016.16030353"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1080\/15374416.2017.1310046"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2005.11.004"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2011.04.005"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.111.1.107"},{"key":"e_1_2_7_48_1","volume-title":"Detection theory: A user's guide","author":"Macmillan N.A.","year":"2005"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2018.05.007"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2013.00389"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2011.04.023"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1080\/10615809908248330"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.13818"},{"key":"e_1_2_7_54_1","unstructured":"McMurtry C.M.(2021).Needle fear is an underrecognized vaccine challenge. New York Times. May 21."},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000273"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000272"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2010.05.017"},{"key":"e_1_2_7_58_1","first-page":"1295","volume-title":"The new cognitive neurosciences","author":"Merikle P.M.","year":"2000"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2014.08.006"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.102.2.304"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1177\/2167702617696359"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1038\/30976"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.96.4.1680"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7916(96)00022-5"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22883"},{"key":"e_1_2_7_67_1","unstructured":"NIMH. (2008).Strategic Plan Sidebar 1 to Strategic Objective 3. Available from:www.nimh.nih.gov\/about\/strategic\u2010planning\u2010reports\/nimh\u2010strategic\u2010plan\u20102008.pdf"},{"key":"e_1_2_7_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2014.11.005"},{"key":"e_1_2_7_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2010.09.013"},{"key":"e_1_2_7_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2022.104203"},{"key":"e_1_2_7_71_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.108.3.483"},{"key":"e_1_2_7_72_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.102.1.121"},{"key":"e_1_2_7_73_1","doi-asserted-by":"publisher","DOI":"10.1037\/0096-3445.127.1.69"},{"key":"e_1_2_7_74_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.103.2.231"},{"key":"e_1_2_7_75_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0015158"},{"key":"e_1_2_7_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2017.07.008"},{"key":"e_1_2_7_77_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_7_78_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2835"},{"key":"e_1_2_7_79_1","first-page":"1","article-title":"Cortico\u2010striatal\u2010thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment","volume":"2016","author":"Peters S.K.","year":"2016","journal-title":"Frontiers in Systems Neuroscience"},{"key":"e_1_2_7_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2004.08.042"},{"key":"e_1_2_7_81_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-019-01469-4"},{"key":"e_1_2_7_82_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.61.11.1136"},{"key":"e_1_2_7_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(98)00106-5"},{"key":"e_1_2_7_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2010.12.001"},{"key":"e_1_2_7_85_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.20503"},{"key":"e_1_2_7_86_1","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2009.83"},{"key":"e_1_2_7_87_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2010.09.003"},{"key":"e_1_2_7_88_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2021.08.022"},{"key":"e_1_2_7_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2014.10.005"},{"key":"e_1_2_7_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30285-6"},{"key":"e_1_2_7_91_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699931.2012.756803"},{"key":"e_1_2_7_92_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0030833"},{"key":"e_1_2_7_93_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyp.13045"},{"key":"e_1_2_7_94_1","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.23533"},{"key":"e_1_2_7_95_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2009.08.001"},{"key":"e_1_2_7_96_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0026806"},{"key":"e_1_2_7_97_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0036733"},{"key":"e_1_2_7_98_1","article-title":"Unconsciously formed memories may be smarter than you think: Subliminal event\u2010related theta synchonization moderates extinction","author":"Snodgrass M.","year":"2023","journal-title":"Emotion"},{"key":"e_1_2_7_99_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.conb.2010.02.005"},{"key":"e_1_2_7_100_1","volume-title":"Manual for the state\u2010trait anxiety inventory","author":"Spielberger C.D.","year":"1983"},{"key":"e_1_2_7_101_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291707000086"},{"key":"e_1_2_7_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7916(94)00072-T"},{"key":"e_1_2_7_103_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1721572115"},{"key":"e_1_2_7_104_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-019-0520-3"},{"key":"e_1_2_7_105_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201200454"},{"key":"e_1_2_7_106_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0022681"},{"key":"e_1_2_7_107_1","article-title":"Psychological interventions for needle\u2010related procedural pain and distress in children and adolescents","volume":"10","author":"Uman L.S.","year":"2013","journal-title":"Cochrane Database Systematic Reviews"},{"key":"e_1_2_7_108_1","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2014.220"},{"key":"e_1_2_7_109_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.06.065"},{"key":"e_1_2_7_110_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-050212-185542"},{"key":"e_1_2_7_111_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2008.09.006"},{"key":"e_1_2_7_112_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717000174"},{"key":"e_1_2_7_113_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0015635"},{"key":"e_1_2_7_114_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.86.3.627"},{"key":"e_1_2_7_115_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2011.01.003"},{"key":"e_1_2_7_116_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2017.10.010"},{"key":"e_1_2_7_117_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1103617"},{"key":"e_1_2_7_118_1","doi-asserted-by":"publisher","DOI":"10.1037\/1528-3542.6.4.675"},{"key":"e_1_2_7_119_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4419-6868-5_3"},{"key":"e_1_2_7_120_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.1016-06.2006"},{"key":"e_1_2_7_121_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2008.02.007"},{"key":"e_1_2_7_122_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.20072"},{"key":"e_1_2_7_123_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-26977-3"}],"container-title":["Journal of Child Psychology and Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acamh.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jcpp.14037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T20:07:40Z","timestamp":1762200460000},"score":1,"resource":{"primary":{"URL":"https:\/\/acamh.onlinelibrary.wiley.com\/doi\/10.1111\/jcpp.14037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,11]]},"references-count":122,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/jcpp.14037"],"URL":"https:\/\/doi.org\/10.1111\/jcpp.14037","archive":["Portico"],"relation":{},"ISSN":["0021-9630","1469-7610"],"issn-type":[{"value":"0021-9630","type":"print"},{"value":"1469-7610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,11]]},"assertion":[{"value":"2024-04-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}