Abstract
Anxiety disorders are effectively treated with exposure therapy, but relapse remains high. Fear may reinstate after reoccurrence of the negative event because the expectancy of the aversive outcome (unconditioned stimulus [US]) is adjusted but not its evaluation. Imagery rescripting (ImRs) is an intervention that is proposed to work through revaluation of the US. The aim of our preregistered study was to test the effects of ImRs and extinction on US expectancy and US revaluation. Day 1 ( n = 106) consisted of acquisition with an aversive film clip as US. The manipulation (ImRs + extinction, extinction-only, or ImRs-only) took place on Day 2. Reinstatement of fear was tested on Day 3. Results showed expectancy learning in both extinction conditions but not in the ImRs-only condition and no enhanced revaluation learning in ImRs. The combination of ImRs and extinction slowed down extinction but did not protect against reinstatement, which pleads in favor of stand-alone interventions in clinical practice.
Highlights
Anxiety disorders rank among the most prevalent mental disorders; approximately one out of 10 people in Western cultures suffer from at least one anxiety disorder in the course of their lives (Baxter et al, 2013)
Participants received either a script with a positive ending related to the US to imagine during extinction (ABA-ImRsexp), a US-unrelated script to imagine during extinction (ABA-imagery control), or regular extinction (ABA-no and AAA-no)
We compared the effects of Imagery rescripting (ImRs) and extinction procedures on expectancy and revaluation learning in a 3-day fear-conditioning paradigm
Summary
A total of 120 participants between 18 and 40 years old were recruited between March 2019 and February 2020. To check whether neuroticism scores were distributed between conditions, the neuroticism scale of the short version of the Eysenck Personality Questionnaire (EPQ) was used (Sanderman et al, 1991, 2012) This scale consists of 12 questions that can be answered with either yes (1) or no (0), which creates a sum score ranging from 0 (low neuroticism) to 12 (high neuroticism). Participants in the ImRsexp conditions were asked how well they were able to imagine the script and how credible they found the story of the script on two scales from 0 (not at all) to 10 (very much) They were asked to indicate which of the two memories was stronger (script or film memory). SCR was measured using two 5-mm Ag/AgCl electrodes filled with Signa gel placed on the proximal part of the palm of the left hand, with approximately 1.5 cm between the electrodes (Boucsein et al, 2012)
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