Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany; Center of Mental Health, University of Würzburg, Würzburg, Germany.
Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.
Behav Res Ther. 2021 Feb;137:103797. doi: 10.1016/j.brat.2020.103797. Epub 2021 Jan 8.
Avoidance 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.
回避是临床焦虑的一种跨诊断症状，其减少是认知行为治疗的主要焦点。本研究通过奖励、口头指导和社会观察来检验目标导向回避的工具性消除，以及它们对恐惧消除的影响。参与者获得了条件性恐惧和工具性回避反应（N=160）。在四个随机分组中，将回避的减少与回避的非奖励、回避的避免指令和回避的社会观察进行了比较，在消除厌恶结果之前没有进行干预。随后测试了回避变得不可用时的条件性恐惧。奖励、指导和观察都比不干预更能有效地减少回避，但对条件性恐惧的影响程度和方式不同。奖励和指令尽管存在高度恐惧（即恐惧相反的行为），但仍能强烈地减少回避。这引发了恐惧的消退，从而在回避变得不可用时降低了条件性恐惧。社会观察直接降低了条件性恐惧，可能是因为它传达了关于厌恶结果不存在的额外信息。然而，观察只适度地减少了回避，并在回避变得不可用时导致了更高的恐惧。社会观察的效果可能取决于示范者行为的细微差别。奖励和指令的明显效果为在暴露疗法中减少回避提供了临床干预的支持，并可作为其对照研究的实验模型。
