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 |
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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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•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.</description><identifier>ISSN: 0005-7967</identifier><identifier>EISSN: 1873-622X</identifier><identifier>DOI: 10.1016/j.brat.2014.04.006</identifier><identifier>PMID: 24864005</identifier><identifier>CODEN: BRTHAA</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>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</subject><ispartof>Behaviour research and therapy, 2014-07, Vol.58, p.10-23</ispartof><rights>2014 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Pergamon Press Inc. Jul 2014</rights><rights>2014 Elsevier Ltd. All rights reserved. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c706t-28fd004c53b76a918aa474fe1b968bba14f364c428958d00949765344c8978433</citedby><cites>FETCH-LOGICAL-c706t-28fd004c53b76a918aa474fe1b968bba14f364c428958d00949765344c8978433</cites><orcidid>0000-0002-3704-5240</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0005796714000606$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,30976,30977,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28579511$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24864005$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Craske, Michelle G.</creatorcontrib><creatorcontrib>Treanor, Michael</creatorcontrib><creatorcontrib>Conway, Christopher C.</creatorcontrib><creatorcontrib>Zbozinek, Tomislav</creatorcontrib><creatorcontrib>Vervliet, Bram</creatorcontrib><title>Maximizing exposure therapy: An inhibitory learning approach</title><title>Behaviour research and therapy</title><addtitle>Behav Res Ther</addtitle><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.</description><subject>Adult</subject><subject>Affect labeling</subject><subject>Anxiety</subject><subject>Anxiety disorders</subject><subject>Anxiety Disorders - therapy</subject><subject>Behavior modification</subject><subject>Behavior therapy. Cognitive therapy</subject><subject>Biological and medical sciences</subject><subject>Clinical medicine</subject><subject>Cognitive therapy</subject><subject>Deepened extinction</subject><subject>Efficacy</subject><subject>Expectancy violation</subject><subject>Exposure therapy</subject><subject>Extinction</subject><subject>Extinction, Psychological</subject><subject>Fear</subject><subject>Female</subject><subject>Humans</subject><subject>Implosive Therapy - methods</subject><subject>Inhibition, Psychological</subject><subject>Inhibitory learning</subject><subject>Learning</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental disorders</subject><subject>Multiple contexts</subject><subject>Occasional reinforced extinction</subject><subject>Optimization techniques</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Retrieval cues</subject><subject>Safety signals</subject><subject>Treatments</subject><issn>0005-7967</issn><issn>1873-622X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqN0VtrFDEUB_Agil2rX8AHGRDBl1mTzMlNSqGUeoGKLwq-hUw2080ym4zJTOn66Ztx13p5kEIghPPLISd_hJ4TvCSY8DebZZvMuKSYwBKXhfkDtCBSNDWn9NtDtMAYs1ooLo7Qk5w35dhIih-jIwqSQyku0Mknc-O3_ocPV5W7GWKekqvGtUtm2L2tzkLlw9q3foxpV_XOpDBDMwwpGrt-ih51ps_u2WE_Rl_fXXw5_1Bffn7_8fzssrYC87GmslthDJY1reBGEWkMCOgcaRWXbWsIdA0HC1QqJotUoARnDYCVSkhommN0uu87TO3WrawLYzK9HpLfmrTT0Xj9dyX4tb6K1xoIAUF5afD60CDF75PLo976bF3fm-DilDVhjHAigMF9KFaSNUzdgwItcwOe6ct_6CZOKZRP-6lKS9KIouhe2RRzTq67G5FgPUeuN3qOXM-Ra1wWnmd78efn3F35lXEBrw7AZGv6Lplgff7tJBOKEVLcyd65EuW1d0ln612wbuWTs6NeRf-_d9wCCkvHuA</recordid><startdate>20140701</startdate><enddate>20140701</enddate><creator>Craske, Michelle G.</creator><creator>Treanor, Michael</creator><creator>Conway, Christopher C.</creator><creator>Zbozinek, Tomislav</creator><creator>Vervliet, Bram</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Science Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TK</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3704-5240</orcidid></search><sort><creationdate>20140701</creationdate><title>Maximizing exposure therapy: An inhibitory learning approach</title><author>Craske, Michelle G. ; Treanor, Michael ; Conway, Christopher C. ; Zbozinek, Tomislav ; Vervliet, Bram</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c706t-28fd004c53b76a918aa474fe1b968bba14f364c428958d00949765344c8978433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Affect labeling</topic><topic>Anxiety</topic><topic>Anxiety disorders</topic><topic>Anxiety Disorders - therapy</topic><topic>Behavior modification</topic><topic>Behavior therapy. Cognitive therapy</topic><topic>Biological and medical sciences</topic><topic>Clinical medicine</topic><topic>Cognitive therapy</topic><topic>Deepened extinction</topic><topic>Efficacy</topic><topic>Expectancy violation</topic><topic>Exposure therapy</topic><topic>Extinction</topic><topic>Extinction, Psychological</topic><topic>Fear</topic><topic>Female</topic><topic>Humans</topic><topic>Implosive Therapy - methods</topic><topic>Inhibition, Psychological</topic><topic>Inhibitory learning</topic><topic>Learning</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental disorders</topic><topic>Multiple contexts</topic><topic>Occasional reinforced extinction</topic><topic>Optimization techniques</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Retrieval cues</topic><topic>Safety signals</topic><topic>Treatments</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Craske, Michelle G.</creatorcontrib><creatorcontrib>Treanor, Michael</creatorcontrib><creatorcontrib>Conway, Christopher C.</creatorcontrib><creatorcontrib>Zbozinek, Tomislav</creatorcontrib><creatorcontrib>Vervliet, Bram</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Behaviour research and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Craske, Michelle G.</au><au>Treanor, Michael</au><au>Conway, Christopher C.</au><au>Zbozinek, Tomislav</au><au>Vervliet, Bram</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maximizing exposure therapy: An inhibitory learning approach</atitle><jtitle>Behaviour research and therapy</jtitle><addtitle>Behav Res Ther</addtitle><date>2014-07-01</date><risdate>2014</risdate><volume>58</volume><spage>10</spage><epage>23</epage><pages>10-23</pages><issn>0005-7967</issn><eissn>1873-622X</eissn><coden>BRTHAA</coden><abstract>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.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>24864005</pmid><doi>10.1016/j.brat.2014.04.006</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-3704-5240</orcidid><oa>free_for_read</oa></addata></record> |
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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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