Maximizing exposure therapy: An inhibitory learning approach

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. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, suc...

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Veröffentlicht in:Behaviour research and therapy 2014-07, Vol.58, p.10-23
Hauptverfasser: Craske, Michelle G., Treanor, Michael, Conway, Christopher C., Zbozinek, Tomislav, Vervliet, Bram
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container_end_page 23
container_issue
container_start_page 10
container_title Behaviour research and therapy
container_volume 58
creator Craske, Michelle G.
Treanor, Michael
Conway, Christopher C.
Zbozinek, Tomislav
Vervliet, Bram
description 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. 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. Although evidence supports an inhibitory learning model of extinction, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a ‘fear habituation’ approach and ‘belief disconfirmation’ approach within standard cognitive-behavior therapy. Exposure optimization strategies include 1) expectancy violation, 2) deepened extinction, 3) occasional reinforced extinction, 4) removal of safety signals, 5) variability, 6) retrieval cues, 7) multiple contexts, and 8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, specific phobia, and panic disorder. •We summarize the research related to an inhibitory model of exposure therapy.•Includes strategies for the acquisition, consolidation and retrieval of extinction.•Case studies provide useful guides for implementing these strategies with patients.
doi_str_mv 10.1016/j.brat.2014.04.006
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source Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Elsevier ScienceDirect Journals
subjects Adult
Affect labeling
Anxiety
Anxiety disorders
Anxiety Disorders - therapy
Behavior modification
Behavior therapy. Cognitive therapy
Biological and medical sciences
Clinical medicine
Cognitive therapy
Deepened extinction
Efficacy
Expectancy violation
Exposure therapy
Extinction
Extinction, Psychological
Fear
Female
Humans
Implosive Therapy - methods
Inhibition, Psychological
Inhibitory learning
Learning
Male
Medical sciences
Mental disorders
Multiple contexts
Occasional reinforced extinction
Optimization techniques
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Retrieval cues
Safety signals
Treatments
title Maximizing exposure therapy: An inhibitory learning approach
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