Reducing contamination by exposure plus safety behaviour

Rachman, S.; Shafran, Roz; Radomsky, Adam S.; Zysk, Eva

doi:10.1016/j.jbtep.2011.02.010

Cited by 83 publications

(81 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This type of therapy can be very challenging for patients, with many of them unable to complete or engage in ERP, which has led to the idea of modifying ERP to allow for certain safety behaviors (11). Therefore, it remains a critical question how the processing of safety could be altered in OCD.…”

supporting

confidence: 91%

Neural basis of impaired safety signaling in Obsessive Compulsive Disorder

Apergis-Schoute

Gillan

Fineberg

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

138

152

View full text Add to dashboard Cite

The ability to assign safety to stimuli in the environment is integral to everyday functioning. A key brain region for this evaluation is the ventromedial prefrontal cortex (vmPFC). To investigate the importance of vmPFC safety signaling, we used neuroimaging of Pavlovian fear reversal, a paradigm that involves flexible updating when the contingencies for a threatening (CS+) and safe (CS-) stimulus reverse, in a prototypical disorder of inflexible behavior influenced by anxiety, Obsessive Compulsive Disorder (OCD). Skin conductance responses in OCD patients (n = 43) failed to differentiate during reversal compared with healthy controls (n = 35), although significant differentiation did occur during early conditioning and amygdala BOLD signaling was unaffected in these patients. Increased vmPFC activation (for CS+ > CS-) during early conditioning predicted the degree of generalization in OCD patients during reversal, whereas vmPFC safety signals were absent throughout learning in these patients. Regions of the salience network (dorsal anterior cingulate, insula, and thalamus) showed early learning task-related hyperconnectivity with the vmPFC in OCD, consistent with biased processing of the CS+. Our findings reveal an absence of vmPFC safety signaling in OCD, undermining flexible threat updating and explicit contingency knowledge. Although differential threat learning can occur to some extent in the absence of vmPFC safety signals, effective CS-signaling becomes crucial during conflicting threat and safety cues. These results promote further investigation of vmPFC safety signaling in other anxiety disorders, with potential implications for the development of exposure-based therapies, in which safety signaling is likely to play a key role.Obsessive Compulsive Disorder | vmPFC | Pavlovian | fMRI | safety signals C urrent behavioral therapies in anxiety-related disorders are based on Pavlovian fear extinction models. As fear extinction relies on revaluation of threatening stimuli as safe, it is critical to address how the brain processes the safety of stimuli in the environment. The ventromedial prefrontal cortex (vmPFC) is known to play a multifaceted role in integrating affective evaluative processes while mediating flexible behavior and is implicated in fear learning and anxiety-related disorders (1-7). Prefrontal inflexibility in Obsessive Compulsive Disorder (OCD) suggests rigidity in threat estimation alongside a persistent urge to perform compulsive behaviors, yet only one study has examined the neural correlates of fear learning and extinction in this disorder, implicating a maladaptive vmPFC (8).Human fear learning studies usually involve contrasting a threatening (CS+) stimulus that is occasionally paired with a shock with a stimulus that is never paired with a shock and thus safe (CS-). When using the CS+ > CS-contrast, the vmPFC consistently exhibits negative activation values in healthy controls, indicating stronger activation to the CS-than to the CS+ in this region (1-3, 7, 9). Fear reversal (Fig. 1A)...

show abstract

supporting

confidence: 91%

Neural basis of impaired safety signaling in Obsessive Compulsive Disorder

Apergis-Schoute

Gillan

Fineberg

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

138

152

View full text Add to dashboard Cite

show abstract

“…Repeated exposure to a threat-relevant stimulus (e.g., a dirty bed-pan) has been shown to reduce subject fear ratings, but not ratings of subjective disgust in students high on contamination fears (Olatunji, Wolitzky-Taylor, Willems, Lohr, & Armstrong, 2009). In cases where exposure results in fear and disgust reductions, disgust responses may be more likely to return, suggesting that the changes occurring in extinction are more ephemeral for disgust responses (Rachman, Shafran, Radomsky, & Zysk, 2011). This resilience of disgust responses may be most pronounced in individuals with C-OCD.…”

Section: Exposurementioning

confidence: 99%

Effective behavioural strategies for reducing disgust in contamination-related OCD: A review

Ludvik

Boschen

Neumann

2015

Clinical Psychology Review

View full text Add to dashboard Cite

“…Contextual and temporal factors influence the degree to which patients will be able to recall the new nonthreat associations when obsessional thoughts and external cues are encountered. It is as if the learning and memory system 3 A recent study suggested that the judicious use of safety behaviors may not be harmful to exposure therapy outcomes in OCD (Rachman, Shafran, Radomsky, & Zysk, 2011), yet the finding was limited to shortterm outcomes in a nonclinical undergraduate sample. Thus, our recommendation to eliminate safety behaviors and cues as much as possible still holds at present.…”

Section: Enhancing the Retrievability Of Nonthreat Associationsmentioning

confidence: 99%