Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial

Maximizar la terapia de exposición: Un enfoque basado en el aprendizaje inhibitorio

“…En la agorafobia, esta aproximación mostró el mismo benefi cio a largo plazo con un solo ensayo de exposición en dos días que con ensayos de exposición repetidos cada día (Baker et al, 2010). Deacon et al (2013) mostraron que la exposición interoceptiva que duraba hasta que las expectativas de una consecuencia aversiva disminuían a menos del 5% era superior a una exposición interoceptiva estándar. Desde este enfoque, las tareas de exposición se diseñan para acomodar "qué es lo que necesitas aprender" en lugar de primar la reducción del miedo o "continúa en la situación hasta que el miedo disminuya", como se defendería desde un modelo de terapia de exposición basado en la habituación.…”

Conquer your cravings

“…In this study, participants in the expectancy violation condition reported less panic attacks, anxiety and avoidance of fearful situations after therapy, and also dared to encounter more fearful situations in a behavioural test, compared to the habituation condition in which exposure exercises to feared situations were followed in a hierarchical order. Evidence for the importance of targeting expectancies during exposure was also found in another study in students suffering from anxiety specific for respiratory sensations (Deacon et al, 2013). In this study, an intensive exposure condition, in which participants received as much 60-second exposure trials as needed (with a minimum of eight trials) to reduce the feared outcome, was compared to 'standard' exposure conditions, in which a standard number of three 60-second exposure trials were used, and progress to the next exposure trial was based on sufficient habituation of body sensations.…”

“…Using this method, exposure sessions can be stopped when the feared outcome is no longer expected, which might take less time than waiting until fear levels habituate. Exposure sessions for panic disorder with agoraphobia focusing on expectancy violation have shown to result in better treatment outcome compared to exposure sessions focusing on habituation (Salkovskis, Hackmann, Wells, Gelder, & Clark, 2006), and continuing exposure therapy until the expectancy of the feared outcome was 5% or less was superior to exposure therapy that ended at higher expectancies (Deacon et al, 2013). Expectancy violation during exposure seems well-translatable to food cue exposure, as expectancies of overeating and loss of control can be violated .…”

“…Others found that an intensive exposure condition that continued exposure therapy until the expectancy of the feared outcome was 5% or less was superior to two lower-dose exposure therapy conditions that ended at higher expectancies (Deacon et al, 2013). In this study, the amount of exposure was much longer in the intensive exposure condition compared to the lower-dose conditions, though, interestingly, the superior treatment outcome in the intensive exposure condition compared to the other conditions was fully mediated by the violation of danger expectancies during exposure (Deacon et al, 2013).…”

“…This violation of CS-US expectancies could be achieved in food cue exposure by identifying a patient's specific overeating cues that are linked to strong eating expectancies (e.g., "If I feel exhausted and chocolate is available [CS], then I will lose control and eat the entire chocolate bar [US]"), and exposing that patient to these exact cues while testing whether the US indeed takes place as expected. Exposure therapy for panic disorder aimed at expectancy violation has been shown to be superior to exposure aimed a habituation of anxiety (Salkovskis, Hackmann, Wells, Gelder, & Clark, 2006) and continuing exposure therapy until the expectancy of the feared outcome was maximally 5% led to better outcomes than ending at higher expectancies (Deacon et al, 2013). To date, no food cue exposure studies have aimed exposure sessions on expectancy violation, or have compared the expectancy violation approach to the traditional habituation approach.…”