Department of Clinical Psychology, Utrecht University, The Netherlands.
Center for the Psychology of Learning and Experimental Psychopathology, Leuven University, Belgium.
Behav Res Ther. 2018 Sep;108:78-84. doi: 10.1016/j.brat.2018.06.009. Epub 2018 Jun 26.
Exposure-based therapies are effective for anxiety disorders, but relapse remains a problem. One explanation might be that exposure therapy reduces threat expectancy but not related feelings of unpleasantness (negative valence of the conditioned stimulus; CS+), which may promote return of threat expectancy and associated fear. Laboratory research has indeed shown that fear extinction leaves negative valence of the conditioned stimulus (CS+) intact. Here, we tested whether adding positive consequences to the CS+ during extinction, a procedure known as counterconditioning, would change the valence of the CS+ and thereby prevent return of threat expectancy. Participants underwent Acquisition (day 1), Intervention (counterconditioning or extinction; day 2), and Spontaneous recovery and Reinstatement (day 3). As expected, threat expectancy ratings during the Spontaneous recovery and Reinstatement tests were lower after counterconditioning than after extinction, but counterconditioning did not reduce CS + negative valence more than extinction. Alternative mechanisms and clinical implications are discussed.
暴露疗法对于治疗焦虑症是有效的，但疾病复发仍然是一个问题。一种解释可能是暴露疗法降低了对威胁的预期，但并未改变相关的不愉快感（条件刺激的负效价；CS+），而后者可能会促进威胁预期和相关恐惧的回归。实验室研究确实表明，恐惧消退会使条件刺激的负效价（CS+）保持不变。在这里，我们测试了在消退过程中给 CS+增加正后果（一种称为条件反射的程序）是否会改变 CS+的效价，从而防止威胁预期的回归。参与者经历了获得（第 1 天）、干预（条件反射或消退；第 2 天）和自发恢复和再巩固（第 3 天）。正如预期的那样，在自发恢复和再巩固测试期间，条件反射的威胁预期评分在条件反射后低于消退后，但条件反射并未比消退更能降低 CS+的负效价。讨论了替代机制和临床意义。
