1,721,056 research outputs found
Incentive-based extinction of safety behaviors: Positive outcomes competing with aversive outcomes trigger fear-opposite action to prevent protection from fear extinction
No full textMaladaptive safety behavior maintains fear and anxiety by prohibiting inhibitory learning about the non-occurrence of feared outcomes (known as protection from extinction). Not engaging in safety behavior, however, requires to act opposite to fear-motivated behavioral tendencies. The initiation of such fear-opposite action by positive outcomes, which were in conflict with safety behavior, was tested. Following fear acquisition to a warning signal (CS+), participants acquired safety behavior to prevent the aversive outcome (n = 48). Next, safety behavior also prevented gaining rewards. In a control group (n = 50), neutral outcomes were presented to control for novelty effects of the second outcome. Subsequently, no aversive outcome occurred anymore. Phases with safety behavior were intermitted by phases without safety behavior being available to examine cognitive and physiological indicators of fear and anxiety. Without competing positive outcomes, safety behavior was frequently executed, persisted in absence of the aversive outcome, and prohibited extinction learning. Positive outcomes clearly reduced safety behavior despite equal levels of acquired fear. This enabled fear extinction as soon as the aversive outcome was absent. Importantly, this extinction learning resulted in attenuated fear and anxiety responses when safety behavior became unavailable. Post-hoc findings indicated that the mere anticipation of positive outcomes slightly reduced safety behavior. Thus, competing positive outcomes triggered fear-opposite action that prevented persistent safety behavior and protection from extinction
Same fear responses, less avoidance: Rewards competing with aversive outcomes do not buffer fear acquisition, but attenuate avoidance to accelerate subsequent fear extinction
No full textRewards for approaching a feared stimulus may compete with fear reduction inherent to avoidance and thereby alter fear and avoidance learning. However, the impact of such competing rewards on fear and avoidance acquisition has rarely been investigated. During acquisition, participants chose between one option (CS+ option) associated with a neutral stimulus followed by an aversive unconditioned stimulus (US) and another option (CS- option) associated with another neutral stimulus followed by no US (N = 223 randomized into three groups). In a subsequent test, no more USs occurred. In one group, competing rewards were established by linking the CS+ option to high rewards and the CS- option to low rewards during acquisition and test (Reward Group). In a second group, rewards were present during acquisition, but discontinued during test (Initial-Reward Group). In a third group, rewards were completely absent (No-Reward Group). Without competing rewards, significant avoidance was acquired and persisted in the absence of the US. Competing rewards attenuated avoidance acquisition already after the first experience of the aversive US. Avoidance remained attenuated even when rewards were discontinued during test. Rewards did, however, not change the level of fear responses to the CS+ (US expectancy, skin conductance). Finally, rewards did not change the level of fear reduction during test, which was, however, experienced earlier. Summarized, rewards for approaching aversive events do not buffer fear acquisition, but can prevent avoidance. This damping of avoidance may initiate fear extinction
Incentive-based, instructed, and social observational extinction of avoidance: Fear-opposite actions and their influence on fear extinction
No full textAvoidance is a transdiagnostic symptom of clinical anxiety and its reduction a major focus of cognitive-behavioral treatments. This study examined the instrumental extinction of goal-directed avoidance by means of incentives, verbal instruction, and social observation and their influence on fear extinction. Participants acquired conditioned fear and instrumental avoidance responses (N = 160). In four randomized groups, the reduction of avoidance by incentives for non-avoidance, instructions to refrain from avoidance, and social observation of non-avoidance was compared to no intervention before removing the aversive outcome. Conditioned fear when avoidance became unavailable subsequently was tested. Incentives, instruction, and observation all reduced avoidance better than no intervention, however, with different degrees and influence on conditioned fear. Incentives and instructions strongly reduced avoidance despite high levels of fear (i.e., fear-opposite actions). This initiated fear extinction, thereby reducing conditioned fear when avoidance became unavailable. Social observation directly reduced conditioned fear, presumably because it conveyed additional information about the absence of the aversive outcome. However, observation only moderately reduced avoidance and resulted in higher fear when avoidance became unavailable. The effects of social observation may depend on the nuances of the demonstrator's behavior. The clear effects of incentive and instructions provide support for clinical interventions to reduce avoidance during exposure therapy and can serve as experimental models for their controlled investigation
Costly avoidance in anxious individuals: Elevated threat avoidance in anxious individuals under high, but not low competing rewards
No full textWhen avoiding threat conflicts with approaching rewards, balanced responses to threat and reward information is required to guide functional behavior. Elevated threat avoidance characterizes anxious psychopathology. However, little is known about the mutual impact of threat and reward information on approach-avoidance behavior and its link to anxiety
The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability, Negative Beliefs, and Therapist Distress About Exposure-Based Interventions
No full textExposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions
From avoidance to approach: The influence of threat-of-shock on reward-based decision making
No full textPotential threat can prime defensive responding and avoidance behavior, which may result in the loss of rewards. When aversive consequences do not occur, avoidance should, thus, be quickly overcome in healthy individuals. This study examined the impact of threat anticipation on reward-based decisions. Sixty-five participants completed a decision-making task in which they had to choose between high- and low-reward options. To model an approach-avoidance conflict, the high-reward option was contingent with a threat-of-shock cue; the low-reward option was contingent with a safety cue. In control trials, decisions were made without threat/safety instructions. Overall, behavioral data documented a typical preference for the profitable option. Importantly, under threat-of-shock, participants initially avoided the profitable option (i.e., safe, but less profitable choices). However, when they experienced that shocks did actually not occur, participants overcame initial avoidance in favor of larger gains. Furthermore, autonomic arousal (skin conductance and heart rate responses) was elevated during threat cues compared to safety and non-threatening control cues. Taken together, threat-of-shock was associated with behavioral consequences: initially, participants avoided threat-related options but made more profitable decisions as they experienced no aversive consequences. Although socially acquired threat contingencies are typically stable, incentives for approach can help to overcome threat-related avoidance
Avoiding a feared stimulus: Modelling costly avoidance of learnt fear in a sensory preconditioning paradigm
No full textAvoidance of learnt fear prevents the onset of a feared stimulus and the threat that follows. In anxiety-related disorders, it turns pathological given its cost and persistence in the absence of realistic threat. The current study examined the acquisition of costly avoidance of learnt fear in healthy individuals (n = 45), via a sensory preconditioning paradigm. Two neutral preconditioning stimuli (PSs) were paired with two neutral conditioned stimuli (CSs). One CS then came to predict an aversive outcome whereas the other CS came to predict safety. In test, participants engaged in stronger avoidance to the PS associated with the fear-related CS than the PS associated with the safety-related CS. Of note, executing behavioral avoidance led to missing out a competing reward, thus rendering avoidance costly. The results also provide preliminary evidence that threat anticipation and a negative change in valence play a role in driving costly avoidance of learnt fear. Future studies should examine how avoidance of learnt fear maintains pathological anxiety
Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten
No full text Zusammenfassung. Theoretischer Hintergrund: Expositionsbasierte Interventionen gehören zu den wirksamsten Methoden bei der Behandlung von Angststörungen. Dennoch legen vergangene Studien nahe, dass Exposition in der verhaltenstherapeutischen Routinepraxis nur selten eingesetzt wird. Barrieren, die eine Anwendung verhindern, wurden bisher nicht systematisch erfasst. Fragestellung und Methode: Hauptziel dieser Studie war eine praxis-orientierte Erhebung systemischer Barrieren und Veränderungswünschen bei der Anwendung von Exposition aus Sicht ambulant tätiger Verhaltenstherapeutinnen und -therapeuten. Mittels postalischer Befragung wurden diese Barrieren sowie die Anwendungshäufigkeit von expositionsbasierten Interventionen erfasst (N = 684). Ergebnisse: Gemäß Selbstbericht wurde bei weniger als der Hälfte der Behandlungen von Angststörungen eine Form der Exposition eingesetzt (46.8 %), wobei die Anwendungshäufigkeit stark zwischen den Behandelnden variierte. Exposition wurde hauptsächlich in der eigenen Praxis, durchschnittlich für eine Dauer von einer Stunde und mit einer wöchentlichen bis zweiwöchentlichen Frequenz eingesetzt. Eine häufigere Anwendung war mit jüngerem Alter, weniger Berufsjahren und mehr expositionsspezifischen Aus- und Weiterbildungsstunden assoziiert. Systemische Barrieren bezogen sich besonders auf finanzielle Aspekte und das Aufwand-Vergütungsverhältnis, Unklarheiten bezüglich Versicherungs- und Abrechnungsaspekten, sowie das begrenzte Stundenkontingent. Schlussfolgerung: Exposition bei Angststörungen scheint nicht so häufig und intensiv eingesetzt zu werden, wie in aktuellen evidenzbasierten Leitlinien empfohlen wird. Diverse systemische Barrieren erschweren die Anwendung in der ambulanten Routineversorgung. </jats:p
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