The association between fear extinction, the ability to accomplish exposure and exposure therapy outcome in specific phobia

Abstract

Great interest exists in maximizing exposure therapy efficacy in anxiety disorders. At the same time, reduced frequency and shortened duration of exposure sessions are required to meet the specific regularities in routine care settings. extinction has emerged as the key mechanism of exposure treatment in anxiety disorders. examining exposure treatment processes from the perspective of extinction learning might provide novel insights into variability in exposure treatment duration and outcome. the present study sought to examine the functional link between fear extinction, the ability to accomplish exposure in a predetermined time and exposure therapy outcome in specific phobia. treatment-seeking individuals (N = 53) with spider phobia underwent a context-dependent fear conditioning paradigm prior to a standardized exposure. Spider-phobic participants who were able to complete exposure within the pre-determined time (i.e., completers) showed a more pronounced shortand long-term exposure therapy benefit. In the fear conditioning task, a more pronounced decline in CS-US contingency ratings during extinction (retrieval) was found in completers relative to noncompleters. The failure to further extinguish US expectancy to the CSs in non-completers might offer a potential mechanistic explanation why non-completers have difficulties to accomplish all exposure steps in a fixed time and show less pronounced treatment gains. Our findings bear specific implications for the implementation of exposure treatment to routine care settings.Exposure is considered as the treatment of choice for anxiety disorders. Exposure therapy is aimed at helping patients to overcome their anxiety by creating a safe environment, in which they are repeatedly and systematically exposed to feared or avoided scenarios, leading to decreases of fear 1,2 . Despite its effectiveness, some patients show no or only a partial remission of symptoms or experience a recovery of symptoms after treatment 3 . Likewise, some patients exhibit a delayed therapeutic benefit, requiring an extended treatment duration and frequency 4 . This, however, is at odds with the organizational and economic demands in routine care, which requires efficient time schedules and reduction of treatment-associated costs 5 . The frequency and duration of exposure sessions thus needs to be adapted to the specific regularities in routine care settings (e.g. see 6 ). The identification of new pathways to improve exposure treatment efficacy while at the same time decreasing barriers to transfer exposure treatment to routine care would be highly desirable 7 . So far, only little is known about mechanisms contributing to treatment duration and short-and long-term treatment outcome.Extinction has emerged as a central candidate for the main process underlying exposure 8 . Consequently, research on the cognitive and neurobiological foundations of extinction as the laboratory analog of exposure might pave the way to understand and improve exposure treatment efficacy. Ultimately, by bridging the g...

Effects of acute stress on exposure therapy outcome and generalization in women: considering the modulatory role of hormonal contraceptive use

“…Among other studies, investigations showing a functional link between fear extinction learning and exposure therapy outcome support this assumption (e.g. [43,44]). GCs might facilitate extinction learning during exposure, or alternatively, inhibit the activation of full-blown fear-related memories in the presence of fear-provoking stimuli [7].…”

“…The analysis of approach distance from pre-treatment to follow-up revealed a significantly higher approach distance at follow-up (main effect for time: F (1,44) =54.19, effect for OC (F (1,44) =10.6, p=.006), but no main effects for stress or any interactions were observed (all p>.48). Fear at the final approach distance of the BAT did not reduce over time (F (1,43) =3.25, p=.078) and there were no main effects for OC, stress, or any interaction (all p>.5). However, a significant reduction in fear at the initial approach distance emerged from pre-treatment to follow-up (main effect for time: F (1,42) =50.1, p<.001; Figure 2), which was not subjected to any group differences (i.e., all other main and interaction effects, p>.25)…”

Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review

“…This can be achieved either by conducting separate trials for simplified versions or components of evidence-based interventions or isolating the effects of components of a complex intervention through data analysis techniques [ 83 , 84 ]. Research on the minimal amount of resources required to achieve treatment outcomes (e.g., complexity of the necessary exposure techniques, number and duration of sessions, amount of work expected from patients between sessions, degree of therapist involvement, therapists’ expertise level and amount of training) is also relevant to facilitate the development of low-intensity CBT interventions for integration in routine care [ 47 , 69 , 80 , 85 – 88 ]. Secondly, evidence relevant to predicting individual patient response to specific CBT delivery modalities can be gathered to allow for more informed resource allocation [ 46 , 49 , 73 , 89 ].…”

From virtual to real healing: a critical overview of the therapeutic use of virtual reality to cope with mourning

“…As an initial step, future studies might test the feasibility and utility of insert simple stimuli related to the bereavement (such as objects or places) to try to target anxious and posttraumatic symptoms with a process already validated like extinction (Myers & Davis, 2007;Raeder et al, 2020). Furthermore, using techniques that are already employed in traditional settings might reduce the likelihood of harm for the patients or, at least, it should cause a tolerable dose of stress, as it is done in the case of exposure therapies and extinction for specific phobias (Choy et al, 2007;Eaton et al, 2018;Raeder et al, 2020), where patients have to confront with feared and distressing stimuli, with the long-term scope of alleviating anxiety. Importantly, each one of these steps should be carried out by qualified scientific institutions (universities and/or hospitals) and carefully revised and approved by Institutional Review Board.…”