Craske Paper - Inhibitory learning in exposure therapy Flashcards
What is an underlying mechanism of exposure therapy?
Inhibitory learning
Why may targeting underlying mechanisms of exposure therapy prove useful?
As many people fail to benefit or experience a return of fear after exposure treatment, targeting underlying mechanisms might help improve treatment efficacy
Name the 9 exposure optimization strategies mentioned in the Craske paper
- Expectancy violation
- Deepened extinction
- occasional reinforced extinction
- removal of safety signals
- variability
- retrieval cues
- multiple contexts
- affect labeling
- Reconsolidation
What are two other models, beside the inhibitory learning model, for exposure therapy?
- Habituation model (reduction in fear throughout repeated exposure)
- Behavioural-testing (disconfirms threat-laden beliefs and assumptions)
What does the inhibitory model pose, happens?
The original CS-US association is not erased, instead a new, inhibitory learning CS-US is made. Specifically that of the CS no longer predicting the US
Specific (negative) qualities of extinction, that support the inhibitory learning model?
- Spontaneous recovery
- Renewal of conditional fears (extinction is context specific)
- Reinstatement of conditional fears (US presented unsignalled/unpaired will see a return of fear)
What type of deficit is seen in ppl with anxiety disorders and how is this problematic for exposure therapy?
- Deficits inhibitory learning
- Problematic because many types of exposure therapy hinge on proper inhibitory learning to ensure extinction
On what model did traditional exposure therapy rely mostly?
Habituation model
How does the inhibitory model differ from the habituation model?
Fear reduction due to time vs. expectancy violation to create a strong new memory
What is a predictor of long-term outcomes in fear conditioning?
Mismatch between expectation and reality (i.e., prediction error)
How does the inhibitory model differ from the behavioural testing model?
Both focus on disconfirming maladaptive beliefs, but inhibitory also focuses on developing strong inhibitory associations
Expectancy violation?
expectancy vs. actuality mismatch (prediction error)- the greater the violation of expectancy, the stronger the new inhibitory learning
How does expectancy violation work in a clinical setting?
- Clients state their fear-based expectations
- Exposure exercises continue until the expectation is proven false
- The focus is on learning that feared outcomes do not occur
Deepened extinction?
Combining previously extinguished fear cues during later exposure settings- this enhances inhibitory learning by making the fear memory more resistant to relapse
- Note: both cues need to predict the same US
Deepened extinction in clinical setting? (3)
- Individually fear stimuli are presented separately (e.g., heart palpitations and public speaking)
- Multiple cues are later combined in a single exposure setting (induced heart palpitations + presentation)
- Prevents things like spontaneous recovery and reinstatement (because multiple cues are predicting the same non-occurence of a feared outcome as such increasing the generalization)
What is affect labeling?
A linguistic processing approach, which encourages clients to verbally express their emotions during exposure
- Activates the prefrontal and reduces activity in the amygdala = better emotional regulation
How is affect labeling different from traditional cognitive therapies?
Cognitive therapies focus on changing appraisals, affect labeling focuses on acceptance and expresssion
How do the strategies mentioned in Craske help OCD?
- Client with intrusive thoughts of harming their child
- Deepened extinction used (e.g., holding the child while reading about violent crimes)
- Expectancy violation achieved by demonstrating that urges do not lead to harmful actions
Occasional reinforced extinction?
Intentionally inducing occasional exposures where the US does occur- enhances learning because the client learns that even when feared outcome does happen, it is tolerable
Occasional reinforced extinction clinical setting?
- Inclusion of mildly aversive event
- Disruption of expectations of certainty, making it less likely to reacquire fear when setbacks occur in real life (prevention of overreliance on positive experiences and reinforcement of the idea that they can handle social discomfort). I.e., prevention of relapse
Removal of safety signals?
Objects/people/behaviours that client relies on to feel safe are removed as these safety signals prevent inhibitory learning as safety is attributed to the signal rather than the situation
Removal of safety signals in clinical settings?
- Identification of safety signals + gradual removal to increase confidence of independently facing the fears
- Feared outcome does not occur, even without safety signals
- Increases long-term extinction learning
Variability in exposure?
Varying of exposure = greater generalization of inhibitory learning & making it more resistant to relapse
Variability in exposure clinical setting?
- Different sequence, different stimuli, different times, etc.
- Prevents predictability
- inhibitory learning transfers to multiple contexts
- prevention of context-dependent extinction, reducs spontaneous recovery and more effective at preventing relapse
Retrieval cues?
Reminders that help reactivate inhibitory learning when clients face fear-provoking situations outside therapy
Retrieval cues clinical setting?
- Object/word/action associated with successful fear reduction
- Use cue in real-life to enhance recall
- Cue should not become a safety signal
Multiple contexts for exposure?
Fear extinction in multiple different contexts, preventing context renewal- this includes different emotional contexts
Reconsolidation and memory updating?
Retrieved (reactivated) memories become labile (malleable) allowing for modification before they are stored again (reconsolidation)- aka the whole Elsey paper
Difference between variability in exposure and multiple contexts?
- Variability = changing aspects of the exposure itself, to train the brain to not associate safety with one type of exposure > feared stimulus is experienced in different ways
- Multiple contexts = changing setting or internal state to prevent context-dependent extinction > fear is faced in different places/situations
Difference between spontaneous recovery, reinstatement and renewal?
Respectively:
- Fear returns over time (even without the presence of fearful experiences)
- Fear returns after an unrelated fearful experience
- Fear returns in a different setting
