Does fear extinction in the laboratory predict outcomes of exposure therapy? A treatment analog study

Abstract

Fear extinction models have a key role in our understanding of anxiety disorders and their treatment with exposure therapy. Here, we tested whether individual differences in fear extinction learning and fear extinction recall in the laboratory were associated with the outcomes of an exposure therapy analog (ETA). Fifty adults with fear of spiders participated in a two-day fear-learning paradigm assessing fear extinction learning and fear extinction recall, and then underwent a brief ETA. Correlational analyses indicated that enhanced extinction learning was associated with better ETA outcome. Our results partially support the idea that individual differences in fear extinction learning may be associated with exposure therapy outcome, but suggest that further research in this area is needed.

Generalization of fear in post‐traumatic stress disorder

“…Additionally, the stability of parameters of generalization has to be investigated. Similarly, we cannot answer the question whether parameters from experimental approaches can be linked to treatment responses, as has been shown, for example, for the FPS response during extinction of conditioned fear and the effectiveness of an exposure therapy in spider phobia (Forcadell et al, ).…”

The association between fear extinction, the ability to accomplish exposure and exposure therapy outcome in specific phobia

“…Consequently, research on the cognitive and neurobiological foundations of extinction as the laboratory analog of exposure might pave the way to understand and improve exposure treatment efficacy. Ultimately, by bridging the gap between the laboratory and the clinic 9 , it might guide individualized treatment options for anxiety disorders, which are derived from a mechanism-based understanding of extinction 10 .Despite the strong evidence for an implication of the extinction model in the etiology and treatment of anxiety disorders 11 , very few studies have examined the mutual relationship between extinction learning performance and exposure therapy outcome [12][13][14] . Waters and Pine 12 assessed fear conditioning in anxious children who responded well and children who did not respond to cognitive behavioral therapy (CBT).…”

“…Despite the strong evidence for an implication of the extinction model in the etiology and treatment of anxiety disorders 11 , very few studies have examined the mutual relationship between extinction learning performance and exposure therapy outcome [12][13][14] . Waters and Pine 12 assessed fear conditioning in anxious children who responded well and children who did not respond to cognitive behavioral therapy (CBT).…”

“…While in this pioneering work of Waters and Pine 12 the relation between CBT-success in general (defined as the absence of a diagnosis after therapy completion) and fear conditioning was assessed in children, two other studies analyzed the predictive value of fear conditioning measures to standardized exposure benefit in adults. Forcadell et al 13 provided evidence for an association between fear extinction and the outcomes of an analog of exposure therapy. Individuals with fear of spiders showed higher extinction learning capacity (based on the discrimination ratio between the CS+ and CS−) and exhibited greater fear reduction from pre-to postexposure therapy analog.…”

“…In conclusion, the methodology, direction and pattern of associations between fear conditioning measures and exposure outcome measures varies greatly and warrants further replication. In terms of methodology, some studies related different fear conditioning measures to various treatment outcome measures to derive meaningful associations 13,14 . This approach might be difficult for several reasons: Fear conditioning can be assessed on different fear system levels, e.g., by using physiological, valence and/or contingency measures.…”