The effect of UCS inflation and deflation procedures on 'fear' conditioning

Targeting negative flashforward imagery in speech anxiety with a visuospatial dual-task: Do attenuated flashforwards lead to less anxiety and avoidance?

BACKGROUND AND OBJECTIVES

It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech.

METHODS

Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech.

RESULTS

Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech.

LIMITATIONS

The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample.

CONCLUSIONS

Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears.

Unconditioned stimulus devaluation decreases the generalization of costly safety behaviors

Safety behaviors are often maladaptive in clinical anxiety as they typically persist without realistic threat and cause various impairments. In the laboratory, safety behaviors are modelled by responses to a conditioned stimulus (CS) that reduce the occurrence of an expected aversive unconditioned stimulus (US). Preliminary evidence suggests that US devaluation, a procedure that decreases US aversiveness, devalues the threat value of the CS and thus diminishes safety behaviors to the CS. This study (n = 78) aimed to extend this finding and examined whether US-devaluation can reduce the generalization of safety behaviors to various stimuli. After acquiring safety behaviors to CSs of different categories, the US predicted by one CS category was devalued. In test, participants showed a selective reduction in safety behaviors to novel stimuli of the devalued CS category, reflecting a decrease in generalization of safety behaviors. Trait anxiety was associated with persistent generalized safety behaviors to novel stimuli of the devalued category. We discuss how US devaluation may improve treatment outcome but also the challenges of clinical translation.

Inhibitory Learning during Exposure Treatment in Anorexia Nervosa: A Practical Guide

Exposure therapy is known to be an effective intervention in the treatment of anxiety-related disorders. In eating disorders, such as anorexia nervosa, anxiety and avoidance are identified as maintenance factors. Therefore, they may constitute an important treatment target, suitable for the use of exposure therapy. Remarkably, exposure techniques to target fears and avoidance behaviors are not commonly used in the treatment of anorexia nervosa. We present a practical guide for the implementation of exposure therapy in the treatment of anorexia nervosa. We outline how exposure therapy is supposed to work according to the inhibitory learning model and how the exposure intervention can be designed for individuals with anorexia nervosa. Practical examples are provided through the case presentation of a patient with anorexia nervosa who completed 31 exposure sessions that focused on her fears of food, eating, weight, weight gain, their feared social consequences and the associated safety behaviors.

Learning via instructions about observations: exploring similarities and differences with learning via actual observations

Our behaviour toward stimuli can be influenced by observing how another person (a model) interacts with those stimuli. We investigated whether mere instructions about a model's interactions with stimuli (i.e. instructions about observations) are sufficient to alter evaluative and fear responses and whether these changes are similar in magnitude to those resulting from actually observing the interactions. In Experiments 1 (n = 268) and 2 (n = 260), participants either observed or read about a model reacting positively or negatively to stimuli. Evaluations of those stimuli were then assessed via ratings and a personalized implicit association test. In Experiments 3 (n = 60) and 4 (n = 190), we assessed participants' fear toward stimuli after observing or reading about a model displaying distress in the presence of those stimuli. While the results consistently indicated that instructions about observations induced behavioural changes, they were mixed with regard to whether instructions were as powerful in changing behaviour as observations. We discuss whether learning via observations and via instructions may be mediated by similar or different processes, how they might differ in their suitability for conveying certain types of information, and how their relative effectiveness may depend on the information to be transmitted.

The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine

Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.

Preventing and reducing fear using positive modelling: A systematic review of experimental research with children

Fear of specific stimuli is thought to develop through associative learning mechanisms and research indicates that a form of observational (vicarious) learning known as positive modelling can counter these effects. This systematic review examined and synthesised the experimental positive modelling literature to establish its efficacy for reducing fear. Psych Info, Medline and the Psychology and Behavioural Science Collection databases were systematically searched until August 2021. Of the 1,677 papers identified, 18 experiments across 14 articles met the inclusion criteria. In the majority of these, positive modelling was found to lower fear levels in one or more of three procedures: fear prevention, fear reduction and fear reversal. Procedures inform prevention and treatment initiatives for specific phobias in several ways. The overall efficacy of positive modelling techniques and the ease in which they can be implemented highlight the importance of further research to evaluate their inclusion in prevention and treatment interventions. More research is required to establish the longevity and transferability of positive modelling.

Specificity of spiders among fear- and disgust-eliciting arthropods: Spiders are special, but phobics not so much

To investigate a specificity of spiders as a prototypical fear- and disgust-eliciting stimuli, we conducted an online experiment. The respondents rated images of 25 spiders, 12 non-spider chelicerates, and 10 other arthropods on a fear and disgust 7-point scale. The evaluation of 968 Central European respondents confirmed the specificity of spiders among fear- and disgust-eliciting arthropods and supported the notion of spiders as a cognitive category. We delineated this category as covering extant spider species as well as some other chelicerates bearing a physical resemblance to spiders, mainly whip spiders and camel spiders. We suggested calling this category the spider-like cognitive category. We discussed evolutionary roots of the spider-like category and concluded that its roots should be sought in fear, with disgust being secondary of the two emotions. We suggested other chelicerates, e.g., scorpions, might have been important in formation and fixation of the spider-like category. Further, we investigated an effect of respondent's sensitivity to a specific fear of spiders on evaluation of the stimuli. We found that suspected phobic respondents were in their rating nearly identical to those with only high fear of spiders and similar to those with only moderate fear of spiders. We concluded that results based on healthy respondents with elevated fear should also be considered relevant for arachnophobia research.

Does an unconditioned stimulus memory devaluation procedure decrease disgust memories and conditioned disgust? Results of two laboratory studies

Research has demonstrated that disgust can be installed through classical conditioning by pairing neutral conditioned stimuli (CSs) with disgusting unconditioned stimuli (USs). Disgust has been argued to play an important role in maintaining fear-related disorders. This maintaining role may be explained by conditioned disgust being less sensitive to extinction (i.e., experiencing the CS in the absence of the US). Promising alternatives to extinction training are procedures that focus on the devaluation of US memory representations. In the current study, we investigated whether such devaluation procedures can be successful to counter conditioned disgust. We conducted two laboratory studies (N = 120 and N = 51) in which disgust was conditioned using audio-visual USs. Memory representations of the USs were devalued by having participants recall these USs while they performed a taxing eye-movement task or executed one of several control tasks. The results showed successful conditioned disgust acquisition. However, no strong evidence was obtained that an US memory devaluation procedure modulates disgust memory and diminishes conditioned disgust as indicated by subjective, behavioral, or psychophysiological measures. We discuss the relevance of our results for methodological improvements regarding US memory devaluation procedures and disgust conditioning.

Experimental models in psychopathology research: The relation between Research Domain Criteria and Experimental Psychopathology

Experimental Psychopathology (EPP) and the Research Domain Criteria (RDoC) are research approaches that have developed in parallel, providing inter-related yet different scientific frameworks to investigate psychopathology at the intersection of fundamental and applied research. Here we address the overlap and differences between RDoC and EPP, and the challenges that both approaches face. Although overlap between EPP and RDoC can be clearly observed, each approach has its own unique strengths and weaknesses. These aspects will be illustrated by examples with respect to fear conditioning, an experimental procedure that has played a central role in both EPP and RDoC. We see much potential in boosting psychopathology research by combining the strengths of these two approaches.

Measuring fear: Association among different measures of fear learning

BACKGROUND AND OBJECTIVES

Fear conditioning paradigms use various measures to assess learned fear, including autonomic arousal responses like skin conductance, and self-reports of both associative (US-expectancies) and evaluative (affective ratings) learning. The present study uses a dimensional approach to examine associations among fear indices directly.

METHODS

Seventy-three participants completed a differential fear conditioning experiment, during which a neutral stimulus (CS+) was paired with an electric shock (US), while another stimulus (CS-) was never paired with the shock (partially instructed fear acquisition). Ten minutes later, both stimuli were presented without any shocks (fear extinction). Skin conductance responses and US-expectancy ratings were recorded during each phase, while self-reported negative affect was assessed for each CS at the end of extinction.

RESULTS

Results showed a positive association among US-expectancy ratings and skin conductance responses during acquisition and early extinction. US-expectancy ratings during overall extinction were positively associated with post-extinction negative affect.

LIMITATIONS

The lack of affective ratings post-acquisition may have obscured associations between associative and evaluative learning indices.

CONCLUSIONS

Results provide evidence for the expected correspondence among different indices of associative fear learning. Findings emphasize the need for incorporating both associative and evaluative learning measures in fear conditioning paradigms.

Category-based generalization of placebo and nocebo effects

Human beings possess the adaptive ability to apply experiential knowledge to new situations. Although this generalization capability has been demonstrated in fear and reward learning, it remains unclear whether it extends to analgesic and hyperalgesic pain responses. Here, we conducted two experiments (total n = 104) to test the generalization effects of placebo analgesia and nocebo hyperalgesia. The first experiment, using a category-based conditioning paradigm in which two categories of images were used as acquisition stimuli, assessed whether pain perception can be generalized to never-seen pictures of the same category in the generalization phase. The second experiment adopted a single stimulus for each category as CS to further examine the generalization effects after learning a single exemplar. Pain ratings showed that participants reported higher pain or lower pain when the pain was preceded by novel stimuli that were conceptually similar to the previously conditioned stimuli, suggesting a generalization of analgesic and hyperalgesic pain modulation effects. These results provide novel evidence that analgesic and hyperalgesic effects on pain perception can be generalized to conceptually similar new items.

Impaired discriminative fear conditioning during later training trials differentiates generalized anxiety disorder, but not panic disorder, from healthy control participants

BACKGROUND

Fear conditioning is implicated as a central psychopathological mechanism of anxiety disorders. People with anxiety disorders typically demonstrate reduced affective discrimination between conditioned danger and safety cues. Here, affective discrimination refers to the ability to selectively display fear to dangerous but not safe situations. Though both generalized anxiety disorder (GAD) and panic disorder (PD) are linked to impaired affective discrimination, the clinical phenomenology of these disorders suggests that people with GAD versus PD might be less able to overcome such deficits. It is unclear how this potential difference would manifest during lab-based conditioning.

METHODS

We used a classical fear conditioning paradigm over two discrimination training sessions to examine whether those with GAD, but not PD, would display persistent discrimination deficits. Sixty-seven participants (21 GAD, 19 PD, 27 Healthy Controls) completed a task in which conditioned fear was measured psychophysiologically (fear-potentiated startle), behaviorally, and via self-report.

RESULTS

Although similar levels of impaired discrimination were found for both GAD and PD groups during initial training, such impairments tended to persist across a subsequent training session only for patients with GAD when compared with Controls.

CONCLUSION

Our results provide a foundation for additional research of discrimination deficits in specific anxiety disorders, with an ultimate goal of improved customization of psychological treatments.

Is it possible to modify fear memories in humans with extinction training within a single day?

Extinction procedures have been used widely in the study of fear memories, and different positions have been adopted regarding the efficacy of such procedures and the mechanisms involved. It has been argued that extinction may interfere with the consolidation of the fear memory if the procedure is applied with the appropriate timing after acquisition. However, the opposite position is also held, that is, that the extinction does not achieve an elimination of the fear response. The aim of the present study is to test the short-term effects of immediate extinction in fear reduction when this extinction is preceded by a retrieval trial. For this, a procedure similar to that employed by Schiller et al. (Nature 463(7277): 49-53, 2010) was used, but in a single day and with white noise as an aversive unconditioned stimulus. The results indicate that a CS+ single retrieval trial before the extinction procedure after acquisition was more effective in fear reduction than standard immediate extinction.

Effects of orientation and differential reinforcement II: transitivity and transfer across five-member sets

A recent report by Amd et al. (2017) demonstrated that orienting towards successively presented stimulus-stimulus pairs yielded significantly more transitive relations then when those same pairs were differentially reinforced following training for three, 3-member stimulus sets. We build on that work in four important ways. First, transitivity yields produced by Pavlovian and instrumental procedures were compared following training for three 5-member sets (A1-B1-C1-D1-E1, A2-B2-C2-D2-E2, A3-B3-C3-D3-E3), where the 'A' stimuli were emotional faces and all remaining stimuli were nonsense words. Second, our instrumental task here required two orienting/observing responses per trial. Third, we compared differences in multi-nodal transfer following Pavlovian and instrumental relational learning procedures. Finally, we tested whether functioning as 'end terms' in a relational series can mitigate transfer following instrumental conditioning. Transitivity, as measured by sorting tests, was significantly more pronounced following Pavlovian training. Transfer, assessed before and after relational training with two visual analog scales corresponding to valence and arousal dimensions, appeared marginally more robust observed for participants exposed to the Pavlovian condition. Transfer magnitude was positively related with demonstrations of transitivity, regardless of type of conditioning.

The moderating role of avoidance behavior on anxiety over time: Is there a difference between social anxiety disorder and specific phobia?

Theories of anxiety disorders and phobias have ascribed a critical role to avoidance behavior in explaining the persistence of fear and anxiety, but knowledge about the role of avoidance behavior in the maintenance of anxiety in social anxiety disorder relative to specific phobia is lacking. This study examined the extent to which avoidance behavior moderates the relationship between general anxiety at baseline and 18 months later in women with a diagnosed social anxiety disorder (n = 91) and women with a diagnosed specific phobia (n = 130) at baseline. Circumscribed avoidance of social and specific situations were clinician-rated using the Anxiety Disorders Interview Schedule-Lifetime (ADIS-IV-L), and general anxiety was measured using the Beck Anxiety Inventory (BAI). Moderated regression analyses revealed that (a) general anxiety at baseline predicted general anxiety at follow-up in both women with a specific phobia and women with a social anxiety disorder and (b) avoidance behavior moderated this relationship in women with a specific phobia but not in women with a social anxiety disorder. Specifically, high avoidance behavior was found to amplify the effect between general anxiety at baseline and follow-up in specific phobia. Reasons for the absence of a similar moderating effect of avoidance behavior within social anxiety disorder are discussed.

Learning, Reward, and Decision Making

In this review, we summarize findings supporting the existence of multiple behavioral strategies for controlling reward-related behavior, including a dichotomy between the goal-directed or model-based system and the habitual or model-free system in the domain of instrumental conditioning and a similar dichotomy in the realm of Pavlovian conditioning. We evaluate evidence from neuroscience supporting the existence of at least partly distinct neuronal substrates contributing to the key computations necessary for the function of these different control systems. We consider the nature of the interactions between these systems and show how these interactions can lead to either adaptive or maladaptive behavioral outcomes. We then review evidence that an additional system guides inference concerning the hidden states of other agents, such as their beliefs, preferences, and intentions, in a social context. We also describe emerging evidence for an arbitration mechanism between model-based and model-free reinforcement learning, placing such a mechanism within the broader context of the hierarchical control of behavior.

Aversive learning of odor-heat associations in ants

Ants have recently emerged as useful models for the study of olfactory learning. In this framework, the development of a protocol for the appetitive conditioning of the maxilla-labium extension response (MaLER) provided the possibility of studying Pavlovian odor-food learning in a controlled environment. Here we extend these studies by introducing the first Pavlovian aversive learning protocol for harnessed ants in the laboratory. We worked with carpenter ants Camponotus aethiops and first determined the capacity of different temperatures applied to the body surface to elicit the typical aversive mandible opening response (MOR). We determined that 75°C is the optimal temperature to induce MOR and chose the hind legs as the stimulated body region due to their high sensitivity. We then studied the ability of ants to learn and remember odor-heat associations using 75°C as unconditioned stimulus. We studied learning and short-term retention after absolute (one odor paired with heat) and differential conditioning (a punished odor versus an unpunished odor). Our results show that ants successfully learn the odor-heat association under a differential-conditioning regime and thus exhibit conditioned MOR to the punished odor. Yet, their performance under an absolute-conditioning regime is poor. These results demonstrate that ants are capable of aversive learning and confirm previous findings about the different attentional resources solicited by differential and absolute conditioning in general.

One-trial overshadowing: Evidence for fast specific fear learning in humans

Adaptive defensive actions necessitate a fear learning system that is both fast and specific. Fast learning serves to minimize the number of threat confrontations, while specific learning ensures that the acquired fears are tied to threat-relevant cues only. In Pavlovian fear conditioning, fear acquisition is typically studied via repetitive pairings of a single cue with an aversive experience, which is not optimal for the examination of fast specific fear learning. In this study, we adopted the one-trial overshadowing procedure from basic learning research, in which a combination of two visual cues is presented once and paired with an aversive electrical stimulation. Using on-line shock expectancy ratings, skin conductance reactivity and startle reflex modulation as indices of fear learning, we found evidence of strong fear after a single conditioning trial (fast learning) as well as attenuated fear responding when only half of the trained stimulus combination was presented (specific learning). Moreover, specificity of fear responding tended to correlate with levels of state and trait anxiety. These results suggest that one-trial overshadowing can be used as a model to study fast specific fear learning in humans and individual differences therein.

Evaluating Perceived Probability of Threat-Relevant Outcomes and Temporal Orientation in Flying Phobia

Probability bias regarding threat-relevant outcomes has been demonstrated across anxiety disorders but has not been investigated in flying phobia. Individual temporal orientation (time perspective) may be hypothesised to influence estimates of negative outcomes occurring. The present study investigated whether probability bias could be demonstrated in flying phobia and whether probability estimates of negative flying events was predicted by time perspective. Sixty flying phobic and fifty-five non-flying-phobic adults were recruited to complete an online questionnaire. Participants completed the Flight Anxiety Scale, Probability Scale (measuring perceived probability of flying-negative events, general-negative and general positive events) and the Past-Negative, Future and Present-Hedonistic subscales of the Zimbardo Time Perspective Inventory (variables argued to predict mental travel forward and backward in time). The flying phobic group estimated the probability of flying negative and general negative events occurring as significantly higher than non-flying phobics. Past-Negative scores (positively) and Present-Hedonistic scores (negatively) predicted probability estimates of flying negative events. The Future Orientation subscale did not significantly predict probability estimates. This study is the first to demonstrate probability bias for threat-relevant outcomes in flying phobia. Results suggest that time perspective may influence perceived probability of threat-relevant outcomes but the nature of this relationship remains to be determined.

Influences of Age and Emotion on Source Guessing: Are Older Adults More Likely to Show Fear-Relevant Illusory Correlations?

OBJECTIVES

The present study investigates age differences in the vulnerability to illusory correlations between fear-relevant stimuli and threatening information.

METHOD

Younger and older adults saw pictures of threatening snakes and nonthreatening fish, paired with threatening and nonthreatening context information ("poisonous" and "nonpoisonous") with a null contingency between animal type and poisonousness. In a source monitoring test, participants were required to remember whether an animal was associated with poisonousness or nonpoisonousness. Illusory correlations were implicitly measured via a multinomial model. One advantage of this approach is that memory and guessing processes can be assessed independently. An illusory correlation would be reflected in a higher probability of guessing that a snake rather than a fish was poisonous if the poisonousness of the animal was not remembered.

RESULTS

Older adults showed evidence of illusory correlations in source guessing while younger adults did not; instead they showed evidence of probability matching. Moreover, snake fear was associated with increased vulnerability to illusory correlations in older adults.

DISCUSSION

The findings confirm that older adults are more susceptible to fear-relevant illusory correlations than younger adults.

Pathways of fear and anxiety in dentistry: A review

The aim of this article was to analyze the theories underpinning dental fear, anxiety and phobias. To be included, articles must have been published between the years of 1949 and 2013 concerning fears and phobias within dentistry and/or psychiatry. Of 200 articles originally under review, 140 were included and reviewed by the authors.Five specific pathways relating to dental fear and anxiety were identified; Cognitive Conditioning, Informative, Visual Vicarious, Verbal Threat, and Parental. Eight currently accepted management techniques across all dental disciplines for dental fear and anxiety were identified. Further research is required to identify clinical diagnosis and treatment for fears originating from different pathways.

Trauma Revaluation, Conditioning, and Anxiety Disorders

This paper describes a two-component conditioning model of anxiety disorders whose two main components are an associative process and a process which determines the evaluation of the unconditioned stimulus (UCS). It is argued that the inclusion of UCS revaluation processes enables conditioning models to explain a variety of anxiety-related phenomena that hitherto had been difficult to explain solely in associative terms. In particular, (a) experiments are described which suggest that incubation of the conditioned response (CR) can be explained in terms of processes contributing to UCS inflation, (b) the experimental evidence on UCS revaluation is assessed in relation to cognitive processes that might lead to trauma revaluation within specific anxiety disorders, and (c) the role of personality factors in effecting UCS and trauma revaluation is discussed.

Adaptive Behaviour in Children and Adolescents With and Without an Intellectual Disability: Relationships with Fear and Anxiety

Prior research has indicated that people with an intellectual disability experience higher levels of negative affect, including anxiety and fearfulness, than people who are not disabled. This is important because research has also suggested a negative relationship between emotional distress and adaptive behaviour, albeit in nondisabled populations. The present study investigates the relationships between fear, anxiety, and adaptive behaviour in children and adolescents with an intellectual disability as compared to youth of average intelligence. A sample ranging in age from 7 to 18 years participated in the study. Fifty-one respondents (30 male, 21 female) constituted the intellectually disabled sample, and 57 (28 male, 29 female) constituted the comparison group. Analysis revealed higher levels of fear and anxiety among the group with disabilities. An inverse relationship was also found between negative affect and adaptive behaviour among the youth with disabilities, but not for youth of average intelligence. The results are discussed in relation to their implications for intervention programs.

Family Processes in Child and Adolescent Anxiety and Depression

Anxiety and depression tend to run in families. This paper reviews some of the family processes that are implicated in the development, maintenance, and treatment of these problems in children and adolescents. Empirical studies and our theoretical review show that social learning processes within the context of intimate relationships are important in the development of anxiety and depression. Family processes have been shown to be important in the treatment of anxiety disorders but parallel evidence is lacking with regard to depression in adolescents. Two models are shown to have demonstrated explanatory power and empirical support: social learning theory and attachment theory. Examples are given of how these models can be contrasted and integrated at both clinical and theoretical levels.

Maximizing exposure therapy: an inhibitory learning approach

Exposure therapy is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear after treatment. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure-based procedures. Although evidence supports an inhibitory learning model of extinction, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a 'fear habituation' approach and 'belief disconfirmation' approach within standard cognitive-behavior therapy. Exposure optimization strategies include (1) expectancy violation, (2) deepened extinction, (3) occasional reinforced extinction, (4) removal of safety signals, (5) variability, (6) retrieval cues, (7) multiple contexts, and (8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, specific phobia, and panic disorder.

Unconscious Learning. Conditioning to Subliminal Visual Stimuli

The role of consciousness in Pavlovian conditioning was examined in two experiments in which visually masked neutral words were used as the conditioned stimuli (CS) and an electric shock as the unconditioned stimulus (US). The inter-stimulus interval (ISI) was established individually. A detection threshold was used in Experiment 1 and an identification threshold in Experiment 2. The primary dependent variable was the skin conductance response (SCR). Results showed that the conditioned response (CR) was acquired by 58% of participants who perceived stimuli above the identification threshold, 50% of participants who perceived stimuli below the detection threshold, and 11% of participants who perceived stimuli below the identification threshold, but above the detection threshold. These results suggest that consciousness of the CS-US contingency is not a necessary condition for acquiring a CR of the autonomous nervous system (ANS).

Do CS-US pairings actually matter? A within-subject comparison of instructed fear conditioning with and without actual CS-US pairings

Previous research showed that instructions about CS-US pairings can lead to fear of the CS even when the pairings are never presented. In the present study, we examined whether the experience of CS-US pairings adds to the effect of instructions by comparing instructed conditioning with and without actual CS-US pairings in a within-subject design. Thirty-two participants saw three fractals as CSs (CS⁺1, CS⁺2, CS⁻) and received electric shocks as USs. Before the start of a so-called training phase, participants were instructed that both CS⁺1 and CS⁺2 would be followed by the US, but only CS⁺1 was actually paired with the US. The absence of the US after CS⁺2 was explained in such a way that participants would not doubt the instructions about the CS⁺2-US relation. After the training phase, a test phase was carried out. In this phase, participants expected the US after both CS⁺s but none of the CS⁺s was actually paired with the US. During test, self-reported fear was initially higher for CS⁺1 than for CS⁺2, which indicates that the experience of actual CS-US pairings adds to instructions about these pairings. On the other hand, the CS⁺s elicited similar skin conductance responses and US expectancies. Theoretical and clinical implications are discussed.

The moderating role of dental expectancies on the relationship between cognitive vulnerability and dental fear in children and adolescents

OBJECTIVE

Recently, cognitive approaches have been successfully applied to the understanding of child dental anxiety. Our study aimed to analyze the interplay between cognitive variables and their associations with dental fear. In particular, we proposed that the observed relationship between dental treatment-related cognitive vulnerability (i.e., uncontrollability, unpredictability, dangerousness, and disgustingness appraisals) and dental fear is moderated by the expectancies of the probability and aversiveness of negative events during dental treatments.

METHODS

A questionnaire survey was conducted with data obtained from 179 participants (8-18 years, 55.9% female) who attended 12 randomly selected educational establishments in Madrid (Spain).

RESULTS

Dental fear was associated with an irregular pattern of dental visits. As expected, cognitive vulnerability was strongly linked to dental anxiety. For those children who expected a lower likelihood of negative dental events or appraised them in a less aversive way, the relationship between cognitive vulnerability and fear was attenuated.

CONCLUSIONS

As dental fear and oral health are connected, the prevention and reduction of dental fear among children and adolescents might be a worthwhile target for public health interventions. Our study sheds some light on how this could be achieved, that is, by modifying the children's vulnerability appraisals as well as their fearful dental expectancies.

Post-acquisition repetitive thought in fear conditioning: an experimental investigation of the effect of CS-US-rehearsal

BACKGROUND AND OBJECTIVES

Although repetitive thought (e.g., worry) is generally assumed to be a risk factor for psychopathological disorders such as anxiety disorders, the repetitive thought processes occurring after a conditioning event have not yet received much theoretical attention. However, as repetitive thought can be mimicked by (mental) rehearsal, which is well-known to enhance memory performance, it seems worthwhile to explore the role of rehearsal in conditioning. Therefore, the current study investigates the impact of rehearsing an acquired CS-US-contingency on subsequent conditioned fear responding.

METHODS

After acquiring two CS-US-contingencies with either a human scream or a white noise as US, participants were instructed to rehearse one of these CS-US-pairings during an experimental session as well as during the following week.

RESULTS

Fear responding to the CS which was previously paired with the scream persisted in the participants who rehearsed the CS-US(scream)-contingency, but decreased in those participants who rehearsed the CS-US(noise)-contingency. The same pattern emerged in the US-expectancy ratings, but the effect failed to reach significance. For the CS which was paired with the noise-US, no rehearsal effect emerged.

LIMITATIONS

As acquisition to the noise-US was less pronounced and less robust as compared to the scream-US, claims regarding the rehearsal effect might be hampered for the CS-US(noise)-contingency.

CONCLUSIONS

Repetitive post-acquisition activation of a CS-US-contingency impacts CR retention. As the USs were not rated as more intense, aversive or startling after rehearsal compared to post-acquisition, US-inflation is discarded as a possible explanation of this effect.

Isolated effects of number of acquisition trials on extinction of rat conditioned approach behavior

Four conditioned approach experiments with rats assessed for effects of number of acquisition trials on extinction of conditioned responding, when number of acquisition sessions and total acquisition time were held constant. In Experiment 1, 32 trials per acquisition session led to more extinction responding than did 1 or 2 trials per session but less than did 4 trials per session. In Experiment 2, 2 trials per acquisition session led to more spontaneous recovery than did 32 trials per session. These latter findings are reminiscent of the overtraining extinction effect (OEE). Experiment 3 attempted to reduce the OEE with a preconditioning phase of partial reinforcement. Experiment 4 attempted to reduce the beneficial within-subject effects of increasing the number of acquisition trials on extinction observed by Gottlieb and Rescorla (2010) by extinguishing stimuli in different sessions. Overall, results suggest a procedural asymmetry: between-subject, increasing the number of trials between any pair of trials does not lead to greater persistence of responding during extinction; within-subject, it does. Results are discussed from an associative perspective, with a focus on explanations involving either frustration or comparator mechanisms, and from an information processing perspective, with a focus on Rate Estimation Theory.

Role of conceptual knowledge in learning and retention of conditioned fear

Associating sensory cues with aversive outcomes is a relatively basic process shared across species. Yet higher-order cognitive processes likely contribute to associative fear learning in many circumstances, especially in humans. Here we ask whether fears can be acquired based on conceptual knowledge of object categories, and whether such concept-based fear conditioning leads to enhanced memory representations for conditioned objects. Participants were presented with a heterogeneous collection of images of animals and tools. Objects from one category were reinforced by an electrical shock, whereas the other category was never reinforced. Results confirmed concept-based fear learning through subjective report of shock expectancy, heightened skin conductance responses, and enhanced 24h recognition memory for items from the conditioned category. These results provide novel evidence that conditioned fear can generalize through knowledge of object concepts, and sheds light on the persistent nature of fear memories and category-based fear responses symptomatic of some anxiety disorders.

S-R associations, their extinction, and recovery in an animal model of anxiety: a new associative account of phobias without recall of original trauma

Associative accounts of the etiology of phobias have been criticized because of numerous cases of phobias in which the client does not remember a relevant traumatic event (i.e., Pavlovian conditioning trial), instructions, or vicarious experience with the phobic object. In three lick suppression experiments with rats as subjects, we modeled an associative account of such fears. Experiment 1 assessed stimulus-response (S-R) associations in first-order fear conditioning. After behaviorally complete devaluation of the unconditioned stimulus, the target stimulus still produced strong conditioned responses, suggesting that an S-R association had been formed and that this association was not significantly affected when the outcome was devalued through unsignaled presentations of the unconditioned stimulus. Experiments 2 and 3 examined extinction and recovery of S-R associations. Experiment 2 showed that extinguished S-R associations returned when testing occurred outside of the extinction context (i.e., renewal) and Experiment 3 found that a long delay between extinction and testing also produced a return of the extinguished S-R associations (i.e., spontaneous recovery). These experiments suggest that fears for which people cannot recall a cause are explicable in an associative framework, and indicate that those fears are susceptible to relapse after extinction treatment just like stimulus-outcome (S-O) associations.

Conceptual similarity promotes generalization of higher order fear learning

We tested the hypothesis that conceptual similarity promotes generalization of conditioned fear. Using a sensory preconditioning procedure, three groups of subjects learned an association between two cues that were conceptually similar, unrelated, or mismatched. Next, one of the cues was paired with a shock. The other cue was then reintroduced to test for fear generalization, as measured by the skin conductance response. Results showed enhanced fear generalization that correlated with trait anxiety levels in the group that learned an association between conceptually similar stimuli. These findings suggest that conceptual representations of conditional stimuli influence human fear learning processes.