Exposure therapy for obsessive–compulsive disorder: An optimizing inhibitory learning approach

Arch, Joanna J.; Abramowitz, Jonathan S.

doi:10.1016/j.jocrd.2014.12.002

Cited by 78 publications

(29 citation statements)

References 37 publications

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“…The ERP group consisted of 10 two-hour sessions based on treatment recommendations derived from inhibitory learning theory (Abramowitz & Arch, 2014;Arch & Abramowitz, 2015). Session 1 introduced the rationale for ERP.…”

Section: Erp Groupsmentioning

confidence: 99%

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

Strauss

Lea

Hayward

et al. 2018

Journal of Anxiety Disorders

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Background: Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods: This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results: Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP -the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions: MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

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Section: Erp Groupsmentioning

confidence: 99%

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

Strauss

Lea

Hayward

et al. 2018

Journal of Anxiety Disorders

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“…Thus, CBT exposures that emphasize inhibitory learning principles may improve extinction learning and retention and thereby lead to improved clinical outcomes. Several strategies that focus on enhancing inhibitory learning, retention, and retrieval have been suggested to improve extinction during exposures among adults [27,28,89,90], and may be beneficial for youth when implemented in a developmentally appropriate manner. There are a handful of articles that describe the theoretical rationale for inhibitory learning strategies in detail, and clarify more fully how these strategies differ from prior theoretical approaches [27,28].…”

Section: Implications For Treatment Based On Impaired Threat Condimentioning

confidence: 99%

“…For example, the child might view a dog from afar and then wait 10 minutes before actually conducting the repeated exposure trials. Two additional strategies that may improve inhibitory learning include affect labeling ( identifying and labeling emotions during exposures) [92], and increased time intervals between sessions (gradually increasing the time and duration between exposure sessions during relapse prevention and booster sessions) [28,89]. …”

Section: Implications For Treatment Based On Impaired Threat Condimentioning

confidence: 99%

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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“…However, ET seems to be able to disconfirm misattributions by violating expectations without explicitly targeting them with cognitive techniques. Through experiential evidence, ET can thus cause the same cognitive changes as CT, as proposed in the inhibitory learning model (see, for example, Arch and Abramowitz, 2014; Bouton, 1993; Bouton, Woods, Moody, Sunsay and García-Gutiérrez, 2006; Craske et al, 2008; Craske, Treanor, Conway, Zbozinek and Vervliet, 2014; Vervliet, Craske and Hermans, 2013). In this process, non-danger based associations between the conditioned and unconditioned stimulus are formed (“Dizziness is not dangerous and may occur”), and fear tolerance (“Fear is tolerable”) is increased; then, the non-danger based associations compete with original danger based associations (“Dizziness is dangerous and a sign of a brain tumour”).…”

Section: Discussionmentioning

confidence: 83%

Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy

Schwind

Neng

Weck

2016

Behav. Cogn. Psychother.

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Exposure therapy for obsessive–compulsive disorder: An optimizing inhibitory learning approach

Cited by 78 publications

References 37 publications

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

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

Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy

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