Resurgence in humans: Reducing relapse by increasing generalization between treatment and testing

A systematic review of enhanced resurgence paradigms

Following successful treatment in which problem behavior is reduced, it may reemerge as a function of changes in contextual stimuli or the worsening of reinforcement conditions for an alternative response. Although understudied, preliminary research suggests that simultaneous changes in contextual stimuli and reinforcement conditions may represent particularly exigent treatment challenges that create the condition for additive or superadditive relapse. The purpose of the present review was to systematically examine the relapse literature involving simultaneous changes in contextual stimuli and reinforcement conditions in relapse tests and experimental preparations arranged to evaluate their effect on response recovery. We identified 16 empirical articles spanning 27 experiments. Although all experiments included at least one condition that experienced a change in contextual stimuli and worsening of alternative reinforcement conditions, only two experiments included the comparison conditions needed to precisely evaluate additive and superadditive relapse. Our findings establish the preclinical generality of relapse effects associated with simultaneous changes to reinforcement conditions and contextual stimuli across a range of subjects, schedule arrangements, response topographies, reinforcers, and types of contextual changes. We make several recommendations for future research based on our findings from this nascent and clinically relevant subdomain of the relapse literature.

Resurgence of goal-directed actions and habits

This study investigated how goal-directed and habitual behaviors recover after extinction within the context of the resurgence effect, a form of relapse induced by the removal or worsening of alternative reinforcement. Rats were trained to press a target lever with one reinforcer (O1) for either minimal (4) or extended (16) sessions. An extinction test after the completion of O1 devaluation confirmed that minimal and extended training formed goal-directed and habitual behaviors, respectively. Then, pressing an alternative lever was reinforced with a second reinforcer (O2) while the target response was placed on extinction. When O2 was discontinued, the minimally trained target response resurged with goal-directed status as in the extinction test. However, the extinguished habitual behavior in the extensively trained rats did not recover as a habit but instead with goal-directed status, possibly due to the context specificity of habits or the introduction of a new response-reinforcer contingency. The critical finding that reinforcer devaluation consistently led to less resurgence regardless of the amount of acquisition training provides a clinical implication that coupling differential-reinforcement-of-alternative-behavior (DRA) treatments with the devaluation of the associated reinforcer of problematic behavior could effectively diminish its recurrence.

Partial reinforcement extinction and omission effects in the elimination and recovery of discriminated operant behavior

Three experiments explored how training reinforcement schedules and context influence the elimination and recovery of human operant behavior. In Experiment 1, participants learned a discriminated operant response in Context A before the response was eliminated with extinction in Context B. They then received a final test in each context. Groups were trained with a discriminative stimulus that predicted a reinforced response on either every trial (continuous reinforcement [CRF]) or some of the trials (partial reinforcement [PRF]). Extinction was slower following PRF training (a partial reinforcement extinction effect [PREE]) and extinguished responding increased when tested in Context A ("ABA" renewal). Experiment 2 further confirmed the PREE was obtained equally whether extinction occurred in the training context (Context A) or a new context (Context B) which is consistent with trial-based accounts of the PREE. Experiment 3 used the same design as Experiment 1 to evaluate the influence of training reinforcement on response elimination with an omission contingency. Across the omission training phase in Context B, the decrease in responding occurred more slowly in the PRF-trained group in comparison to the CRF-trained group, perhaps the first demonstration of what might be termed a PRF omission effect. Again, ABA renewal was observed in Context A. Training reinforcement schedule therefore had a similar influence on response elimination with extinction and omission. Elimination and recovery of human instrumental behavior, with extinction or omission, are influenced by training reinforcement schedule and context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Comprehensive Systematic Review of Procedures and Analyses Used in Basic and Preclinical Studies of Resurgence, 1970-2020

Resurgence is the return of a previously reinforced response as conditions worsen for an alternative response, such as the introduction of extinction, reductions in reinforcement, or punishment. As a procedure, resurgence has been used to model behavioral treatments and understand behavioral processes contributing both to relapse of problem behavior and flexibility during problem-solving. Identifying existing procedural and analytic methods arranged in basic/preclinical research could be used by basic and preclinical researchers to develop novel approaches to study resurgence, whereas translational and clinical researchers could identify potential approaches to combating relapse during behavioral interventions. Despite the study of resurgence for over half a century, there have been no systematic reviews of the basic/preclinical research on resurgence. To characterize the procedural and analytic methods used in basic/preclinical research on resurgence, we performed a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We identified 120 articles consisting of 200 experiments that presented novel empirical research, examined operant behavior, and included standard elements of a resurgence procedure. We reported prevalence and trends in over 60 categories, including participant characteristics (e.g., species, sample size, disability), designs (e.g., single subject, group), procedural characteristics (e.g., responses, reinforcer types, control conditions), criteria defining resurgence (e.g., single test, multiple tests, relative to control), and analytic strategies (e.g., inferential statistics, quantitative analysis, visual inspection). We make some recommendations for future basic, preclinical, and clinical research based on our findings of this expanding literature.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-022-00361-y.

Response effort and resurgence

This study provides an initial translational examination of response effort and resurgence. Eleven typically developing adults and five adolescents with autism served as participants across two experiments. Participants received points for touching moving stimuli on a computer screen. The resurgence evaluation consisted of three phases: establishment wherein R1 was reinforced, elimination wherein R1 was placed on extinction while R2 was reinforced, and extinction wherein R1 and R2 no longer resulted in reinforcement. Rate of R1 during extinction was compared across three conditions: intermediate, easy, and difficult. Disparity in effort was created by manipulations of the size and speed of objects that moved about on a computer screen. In Experiment 2, control stimuli were added to the experimental arrangement. Across the two experiments, the magnitude of resurgence was greater when R1 was easy. In Experiment 2, both R1 and control responding were greater in the extinction phase than in the elimination phase in all conditions with all participants. The present study supports the hypothesis that response effort affects resurgence and that less effortful responses are likely to recur with greater magnitude under conditions that produce resurgence than are their more effortful counterparts.

Relapse after incentivized choice treatment in humans: A laboratory model for studying behavior change

Behavior change interventions that incentivize desired behavior are highly effective for improving personal health, but difficult to maintain long term. Relapse is common and examining the mechanisms that contribute to relapse in experimental settings can identify processes relevant to substance abuse treatment. We developed a laboratory task that parallels a recent operant model of relapse after incentivized choice reported in the rodent laboratory. In two experiments, undergraduate participants first learned to make an operant response (keyboard button; R1) to earn a reinforcer consisting of an image of a preferred snack food (O1). In a second phase (Phase 2), R1 was still reinforced, but a new response (R2) was introduced and reinforced with a different reinforcer (a coin; O2). In a test phase, contingent incentives for R2 were removed (extinction) and relapse of R1 was assessed. Experiment 1 found that the O2 contingency suppressed R1 during Phase 2, and R1 relapsed rapidly in the test. Neither effect was consistently related to O2 value. Experiment 2 examined whether noncontingent presentations of O1 or O2 during the test could weaken relapse. Here, we found that noncontingent reinforcers did little to reduce or slow the increase in R1 responding. The present experiments highlight a laboratory approach to studying variables that may influence relapse after incentivized treatment. We identify and discuss areas for development to address differences between the present results and prior observations from animal and clinical studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating effects of context changes on resurgence in humans

Laboratory models of relapse provide methods for evaluating challenges to behavioral treatments with differential reinforcement of an alternative response (DRA). Resurgence occurs with the worsening of conditions of reinforcement for appropriate behavior and renewal occurs when transitioning out of a treatment context. Across five experiments, participants recruited via online crowdsourcing pressed onscreen buttons to earn points exchangeable for money and contexts sometimes changed through changes in the background image. Returning to the training context (ABA, Experiment 1) and transitioning to a novel context (ABC, Experiment 2) produced greater resurgence when removing alternative reinforcement in comparison with remaining in the treatment context (ABB). In contrast, we observed little difference in resurgence among AAA, ABB, and AAC context manipulations (Experiment 3) and ABA, ABC, and AAC context manipulations (Experiment 4). In Experiment 5, we evaluated relative contributions of the presence versus absence of context changes (ABA vs. ABB) in combination with or without the removal of alternative reinforcement. Both changing context and removing alternative reinforcement increased responding in isolation and the combination produced greater-than-additive effects. Overall, the present findings demonstrate a consistent effect of removing alternative reinforcement on relapse that, under certain conditions, can be enhanced by context change.

Examining effects of training duration on humans' resurgence and variability using a novel touchscreen procedure

Resurgence occurs when a previously reinforced and then extinguished target response increases due to reducing/eliminating an alternative source of reinforcement or punishing an alternative response. We evaluated whether duration of reinforcement history for a target response (1) affects the degree to which resurgence is observed in humans and (2) produces different gradients of response generalization around target responding during extinction testing. We arranged a novel touchscreen interface in which university students could swipe a 3D soccer ball to spin any direction. In Phase 1, the first direction swiped became the target and produced points exchangeable for money for 3 or 1 min across 2 groups. The first swipe was recorded but had no programmed consequence in a third group. In Phase 2, swipes 180-degrees from the target resulted in points for 3 min in all groups. Point deliveries ceased for 2 min to test for resurgence in Phase 3. Target responses resurged during testing to a relatively greater extent with longer Phase-1 training but gradients of response generalization did not differ among groups. These findings extend prior research on the role of training duration on resurgence. We discuss methodological and conceptual issues surrounding the assessment of response generalization in resurgence.

Dysregulation of threat neurociruitry during fear extinction: the role of anhedonia

Dimensional models of anxiety and depression highlight common and distinct symptom clusters that are thought to reflect disruptions in underlying functional processes. The current study investigated how functioning of threat neurocircuitry relates to symptom dimensions of anxiety and depression. Participants were aged 18-19 years (n = 229, 158 female) and were selected to ensure a range of scores on symptom measures. Symptom dimensions of "General Distress" (common to anxiety disorders and depression), "Fears" (more specific to anxiety disorders), and "Anhedonia-apprehension" (more specific to depression) were evaluated. Participants underwent functional magnetic resonance imaging during a Pavlovian fear conditioning paradigm. Multilevel modeling analyses estimated relationships between symptom dimensions and activation in threat neural circuitry. Exploratory whole brain analyses were also conducted. Threat-related neural activity was not associated with General Distress or Fears. Anhedonia-apprehension was associated with activation of bilateral amygdala, anterior insula and dACC during late extinction. We found no evidence to support an association between symptom dimensions of General Distress or Fears with threat circuitry activation in a large sample of young adults. We did, however, find that the symptom dimension of Anhedonia-apprehension was significantly associated with threat-related neural activation during fear extinction. This effect requires replication in future work but may reflect anhedonic impairments in learning when contingencies are altered, possibly linked to the rewarding relief of an unexpectedly absent threat.

BEHAVIORAL AND NEUROBIOLOGICAL MECHANISMS OF PAVLOVIAN AND INSTRUMENTAL EXTINCTION LEARNING

This article reviews the behavioral neuroscience of extinction, the phenomenon in which a behavior that has been acquired through Pavlovian or instrumental (operant) learning decreases in strength when the outcome that reinforced it is removed. Behavioral research indicates that neither Pavlovian nor operant extinction depends substantially on erasure of the original learning but instead depends on new inhibitory learning that is primarily expressed in the context in which it is learned, as exemplified by the renewal effect. Although the nature of the inhibition may differ in Pavlovian and operant extinction, in either case the decline in responding may depend on both generalization decrement and the correction of prediction error. At the neural level, Pavlovian extinction requires a tripartite neural circuit involving the amygdala, prefrontal cortex, and hippocampus. Synaptic plasticity in the amygdala is essential for extinction learning, and prefrontal cortical inhibition of amygdala neurons encoding fear memories is involved in extinction retrieval. Hippocampal-prefrontal circuits mediate fear relapse phenomena, including renewal. Instrumental extinction involves distinct ensembles in corticostriatal, striatopallidal, and striatohypothalamic circuits as well as their thalamic returns for inhibitory (extinction) and excitatory (renewal and other relapse phenomena) control over operant responding. The field has made significant progress in recent decades, although a fully integrated biobehavioral understanding still awaits.

Examination of alternative-response discrimination training and resurgence in rats

Resurgence is an increase in a previously reinforced behavior following a worsening of conditions for a more recently reinforced behavior. Discrimination training is incorporated into treatment for problem behavior to prevent treatment adherence failures that may result in resurgence. There is evidence that resurgence may be reduced when a stimulus that signals alternative-response extinction is present compared with absent; however, the generality of this effect is unknown given the limited testing conditions. The goal of the present experiments was to further examine the effects of such stimuli in a reverse-translational evaluation using rats. Target responding was reinforced in baseline and then placed on extinction in the following discrimination-training phase. An alternative response was differentially reinforced in a two-component multiple schedule where one stimulus (i.e., S^D) signaled alternative-response reinforcement and the other (i.e., S^Δ) signaled extinction. Experiment 1 assessed resurgence in both the S^Δ and S^D when alternative reinforcement was removed. Experiment 2 evaluated resurgence under conditions that better approximated those used in the clinic in which the alternative-response S^Δ was present or absent. The S^Δ failed to suppress target responding during resurgence testing in both experiments. These findings suggest that the conditions under which an alternative-response S^Δ will successfully mitigate resurgence may be limited and require further research.

Effects of response cost magnitude on resurgence of human operant behavior

Extensive research has been dedicated to the study of resurgence following extinction and differential reinforcement of alternative behavior. Less is known about the effects of punishment on resurgence. This study extended previous research by examining whether the magnitude of response cost punishment affects resurgence of human operant behavior. College students engaged in a computer task using the three-phase resurgence procedure where points were used to reinforce target (Phase 1) or alternative (Phase 2) behavior. Across three groups, Phase 2 contingencies for the target response were manipulated. In one group, only extinction was implemented. In the other two groups, response cost was also implemented. Response cost was equal to or double the number of points that could be gained for alternative responding. Resurgence was similar in Phase 3 across the three groups, demonstrating that neither the addition nor the magnitude of punishment differentially affected response recovery under these conditions. Future research should examine other parameters of punishment (e.g., delay, schedule) and how these variables interact with different parameters of alternative reinforcement to increase our understanding of the conditions under which resurgence may be exacerbated or minimized.

Repeated resurgence with and without a context change

Resurgence is the reoccurrence of a target response when reinforcement for a more recently reinforced alternative response is eliminated or reduced. The present study arranged two successive three-phase procedures to assess whether resurgence decreases with repeated assessments. Moreover, we arranged a contextual change from the first to second assessment for some groups. Phase 1 reinforced a target response on a touchscreen computer with typically developing adults as participants according to either variable-ratio or variable-interval schedules of reinforcement. Phase 2 extinguished target responding and reinforced alternative responding. Phase 3 tested for resurgence by extinguishing alternative responding. Resurgence reliably occurred in all tests and decreased from the first to second exposure to the procedures but there were no effects of context change. Therefore, repeated exposures to resurgence tests reduced those effects but contextual changes had no effect.

Relapse of operant behavior after response elimination with an extinction or an omission contingency

The present study compared relapse after responding was eliminated by extinction or omission training in rats. In Experiment 1, lever pressing was reinforced with food pellets in Context A and then eliminated with either extinction or omission training in Context B. The response was then tested in Contexts A and B in either the presence or absence of free food pellets delivered on a random time schedule. All rats showed higher responding when tested in Context A than Context B, and there was little evidence that omission training attenuated this ABA renewal effect. Noncontingent pellets increased responding after extinction but not after omission. However, when responding on the last day of response elimination was compared to responding during the test in the response-elimination context, there was some evidence that omission-trained rats showed a small increase in responding even when tested with free pellets. Results of Experiment 2 suggest this increase was not due to differences in the temporal distribution of pellets during elimination and the test, and that the result might be due to mere removal of the omission contingency, but any such effect is small and difficult to detect statistically. The results provide new information about factors generating relapse after omission training.

Memories of motor adaptation do not necessarily decay with behavioral unlearning

Motor adaptation reshapes behaviors to habituate novel predictable demands caused by dramatic changes in our body (or environment). In the absence of error signals, behaviors rapidly return to the manner before adaptation. It is still in debate whether this behavioral unlearning is due to memory decay. Recent studies suggested that unlearning may be related to the detection of a context change between adaptation phase and error-absent phase. This context-dependent idea is extended in the present study, which examined the motor adaptation in a ball-tossing task. To facilitate the manipulation of the task and the measurement of the behavior, this tossing task was conducted in a virtual environment. Experiment 1 found that unlearning was more likely to occur when the context in the adaptation phase was less similar to that in the error-absent phase. Experiment 2 further demonstrated that the memory of motor adaptation can bias behavior even after behavioral unlearning. Experiment 3 confirmed that the results in Experiment 1 and 2 were not artifacts. These findings indicate that memories of adaptation are independent of behavioral unlearning, and the contextual similarity between adaptation and error-absent phase determines the unlearning rate.