Evaluating differences in Pavlovian fear acquisition and extinction as predictors of outcome from cognitive behavioural therapy for anxious children

Waters, Allison M.; Pine, Daniel S.

doi:10.1111/jcpp.12522

Cited by 84 publications

(65 citation statements)

References 33 publications

(48 reference statements)

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“…First, given the context dependent nature of extinction learning, future research should examine extinction learning across contexts among unaffected youth and youth with fear-based psychiatric disorders, as it may be associated with symptom relapse after CBT. Second, prospective treatment studies are needed to examine whether pre-treatment extinction learning and/or retention predicts CBT treatment response [79]. This information could clarify the degree to which pre-treatment extinction learning and retention might serve as indicators for a positive response to CBT.…”

Section: Discussionmentioning

confidence: 99%

“…When testing extinction retention, anxious youth were found to exhibit a difference in activated neural structures [41]. Extinction learning in anxious youth has been linked with changes in child-reported anxiety symptoms following group CBT; non-responders were found to have greater SR fear to stimuli during conditioning [79]. Taken together, variable findings exist regarding extinction learning and retention among youth with anxiety disorders across psychophysiological and SR outcomes.…”

Section: Threat Conditioning and Extinction In Youth With Anxiety mentioning

confidence: 99%

“…However, there is inconsistent evidence linking extinction and/or extinction retention with CBT outcomes. Waters and Pine [79] found that greater pre-treatment psychophysiological extinction learning predicted greater reductions in child-rated anxiety after group CBT. However, there has been mixed evidence regarding SR extinction and extinction retention (via subjective units of distress, SUDS) predicting treatment outcome in individual CBT [86,87].…”

Section: Implications For Treatment Based On Impaired Threat Condimentioning

confidence: 99%

“…Fourth, there will likely be an increase in the examination of pre-treatment extinction learning as a potential predictor of exposure-based CBT outcomes. One study has recently provided support for a relationship between conditioning and extinction learning with group CBT treatment response [79], and other studies are on the horizon [95]. Finally, there will likely be several studies examining the benefit of inhibitory learning strategies on extinction learning and retention in unaffected youth and youth with fear-based psychiatric disorders.…”

Section: Five-year Viewmentioning

confidence: 99%

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Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment

McGuire

Orr

Essoe

et al. 2016

Expert Review of Neurotherapeutics

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Introduction Threat conditioning and extinction play an important role in anxiety disorders, obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Although these conditions commonly affect children, threat conditioning and extinction have been primarily studied in adults. However, differences in phenomenology and neural architecture prohibit the generalization of adult findings to youth. Areas covered A comprehensive literature search using PubMed and PsycInfo was conducted to identify studies that have used differential conditioning tasks to examine threat acquisition and extinction in youth. The information obtained from this review helps to clarify the influence of these processes on the etiology and treatment of youth with OCD, PTSD and other anxiety disorders. Thirty studies of threat conditioning and extinction were identified. Expert Commentary Youth with anxiety disorders, OCD, and PTSD have largely comparable threat acquisition relative to unaffected controls, with some distinctions noted for youth with PTSD or youth who have suffered maltreatment. However, impaired extinction was consistently observed across youth with these disorders and appears to be consistent with deficiencies in inhibitory learning. Incorporating strategies to improve inhibitory learning may improve extinction learning within extinction-based treatments like cognitive behavioral therapy (CBT). Strategies to improve inhibitory learning in CBT are discussed.

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Section: Discussionmentioning

confidence: 99%

Section: Threat Conditioning and Extinction In Youth With Anxiety mentioning

confidence: 99%

Section: Implications For Treatment Based On Impaired Threat Condimentioning

confidence: 99%

Section: Five-year Viewmentioning

confidence: 99%

See 2 more Smart Citations

Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment

McGuire

Orr

Essoe

et al. 2016

Expert Review of Neurotherapeutics

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“…These intervention techniques form the backbone of most empirically-supported psychosocial treatments for anxiety, depression, behavior problems, and substance abuse in youth (Chorpita & Daleiden, 2009). For example, exposure-based interventions for anxiety facilitate extinction learning when that process does not occur naturally (Waters & Pine, in press). Behavioral activation for depression aims to increase motivation for reward through repeated engagement in pleasurable activities.…”

Section: A Novel Approach: Dimensions Of Adversitymentioning

confidence: 99%

Beyond Cumulative Risk

McLaughlin

Sheridan

2016

Curr Dir Psychol Sci

563

288

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Children who have experienced environmental adversity—such as abuse, neglect, or poverty—are more likely to develop physical and mental health problems, perform poorly at school, and have difficulties in social relationships than children who have not encountered adversity. What is less clear is how and why adverse early experiences exert such a profound influence on children’s development. Identifying developmental processes that are disrupted by adverse early environments is the key to developing better intervention strategies for children who have experienced adversity. Yet, much existing research relies on a cumulative risk approach that is unlikely to reveal these mechanisms. This approach tallies the number of distinct adversities experienced to create a risk score. This risk score fails to distinguish between distinct types of environmental experience, implicitly assuming that very different experiences influence development through the same underlying mechanisms. We advance an alternative model. This novel approach conceptualizes adversity along distinct dimensions, emphasizes the central role of learning mechanisms, and distinguishes between different forms of adversity that might influence learning in distinct ways. A key advantage of this approach is that learning mechanisms provide clear targets for interventions aimed at preventing negative developmental outcomes in children who have experienced adversity.

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Large‐scale remote fear conditioning: Demonstration of associations with anxiety using the FLARe smartphone app

McGregor

Purves

Constantinou

et al. 2021

Depression and Anxiety

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Objectives: We aimed to examine differences in fear conditioning between anxious and nonanxious participants in a single large sample. Materials and methods:We employed a remote fear conditioning task (FLARe) to collect data from participants from the Twins Early Development Study (n = 1,146; 41% anxious vs. 59% nonanxious). Differences between groups were estimated for their expectancy of an aversive outcome towards a reinforced conditional stimulus (CS+) and an unreinforced conditional stimulus (CS−) during acquisition and extinction phases.Results: During acquisition, the anxious group (vs. nonanxious group) showed greater expectancy towards the CS−. During extinction, the anxious group (vs. nonanxious group) showed greater expectancy to both CSs. These comparisons yielded effect size estimates (d = 0.26-0.34) similar to those identified in previous meta-analyses. Conclusion:The current study demonstrates that remote fear conditioning can be used to detect differences between groups of anxious and nonanxious individuals, which appear to be consistent with previous meta-analyses including in-person studies.

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Evaluating differences in Pavlovian fear acquisition and extinction as predictors of outcome from cognitive behavioural therapy for anxious children

Abstract: Individual differences in evaluative and physiological indices of fear extinction might moderate response to CBT.

Cited by 84 publications

References 33 publications

Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment

Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment

Beyond Cumulative Risk

Large‐scale remote fear conditioning: Demonstration of associations with anxiety using the FLARe smartphone app

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