Breaking the Cycle of Learned Fear: An Experimental Approach

Abstract

About 1 in 10 people will develop an anxiety-related disorder during their lifetime. Anxiety-related disorders are characterized by extreme fear and avoidance in relatively safe situations. Cognitive behavioral therapy (CBT) is currently the recommended treatment. During CBT, patients are repeatedly exposed to fear-provoking stimuli to experience that the feared outcome does not occur. However, there is room for improvement. Some patients refuse the therapy; others improve little or experience a return of their symptoms after the treatment. The studies in this thesis aimed to contribute to knowledge about mechanisms underlying fear reduction and thereby improve the treatment of learned fear. In part 1 of the thesis, we tested how the learned fear is maintained or exacerbated by the threat expectancy, mental representations of threat, and avoidance behavior in relatively safe situations. Part 2 examined the long-term effectiveness of (exposure-based) CBT and how the effects of exposure can be optimized. In conclusion, interventions aimed at strengthening the threat expectancy disconfirmation can potentially improve the (long-term) effects of exposure. However, more attention is needed for other mechanisms, such as reducing negative mental images and avoidance behavior. Future research should examine whether patients who do not sufficiently benefit from exposure-based CBT have better outcomes after receiving additional interventions that better target these other mechanisms.