Inhibitory Learning versus Habituation in an Experimental Exposure Intervention for People With Heightened Health Anxiety: Increase of Distress Tolerance as a Joint Mechanism of Change?

Abstract

The Inhibitory Learning Theory (ILT; Craske et al., 2008) changed the focus of exposure-based treatment from erasing excitatory associations and fear reduction (habituation (HA)) to reinforcing inhibitory associations and fear toleration (inhibitory learning (IL)). Studies which directly compare both approaches, IL versus HA, are scarce. The present study aimed at implementing and comparing an IL-based ( n = 26; Age: M = 23.59, SD = 4.38) with a HA-based ( n = 28; Age: M = 25.46, SD = 6.22) experimental exposure approach (including in vivo, interoceptive, and in sensu exposure) in a sample of people with heightened health anxiety. A significant pre- to post-intervention reduction of state health anxiety ( p < .001), which was especially associated with an increase of distress tolerance (DT) pre- to post-exposure ( F (1, 50) = 12.2, p < .001, ηp2 = .20), was observed. A superiority of the IL-based over the HA-based exposure intervention was not detected in relation to major outcomes (e.g., state health anxiety), as well as in relation to a change of DT. The present study underlines the importance of strengthening DT (for heightened health anxiety) during an exposure-based intervention.

Exposure therapy tailored to inhibitory learning principles in a naturalistic setting: an open pilot trial in obsessive-compulsive outpatient care

“…Habituation can be assumed an indicator of change ( Jacoby and Abramowitz, 2016 ) that, according to IL theory, may or may not occur. Accordingly, from a clinical point of view, there are difficulties distinguishing habituation-based from IL-based procedures ( Sauer and Witthöft, 2022 ). As Weisman and Rodebaugh (2018 , p. 36) put it, IL should thus be regarded “an overarching way to conduct exposure,” “a unified exposure paradigm, with dual foci on violating expectancies and incorporating variability,” and thereby an “ideal path to improving the efficacy of exposure.” In addition, there are further important mechanisms of change, such as increased distress tolerance, or improved self-efficacy, which also contribute to the effectiveness of exposure (e.g., Knowles and Olatunji, 2019 ; Sauer and Witthöft, 2022 ).…”

“…As Weisman and Rodebaugh (2018, p. 36) put it, IL should thus be regarded "an overarching way to conduct exposure, " "a unified exposure paradigm, with dual foci on violating expectancies and incorporating variability, " and thereby an "ideal path to improving the efficacy of exposure. " In addition, there are further important mechanisms of change, such as increased distress tolerance, or improved self-efficacy, which also contribute to the effectiveness of exposure (e.g., Knowles and Olatunji, 2019;Sauer and Witthöft, 2022).…”