Maximizing exposure therapy: An inhibitory learning approach

Question 1

Exposure therapy is an effective approach for treating anxiety disorders, although…

Answer 1

a substantial number of individuals fail to benefit or experience a return of fear after treatment

Question 2

wat is de gedachte achter dit onderzoek

Answer 2

Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure-based procedures.

Question 3

wat zijn de 8 exposure optimization strategies

Answer 3

1) expectancy violation,
2) deepened extinction,
3) occasional reinforced extinction,
4) removal of safety signals,
5) variability,
6) retrieval cues,
7) multiple contexts,
8) reconsolidation

Question 4

wat is exposure therapy

Answer 4

Exposure therapy involves repeated approach toward fear-inducing stimuli and comes in various forms, such as graduated or intense, brief, or prolonged, with or without coping strategies.

Question 5

wat is Pavlovian conditioning

Answer 5

a neutral stimulus (CS) is paired with an aversive stimulus (US), which leads to anticipatory fear reactions (CR).

An association is posited between the memory representations of the CS and the US such that presentations of the CS will indirectly activate the memory of the US. Hence, by ‘thinking’ about the aversive US, fear develops.

Question 6

Fear conditioning is considered a valid model for anxiety disorders, and exposure therapy, a clinical proxy of extinction, is used to reduce conditional fear reactions.

Answer 6

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Question 7

wat is inhibitory learning

Answer 7

Inhibitory learning is central to the process of extinction and involves learning that the aversive events do not always occur when the stimulus is encountered.

Question 8

wat is inhibitory learning in pavlovian conditioning terms

Answer 8

the inhibitory learning models: show that the original CS-US association learned during fear conditioning is not erased during extinction, but rather is left intact as new, secondary inhibitory learning about the CS-US develops - specifically that the CS no longer predicts the US.

Question 9

wat gebeurt er volgens dit model na de extinction met CS-US pathways

Answer 9

After extinction, the CS retains both excitatory (CS-US) and inhibitory (CS-no US) meanings.

Question 10

when does fear return over time:

Answer 10

when fear returns over time:

• in different contexts
• after unsignaled US presentations
• with repeated CS-US pairings post-extinction

Question 11

welke 4 ongewenste effecten zijn er door het grote effect van excitatory associations

Answer 11

• Spontaneous recovery,
• renewal,
• reinstatement,
• rapid reacquisition

(hierdoor blijft een deel van de mensen dus de klachten houden)

Question 12

deficits in inhibitory learning are linked to…

Answer 12

• poor response to exposure therapy
• contribute to excessive fear and anxiety in people with anxiety disorders

Question 13

Considering inhibitory learning in exposure therapy becomes crucial to …

Answer 13

• enhance treatment efficacy
• compensate for deficits in anxious individuals
• offset negative effects like spontaneous recovery and reinstatement

Question 14

what is extinction

Answer 14

the CS is repeatedly presented in the absence of the associated aversive event (the US)

(a powerful way to reduce conditional fear reactions is through extinction)

Question 15

wat is habituation

Answer 15

fear reduction due to habituation, during exposure trials.

Question 16

wat is een verschil tussen inhibitory learning vs habituation

Answer 16

Inhibitory learning challenges the conventional belief that fear reduction during exposure is a prerequisite for therapeutic change (dit is namelijk een vereiste in habituation).

Evidence suggests that fear reduction during exposure may not reliably predict long-term outcomes, and there is a divergence in response systems, with fear expression and underlying learning not always changing at the same time.

Question 17

dus in simpele termen het verschil tussen inhibitory learning en habituation

Answer 17

inhibitory learning= leren dat er niet altijd een US na een CS komt.
habituation= gewend raken aan de CS waardoor de fear verminderd

Question 18

expectancy violation =

Answer 18

• Exposure designed to violate expectancies regarding the frequency or intensity of aversive outcomes.
• Focus on mismatch between expectancy and outcome for new learning.
• Development of inhibitory expectancies that compete with excitatory expectancies.
• The more the expectancy can be violated
  by experience, the greater the inhibitory learning

Question 19

deepened extinction:

Answer 19

• Extinction of multiple fear cues separately before combining during exposure.
• Pairing previously extinguished cues with novel ones to reduce spontaneous recovery and reinstatement of fear.
• Examples include combining interoceptive exposure with in vivo exposure.

Question 20

wat is de vraag die je stelt bij expectancy violation (ipv wat ze bij habituation belangrijk vinden)

Answer 20

“what do you need to learn?”/”what did you learn during the exposure?”

(ipv “stay in the situation until the fear declines”)

Question 21

waar wordt de focus op gelegd tijdens expectancy violation

Answer 21

both the CS, and the non-occurence of the US

Question 22

wat is een verschil tussen the expectancy violation model en habituation, als we het hebben over de interventies die zij gebruiken

Answer 22

expectancy violation gebruikt ook graduated approach: maar hierbij gaat het er echt om dat de conditions moeten worden geviolate (gaat niet perse om fear level dat de persoon heeft) -> conditions that provide optimal violation of expectancy

Question 23

wat is de relatie tussen expectancy violation en cognitive interventions

Answer 23

To this end, traditional cognitive interventions
designed to lessen probability overestimation (e.g., “I am unlikely to be bitten by the dog”) and perceived negative valence (e.g., “It is not so bad to be rejected”) may be deleterious to inhibitory learning when employed prior to, or during, exposures. -> dus cognitieve interventies kunnen het effect verminderen

Question 24

Occasional Reinforced Extinction:

Answer 24

• Involves occasional pairings of conditioned stimuli with unconditioned stimuli during extinction.
• Benefits include expectancy violation and enhanced salience of the conditioned stimuli.
• Shows promise in sustaining fear arousal during extinction and reducing subsequent fear reacquisition.

Question 25

inhibitory learning:

Reduction of fear is due to the formation of …

Answer 25

… a new, non-fear association (CS–no US) that inhibits the original fear association (CS–US)

Question 26

What is the argument of Craske et al. (2014) with respect to extinction learning, which is supported by demonstrations of spontaneous recovery, renewal, reinstatement, and reacquisition?

Answer 26

Fear might be reduced by exposure, but the original fear association (CS–US) is still (partially) present

Question 27

expectancy violation:

a discrepancy between….

Answer 27

… the expected aversive outcome (US) and what actually occurs (no US) when confronted with the feared stimulus (CS)

Question 28

Removal of Safety Signals:

Answer 28

• Prevention or elimination of safety signals or behaviours that alleviate distress.
• Safety signals, including the presence of others, therapists, or substances, may hinder extinction learning.
• Gradual phasing out of safety signals recommended over the course of exposure therapy

Question 29

variability:

Answer 29

• Introduction of stimulus variability throughout exposure sessions.
• Varying stimuli, durations, and intensity levels during exposure.
• Higher physiological arousal and subjective anxiety observed, with long-term beneficial
  effects

Question 30

Retrieval cues:

Answer 30

use a cue present during extinction or imaginally reinstate the previous successful exposures.

Question 31

Multiple contexts:

Answer 31

• Conducting exposures in various internal and external contexts.
• Offsetting context renewal effects observed in both animal and human studies.
• Applied to interoceptive, imaginal, and in vivo exposures.

Question 32

reconsolidation:

Answer 32

• Leveraging the reconsolidation process to change fear memories during retrieval.
• Brief exposure to the phobic stimulus 30 minutes before sustained exposure trials.
• Results in reduced spontaneous recovery, renewal, reinstatement, and rapid reacquisition of fear.

Question 33

therapeutic strategy for enhancing inhibitory regulation =

Answer 33

emphasizes linguistic processing or affect labelling as identified by social neuroscience.

Question 34

affect labelling benefits

Answer 34

= a mechanism to augment associative inhibitory processes within extinction learning. means naming and describing our feelings

• engages the right ventrolateral prefrontal cortex,
• reducing amygdala activity
• attenuating anxious responses.

Question 35

case studies

Answer 35

roberto - intrusive thoughts about harming his new born son.
julia - sexual assault survivor, intrusive images and situational avoidance
deandre - social anxiety
sharon - dog phobia
charlie - panic disorder

Question 36

waar is exposure dus nu meer op gericht

Answer 36

op violating expectancies, rather than fear reduction

Question 37

the translation of extinction learning into exposure therapy for fear and anxiety disorders involves targeting the acquisition, consolidation and retrieval of new learning. exposure therapy generally inclused specific goal setting, identification of anticipated negative outcomes, and practicing exposures until the expected outcome is violated. therapists help clients recognize and consolidate the non-occurence of the feared event, reinforcing the dissociation between the conditional stimulus and the unconditional stimulus.

Answer 37

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Question 38

dus verschil inhibitory learning and inhibitory regulation

Answer 38

inhibitory learning = die 8 strategieen (expectancy violation, deepened extinction, occasional reinforced extinction, removal of safety signals, variability, retrieval cues, multiple contexts, reconsolidation)

inhibitory regulation = affect labelling