Overcoming avoidance in anxiety disorders: The contributions of Pavlovian and operant avoidance extinction methods

Abstract

Avoidance is generally adaptive, yet excessive threat-avoidance may soon become maladaptive and lead to functional impairment and psychopathology. Laboratory-based treatment research has provided important insights about the acquisition, maintenance, and extinction of maladaptive avoidance. Despite this, laboratory research on avoidance learning and extinction in humans is relatively underdeveloped. A better understanding of avoidance extinction methods has implications for basic research with humans and the development of treatment interventions aimed at replacing maladaptive behavior with an adaptive, functional repertoire. The present article reviews, for the first time, the use of the term extinction in human research on avoidance, contrasts existing Pavlovian and operant approaches to the extinction of avoidance, considers the validity of approaches to avoidance extinction, and suggests a consistent terminology and research gaps for future translational research on anxiety and related disorders.

Renewal of fear and avoidance in humans to escalating threat: Implications for translational research on anxiety disorders

“…Translational research on fear and avoidance employs variants of Pavlovian threat conditioning and operant avoidance learning paradigms (Dymond, 2019;Dymond & Roche, 2009;LeDoux, Moscarello, Sears, & Campese, 2017;Lonsdorf et al, 2017;Vervliet et al, 2013). In Pavlovian threat conditioning, presentations of one arbitrary cue (a conditional stimulus or CS) are followed by an aversive event (unconditional stimulus or US) such as electrical shock, making it a cue for danger (CS+).…”

“…Studying negatively reinforced avoidance within this arrangement involves providing opportunities to perform discrete responses (e.g., key pressing) in the presence of the CS+ to cancel or postpone upcoming US delivery (Dymond, 2019;LeDoux et al, 2017). Shockavoidance responding is readily acquired under these circumstances, although it may appear excessive when it continues to occur despite the US being withheld or when nonavoidance is not followed by the US (termed fear extinction; Dymond, 2019). In this way, excessive avoidance precludes disconfirming opportunities with the feared situation or event and is likely therefore to contribute to the both the acquisition and persistence of anxiety.…”

“…Unfortunately, little is known about the renewal of avoidance and associations with fear renewal (Dymond, 2019;LeDoux et al, 2017;Urcelay & Prevel, 2019). This represents a significant gap in our knowledge base, as preclinical and clinical research examining the conditions under which return of fear may facilitate a return of avoidance can broaden the current state of fear extinction and renewal research (Vervliet et al, 2013).…”

Relapse of anxiety‐related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy

“…In the field of experimental psychopathology, research on avoidance is undergoing something of a renaissance (Cain, 2019;Dymond, 2019;Grillon, Robinson, Cornwell, & Ernst, 2019;LeDoux, Moscarello, Sears, & Campese, 2017). The central diagnostic status of maladaptive and excessive repertoires of avoidance in the anxiety disorders (American Psychiatric Association, 2013; Craske et al, 2009), combined with the high translational value of variants of the Pavlovian threat-conditioning and avoidance learning paradigm (Krypotos & Engelhard, 2018;Vervliet & Raes, 2013), has prompted renewed interest in the factors by which avoidance is acquired, maintained, and extinguished.…”

“…However, the majority of this research has examined Pavlovian processes, with very little research on operant contributions to relapse (Craske, Hermans, & Vervliet, 2018;Dymond, 2019). However, the majority of this research has examined Pavlovian processes, with very little research on operant contributions to relapse (Craske, Hermans, & Vervliet, 2018;Dymond, 2019).…”