Department of Psychology, School of Natural and Social Sciences, Purchase College, State University of New York.
Department of Psychiatry, Keck School of Medicine, University of Southern California.
Psychol Bull. 2024 Sep;150(9):1118-1154. doi: 10.1037/bul0000437. Epub 2024 Aug 1.
Research on unconscious fear responses has recently been translated into experimental paradigms for reducing fear that bypass conscious awareness of the phobic stimulus and thus do not induce distress. These paradigms stand in contrast to exposure therapies for anxiety disorders, which require direct confrontation of feared situations and thus are distressing. We systematically review these unconscious exposure paradigms. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-based search yielded 39 controlled experiments based on 10 paradigms that tested whether exposure without awareness can reduce fear-related responses. In randomized controlled trials of phobic participants, unconscious exposure interventions: (a) reduced behavioral avoidance (weighted mean = 0.77, = 469) and self-reported fear ( = 0.78, = 329) during in vivo exposure to feared situations; (b) reduced neurobiological indicators of fear and enhanced such indicators of fear regulation ( = 0.81, = 205); (c) had significantly stronger effects on reducing symptomatic behaviors and enhancing neurobiological indicators of fear regulation than did conscious exposure ( = 0.78, = 342); and (d) produced these effects without inducing subjective fear. In fear-conditioned participants, unconscious exposureinduced extinction learning ( = 0.80, = 420), even during sleep, and yielded somewhat stronger extinction learning than conscious exposure did ( = 0.44, = 438). We organize these findings within a neuroscientific framework and evaluate alternative mechanisms for unconscious exposure. The use of incommensurate outcome measures across exposure paradigms and nonreporting of relevant statistics limited meta-analyses. Despite steps taken to address publication bias, 25.6% of included studies came from a single laboratory. We propose potential clinical applications of these findings. Future research should clarify underlying mechanisms, use common outcome measures, and explore effects on other anxiety disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
最近，对无意识恐惧反应的研究已经转化为减少恐惧的实验范式，这些范式绕过了对恐惧刺激的意识觉察，因此不会引起痛苦。这些范式与焦虑障碍的暴露疗法形成对比，后者需要直接面对恐惧情境，因此会引起痛苦。我们系统地回顾了这些无意识暴露范式。一项基于系统评价和荟萃分析的首选报告项目搜索产生了 39 项基于 10 种范式的对照实验，这些实验旨在测试无意识暴露是否可以减少与恐惧相关的反应。在对恐惧症参与者进行的随机对照试验中，无意识暴露干预措施：(a)减少了对恐惧情境的现场暴露时的行为回避（加权均值 = 0.77， = 469）和自我报告的恐惧（ = 0.78， = 329）；(b)减少了恐惧的神经生物学指标，并增强了恐惧调节的此类指标（ = 0.81， = 205）；(c)与意识暴露相比，对减少症状行为和增强恐惧调节的神经生物学指标具有更强的效果（ = 0.78， = 342）；(d)在不引起主观恐惧的情况下产生这些效果。在恐惧条件化的参与者中，无意识暴露诱导了消退学习（ = 0.80， = 420），甚至在睡眠期间也是如此，并且产生的消退学习比意识暴露更强（ = 0.44， = 438）。我们将这些发现组织在一个神经科学框架内，并评估无意识暴露的替代机制。由于暴露范式之间使用了不兼容的结果衡量标准以及未报告相关统计数据，因此元分析受到限制。尽管采取了措施来解决发表偏倚问题，但纳入的研究中有 25.6%来自一个单一的实验室。我们提出了这些发现的潜在临床应用。未来的研究应该阐明潜在的机制，使用共同的结果衡量标准，并探索对其他焦虑障碍的影响。（PsycInfo 数据库记录（c）2024 APA，保留所有权利）。
