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 short- and 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 non-completers. 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.
Highlights
Great interest exists in maximizing exposure therapy efficacy in anxiety disorders
Anxious children, who retained diagnoses after cognitive behavioral therapy (CBT), tended to acquire more negative evaluations of both CSs and failed to show reductions in physiological responses to the CSs during extinction. While in this pioneering work of Waters and Pine[12] the relation between CBT-success in general and fear conditioning was assessed in children, two other studies analyzed the predictive value of fear conditioning measures to standardized exposure benefit in adults
We showed that fear extinction is related to the ability to complete exposure in a predetermined time and exposure therapy outcome
Summary
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. Anxious children, who retained diagnoses after CBT, tended to acquire more negative evaluations of both CSs and failed to show reductions in physiological responses to the CSs during extinction While in this pioneering work of Waters and Pine[12] the relation between CBT-success in general (defined as the absence of a diagnosis after therapy completion) and fear conditioning was assessed in children, two other studies analyzed the predictive value of fear conditioning measures to standardized exposure benefit in adults. Numerous associations between different conditioning measures (e.g., CS+ responses or CS+ versus CS− responding during fear acquisition or fear extinction or extinction retrieval, etc.) and treatment-related markers (e.g., changes in self-report fear, avoidance behavior, etc.) are possible This can potentially lead to false positive correlations. While this approach is not without pitfalls, it may be less susceptible to the biasing influence of researcher degrees of freedom than the selection of prognostic measures from fear conditioning measures
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