Paskewitz Samuel, Stoddard Joel, Jones Matt
University of Colorado, Denver, US.
University of Colorado, Boulder, US.
Comput Psychiatr. 2022 Sep 14;6(1):213-237. doi: 10.5334/cpsy.88. eCollection 2022.
Exposure therapy - exposure to a feared stimulus without harmful consequences - can reduce fear responses in many mental disorders. However, such relief is often partial and temporary: fear can return after the therapy has ended. Conditioning research has identified three mechanisms for the return of fear, viz. change in physical context (renewal), the passage of time (spontaneous recovery), and an encounter with the fear-producing unconditioned stimulus (reinstatement). To understand why fear returns and thereby develop more effective therapies, we develop mathematical learning models based on that of Rescorla and Wagner. According to this model, context cues present during extinction become conditioned inhibitors (i.e. safety signals) which prevent total erasure of the threat association. Adding various mechanisms to the model allows it to explain different facets of the return of fear. Among these mechanisms is decay of inhibitory associations, which provides a novel explanation for spontaneous recovery. To make the benefits of exposure robust and permanent, one must minimize the degree to which the extinction context becomes inhibitory in order to maximize unlearning. We simulate several experimental paradigms that reduce the return of fear and explain them according to this principle.
暴露疗法——让个体暴露于恐惧刺激下但不产生有害后果——可以减轻许多精神障碍中的恐惧反应。然而,这种缓解往往是部分的且是暂时的:恐惧可能在治疗结束后复发。条件作用研究已经确定了恐惧复发的三种机制,即物理环境的变化(恢复)、时间的推移(自发恢复)以及与引发恐惧的无条件刺激的接触(恢复原状)。为了理解恐惧为何复发并进而开发出更有效的治疗方法,我们基于雷斯克拉和瓦格纳的模型开发了数学学习模型。根据该模型,消退过程中出现的情境线索会变成条件性抑制物(即安全信号),从而阻止对威胁关联的完全消除。在模型中添加各种机制可以使其解释恐惧复发的不同方面。这些机制之一是抑制性关联的衰减,这为自发恢复提供了一种新的解释。为了使暴露疗法的效果稳固且持久,必须尽量减少消退情境产生抑制作用的程度,以便最大限度地消除已习得的恐惧。我们模拟了几种减少恐惧复发的实验范式,并根据这一原理对其进行了解释。