Maximizing exposure therapy: An inhibitory learning approach Flashcards
Exposure therapy is an effective approach for treating anxiety disorders, although…
a substantial number of individuals fail to benefit or experience a return of fear after treatment
wat is de gedachte achter dit onderzoek
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.
wat zijn de 8 exposure optimization strategies
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
wat is exposure therapy
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.
wat is Pavlovian conditioning
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.
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.
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wat is inhibitory learning
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.
wat is inhibitory learning in pavlovian conditioning terms
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.
wat gebeurt er volgens dit model na de extinction met CS-US pathways
After extinction, the CS retains both excitatory (CS-US) and inhibitory (CS-no US) meanings.
when does fear return over time:
when fear returns over time:
- in different contexts
- after unsignaled US presentations
- with repeated CS-US pairings post-extinction
welke 4 ongewenste effecten zijn er door het grote effect van excitatory associations
- Spontaneous recovery,
- renewal,
- reinstatement,
- rapid reacquisition
(hierdoor blijft een deel van de mensen dus de klachten houden)
deficits in inhibitory learning are linked to…
- poor response to exposure therapy
- contribute to excessive fear and anxiety in people with anxiety disorders
Considering inhibitory learning in exposure therapy becomes crucial to …
- enhance treatment efficacy
- compensate for deficits in anxious individuals
- offset negative effects like spontaneous recovery and reinstatement
what is extinction
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)
wat is habituation
fear reduction due to habituation, during exposure trials.
wat is een verschil tussen inhibitory learning vs habituation
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.
dus in simpele termen het verschil tussen inhibitory learning en habituation
inhibitory learning= leren dat er niet altijd een US na een CS komt.
habituation= gewend raken aan de CS waardoor de fear verminderd
expectancy violation =
- 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
deepened extinction:
- 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.
wat is de vraag die je stelt bij expectancy violation (ipv wat ze bij habituation belangrijk vinden)
“what do you need to learn?”/”what did you learn during the exposure?”
(ipv “stay in the situation until the fear declines”)
waar wordt de focus op gelegd tijdens expectancy violation
both the CS, and the non-occurence of the US
wat is een verschil tussen the expectancy violation model en habituation, als we het hebben over de interventies die zij gebruiken
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
wat is de relatie tussen expectancy violation en cognitive interventions
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
Occasional Reinforced Extinction:
- 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.
