Role of Inhibition in Exposure Therapy

Abstract

While many researchers have largely focused on principles of systematic desensitization and habituation in explaining fear extinction, these processes have mixed evidence at best. In particular, these models do not account for spontaneous recovery or reinstatement of fear, nor do they explain the context dependency of extinction or rapid reacquisition. This may in part account for the significant number of patients who fail to respond to our available treatments which rely on these principles in designing exposure sessions. However, recent research is converging to suggest that an inhibitory model of fear reduction, in which the original feared association (CS-US) remains but is inhibited by a newly formed association (CS-noUS) representing safety, holds promise in explaining the long-term attenuation of fear and anxiety. This paper reviews research in a number of areas, including neuroimaging, psychophysiology, and psychopharmacology that all provide support for the inhibition model of anxiety. Limitations to this body of research are discussed, along with recommendations for future research and suggestions for improving exposure therapy for fear and anxiety disorders. Clinical implications discussed in this paper include incorporating random and variable practice in exposure sessions, multiple contexts, and pharmacological aides, among others.

Slower reacquisition after partial extinction in human contingency learning.

“…One of these forms of relapse described in the literature is rapid reacquisition (Ricker & Bouton, 1996). Rapid reacquisition refers to the effect that, after extinction, if the cue is again paired with the outcome with which it was previously associated, this new learning is faster than the original learning, indicating a carry-over effect of the original learning.Interestingly, some other forms of relapse such as renewal, reinstatement or spontaneous recovery have been evidenced in animal as well as human conditioning studies, using different experimental paradigms, and also following exposure therapy in clinical settings (Craske, Liao, Brown, & Vervliet, 2012). Relapse phenomena, then, have been regarded as providing a useful insight into the nature of extinction and its underlying mechanisms.…”

Affect labeling enhances exposure effectiveness for public speaking anxiety

“…Greater ventromedial PFC activity is associated with better extinction of conditioned fear in humans (Delgado, Nearing, LeDoux, & Phelps, 2008;Milad et al, 2005;Phelps, Delgado, Nearing, & LeDoux, 2004). Assuming that extinction is a central mechanism of exposure therapy Craske, Liao, Brown, & Vervliet, 2012), PFC downregulation of amygdala may contribute to successful exposure therapy, and strategies that augment such downregulatory pathways may augment outcomes from exposure therapy. In addition, evidence suggests that patients with social anxiety disorder have weaker connectivity between the medial orbitofrontal PFC and the amygdala compared to healthy controls (Hahn et al, 2011).…”

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

“…La terapia de exposición ha demostrado ser una estrategia efectiva para el tratamiento de los trastornos de ansiedad (Hofmann y Smits, 2008;Norton y Price, 2007). Nuestra comprensión de los mecanismos responsables de los efectos de la terapia de exposición ha evolucionado a lo largo de los años (véase Craske, Liao, Brown, y Verliet, 2012). Los objetivos del presente artículo son repasar el modelo de aprendizaje inhibitorio de la extinción como mecanismo de la terapia de exposición para el miedo y la ansiedad, y explicar la aplicación clínica de este modelo.…”

“…Otros enfoques de la terapia de exposición incluyen los modelos basados en la habituación, que enfatizan la reducción del miedo mediante la ex posición, y los experimentos conductuales dirigidos a desconfi rmar creencias y suposiciones de contenido amenazante (Foa y Kozak, 1986;Foa y McNally, 1996;Salkovskis, Hackmann, Wells, Gelder, y Clark, 2006). En artículos previos, hemos comparado el modelo de aprendizaje inhibitorio con los modelos de habituación del miedo y de desconfi rmación de creencias mediante experimentos conductuales (i.e., Craske et al, 2012). En la discusión que sigue, presentamos aplicaciones específi cas de las distintas formas en que el modelo de aprendizaje inhibitorio se distingue de los otros modelos.…”