Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
J Anxiety Disord. 2024 Aug;106:102911. doi: 10.1016/j.janxdis.2024.102911. Epub 2024 Jul 29.
Anxiety disorders are common and highly distressing mental health conditions. Exposure therapy is a gold-standard treatment for anxiety disorders. Mechanisms of Pavlovian fear learning, and particularly fear extinction, are central to exposure therapy. A growing body of evidence suggests an important role of reward processes during Pavlovian fear extinction. Nonetheless, predominant models of exposure therapy do not currently incorporate reward processes. Herein, we present a theoretical model of reward processes in relation to Pavlovian mechanisms of exposure therapy, including a focus on dopaminergic prediction error signaling, coinciding positive emotional experiences (i.e., relief), and unexpected positive outcomes. We then highlight avenues for further research and discuss potential strategies to leverage reward processes to maximize exposure therapy response, such as pre-exposure interventions to increase reward sensitivity or post-exposure rehearsal (e.g., savoring, imaginal recounting strategies) to enhance retrieval and retention of learned associations.
焦虑障碍是常见且高度令人痛苦的心理健康状况。暴露疗法是焦虑障碍的金标准治疗方法。巴甫洛夫式恐惧学习的机制,特别是恐惧消退,是暴露疗法的核心。越来越多的证据表明,在巴甫洛夫式恐惧消退期间,奖励过程起着重要作用。尽管如此,目前主导的暴露疗法模型并未纳入奖励过程。本文提出了一个关于奖励过程与暴露疗法的巴甫洛夫机制之间关系的理论模型,包括关注多巴胺能预测错误信号、伴随的积极情绪体验(即缓解)和意外的积极结果。然后,我们强调了进一步研究的途径,并讨论了利用奖励过程来最大程度提高暴露疗法反应的潜在策略,例如预先暴露干预以增加奖励敏感性,或事后暴露复述(例如,品味、想象重述策略)以增强已习得关联的检索和保留。
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