What makes treatments work towards a new paradigm beyond behavioural and cognitive therapy

Background: Most psychotherapies that reduced anxiety disorders reliably in randomised controlled trials (RTCs) shared an element of habituation by sy stematic exposure. Recent work, however, suggests that exposure may not be necessary as well as sufficient to reduce fear. Results: In recent RTCs sev eral psychotherapeutic approaches improved anxiety disorders without exposu re: cognitive therapy without exposure in the form of behavioural experimen ts, muscle tensing, and problem-solving. Mindful meditation may be another way to reduce fear. There may be no single common path to fear-reduction. C ertain therapy ingredients might act on specific emotional components with particular rippling effects on other loosely-liked components in fear netwo rks. Conclusions: There may be one or several paths to fear-reduction, some of which may be one-way and others two-way. It is not yet known which mech anisms converge on common end paths of action and which act on unique route s, which act alone and which as cofactors. Particular experiments could hel p map the terrain further, and work is needed to evolve a widely agreed glo ssary of fear-reducing procedures.