Dibbets Pauline, Lemmens Anke, Voncken Marisol
Maastricht University, The Netherlands.
Maastricht University, The Netherlands.
J Behav Ther Exp Psychiatry. 2018 Sep;60:5-12. doi: 10.1016/j.jbtep.2018.02.001. Epub 2018 Feb 13.
It is assumed that fear responses can be altered by changing the contingency between a conditioned stimulus (CS) and an unconditioned stimulus (US), or by devaluing the present mental representation of the US. The aim of the present study was to compare the efficacy of contingency- and devaluation-based intervention techniques on the diminishment in - and return of fear. We hypothesized that extinction (EXT, contingency-based) would outperform devaluation-based techniques regarding contingency measures, but that devaluation-based techniques would be most effective in reducing the mental representation of the US. Additionally, we expected that incorporations of the US during devaluation would result in less reinstatement of the US averseness.
Healthy participants received a fear conditioning paradigm followed by one of three interventions: extinction (EXT, contingency-based), imagery rescripting (ImRs, devaluation-based) or eye movement desensitization and reprocessing (EMDR, devaluation-based). A reinstatement procedure and test followed the next day.
EXT was indeed most successful in diminishing contingency-based US expectancies and skin conductance responses (SCRs), but all interventions were equally successful in reducing the averseness of the mental US representation. After reinstatement EXT showed lowest expectancies and SCRs; no differences were observed between the conditions concerning the mental US representation.
A partial reinforcement schedule was used, resulting in a vast amount of contingency unaware participants. Additionally, a non-clinical sample was used, which may limit the generalizability to clinical populations.
EXT is most effective in reducing conditioned fear responses.
假定恐惧反应可以通过改变条件刺激（CS）与无条件刺激（US）之间的关联性，或者通过贬低当前对无条件刺激的心理表征来改变。本研究的目的是比较基于关联性和贬值的干预技术在减少恐惧及恐惧恢复方面的效果。我们假设，就关联性指标而言，消退（EXT，基于关联性）在效果上会优于基于贬值的技术，但基于贬值的技术在减少对无条件刺激的心理表征方面最为有效。此外，我们预期在贬值过程中引入无条件刺激会减少无条件刺激厌恶感的恢复。
健康参与者接受恐惧条件化范式，随后进行三种干预之一：消退（EXT，基于关联性）、意象重编（ImRs，基于贬值）或眼动脱敏再处理（EMDR，基于贬值）。次日进行恢复程序和测试。
EXT在减少基于关联性的对无条件刺激的预期和皮肤电传导反应（SCR）方面确实最为成功，但所有干预在减少对无条件刺激的心理表征的厌恶感方面同样成功。恢复后，EXT的预期和SCR最低；在对无条件刺激的心理表征方面，各条件之间未观察到差异。
采用了部分强化程序，导致大量参与者未意识到关联性。此外，使用的是非临床样本，这可能会限制研究结果对临床人群的普遍性。
EXT在减少条件性恐惧反应方面最为有效。
