The effect of typicality training on costly safety behavior generalization

Background and objectives: Typicality asymmetry in generalization refers to enhanced fear generalization when trained with typical compared to atypical exemplars. Typical exemplars are highly representative of their category, whereas atypical exemplars are less representative. Individual risk factors, such as trait anxiety, attenuate this effect, due to the high level of threat ambiguity of atypical exemplars. Although recent research provided evidence for generalization of safety behavior, it is unclear whether this generalization also follows typicality asymmetry. This study examined (1) whether participants exhibited typicality asymmetry in the generalization of safety behavior and (2) whether this effect would be attenuated by individual risk factors, such as intolerance of uncertainty and trait anxiety. Methods: Participants were trained with either typical (Typical group, n = 53) or atypical (Atypical group, n = 55) exemplars in a fear and avoidance conditioning procedure. Participants acquired differential conditioned fear and costly safety behavior to the threat- and safety-related exemplars. In a following Generalization Test, the degree of safety behavior to novel exemplars of the same categories was tested. Results: The Atypical group showed greater differential safety behavior responses compared to the Typical group. Higher trait anxiety was associated with lower differential safety behavior generalization, driven by an increase in generalized responding to novel safety-related exemplars. Limitations: This study used hypothetical cost instead of real cost. Conclusions: Training with atypical exemplars led to greater safety behavior generalization. Moreover, individuals with high trait anxiety show impaired safety behavior generalization.</p

The effect of typicality training on costly safety behavior generalization

Background and objectives: Typicality asymmetry in generalization refers to enhanced fear generalization when trained with typical compared to atypical exemplars. Typical exemplars are highly representative of their category, whereas atypical exemplars are less representative. Individual risk factors, such as trait anxiety, attenuate this effect, due to the high level of threat ambiguity of atypical exemplars. Although recent research provided evidence for generalization of safety behavior, it is unclear whether this generalization also follows typicality asymmetry. This study examined (1) whether participants exhibited typicality asymmetry in the generalization of safety behavior and (2) whether this effect would be attenuated by individual risk factors, such as intolerance of uncertainty and trait anxiety. Methods: Participants were trained with either typical (Typical group, n = 53) or atypical (Atypical group, n = 55) exemplars in a fear and avoidance conditioning procedure. Participants acquired differential conditioned fear and costly safety behavior to the threat- and safety-related exemplars. In a following Generalization Test, the degree of safety behavior to novel exemplars of the same categories was tested. Results: The Atypical group showed greater differential safety behavior responses compared to the Typical group. Higher trait anxiety was associated with lower differential safety behavior generalization, driven by an increase in generalized responding to novel safety-related exemplars. Limitations: This study used hypothetical cost instead of real cost. Conclusions: Training with atypical exemplars led to greater safety behavior generalization. Moreover, individuals with high trait anxiety show impaired safety behavior generalization.</p

Inhibition of return in fear of spiders: Discrepant eye movement and reaction time data

Inhibition of return (IOR) refers to a bias against returning the attention to a previously attended location. As a foraging facilitator it is thought to facilitate systematic visual search. With respect to neutral stimuli, this is generally thought to be adaptive, but when threatening stimuli appear in our environment, such a bias may be maladaptive. This experiment investigated the influence of phobia-related stimuli on the IOR effect using a discrimination task. A sample of 50 students (25 high, 25 low in spider fear) completed an IOR task including schematic representations of spiders or butterflies as targets. Eye movements were recorded and to assess discrimination among targets, participants indicated with button presses if targets were spiders or butterflies. Reaction time data did not reveal a significant IOR effect but a significant interaction of group and target; spider fearful participants were faster to respond to spider targets than to butterflies. Furthermore, eye-tracking data showed a robust IOR effect independent of stimulus category. These results offer a more comprehensive assessment of the motor and oculomotor factors involved in the IOR effect

A Systematic Review of the Inter-individual Differences in Avoidance Learning

Avoidance is typically adaptive given it prevents threat. However, avoidance becomes maladaptive when it is executed out of proportion of threat (i.e., excessive or insufficient avoidance), persists in the absence of threat, or excessively generalizes to other innocuous situations. Although there has been an increase in research in these different processes of maladaptive avoidance, the role of inter-individual differences in these avoidance processes receives less research attention, despite its theoretical and clinical importance. In this systematic review, we summarized the role of inter-individual traits that relate to risk or resilient factors for anxiety-related disorders, trauma-and stressor-related disorders, obsessive-compulsive related disorders, pain related disorders, eating-related disorders, and affective disorders. A majority of the inter-individual differences had an apparent mixed or null effect on the different processes of avoidance. We discussed this lack of evidence of inter-individual differences on avoidance due to a lack of methodological and/or analytical consensus in the field, in addition to a lack of integration of recent findings into existing theories. Recommendations for future research are discussed, with a focus on examining the conditions or experimental parameters for certain inter-individual traits to manifest their effects on avoidance, identifying the nuances of methodological and/or inter-individual differences in avoidance, and a call for integrating recent preliminary findings into existing theories.</p

Individualisierte Exposition bei Angststörungen [Individualized exposure for anxiety disorders]

Hardly any other psychotherapeutic intervention can be used as broadly as exposure. Contrary to common assumptions, absolute contraindications to exposure therapy are very rare, since an adaptation to assumed contraindications is possible in the vast majority of cases (e.g., graduated approach, change of exercise focus, creative exercise design). New approaches to exposure move away from the imperative necessity of "habituation" and instead emphasize the role of threat expectancy violation and change. When planning and conducting exposure, a hypothetical "ideal exercise" should first be developed which have the maximal potential to violate the individual core threat expectancy as much as possible. In a next step, the best possible "optimal exercise" can be conducted, based on the willingness of the patient and feasibility. By setting the focus of exposure, special emphasis can be placed on habituation, threat expectancy violation, or other helpful experiences. Recent studies on this approach to exposure in anxiety disorders showed very high and sustainable treatment success and provided evidence for the role of threat expectancy change as a mechanism underlying exposure. [Kaum eine psychotherapeutische Intervention ist so breit einsetzbar wie Exposition. Absolute Kontraindikationen für Expositionstherapie liegen entgegen häufiger Annahmen nur sehr selten vor, da eine Anpassung an vermeintliche Kontraindikatoren in den allermeisten Fällen möglich ist (z.B. graduiertes Vorgehen, Wechsel des Übungsfokus, kreative Übungsgestaltung). Neue Ansätze der Exposition entfernen sich von der zwingenden Notwendigkeit der „Habituation“ und betonen stattdessen die Rolle der Befürchtungswiderlegung und -veränderung. Bei der Planung und Durchführung einer Exposition sollten Therapeuten*innen hierbei zunächst eine hypothetische „ideale Übung“ erarbeiten, mit der Betroffene ihre zentrale Befürchtung maximal widerlegen könnten. Im nächsten Schritt erfolgt dann die Vorbereitung und Durchführung einer realisierbaren, patient*innennahen „optimalen Übung“. Durch die Festlegung des Übungsfokus können Habituation, Befürchtungswiderlegung oder andere Lernerfahrungen in den Vordergrund gestellt werden. Aktuelle Studien zur befürchtungszentrierten Exposition belegen eine sehr hohe und nachhaltige Wirksamkeit sowie die Rolle der Befürchtungsveränderung als Wirkprozess

Incentive-based extinction of safety behaviors: Positive outcomes competing with aversive events reduce safety behaviors and prevent protection from fear extinction

Maladaptive safety behavior maintains fear and anxiety by prohibiting inhibitory learning about the non-occurrence of feared outcomes (known as protection from extinction). Not engaging in safety behavior, however, requires to act opposite to fear-motivated behavioral tendencies. The initiation of such fear-opposite action by positive outcomes, which were in conflict with safety behavior, was tested. Following fear acquisition to a warning signal (CS+), participants acquired safety behavior to prevent the aversive outcome (N=98). Next, safety behavior also prevented gaining rewards. In a control group, neutral outcomes were presented to control for novelty effects of the second outcome. Subsequently, no aversive outcome occurred anymore. Phases with safety behavior were intermitted by phases without safety behavior to examine cognitive and physiological indicators of fear and anxiety. Without competing positive outcomes, safety behavior was frequently executed, persisted in absence of the aversive outcome, and prohibited extinction learning. Positive outcomes clearly reduced safety behavior despite equal levels of acquired fear. This enabled fear extinction as soon as the aversive outcome was absent. Importantly, this extinction learning resulted in attenuated fear and anxiety responses when safety behavior became unavailable. Post-hoc findings indicated that the mere anticipation of positive outcomes slightly reduced safety behavior. Thus, competing positive outcomes triggered fear-opposite action that prevented persistent safety behavior and protection from extinction

Reducing the return of avoidance and fear by directly targeting avoidance:Comparing incentive-based and instructed extinction of avoidance to passive fear extinction

Enhancing the reduction of avoidance may optimize treatment for anxiety disorders. Past research focused on boosting fear extinction to reduce avoidance, however, with limited success. Directly extinguishing avoidance may be more promising. This preregistered study tested the impact of incentives and instruction for non-avoidance compared to passive fear extinction on long-term avoidance and fear reduction. On Day 1, participants acquired conditioned fear and avoidance to a conditioned stimulus (CS) paired with an aversive outcome. Next, incentives or instructions encouraged non-avoidance to the CS, which was no longer reinforced by a US regardless of avoidance (Incentives and Instruction group). In a third group, avoidance was unavailable and the CS was passively presented in absence of the US (Passive Fear Extinction group). On Day 2, avoidance retention and reinstatement and return of fear were tested. In the short term, incentives and instruction strongly reduced avoidance with similar fear reduction compared to passive fear extinction. Importantly, incentives and instruction were linked to lower long-term avoidance retention. Avoidance reinstatement was evident in all groups, but avoidance remained higher after passive fear extinction. Finally, incentives yielded a lower return of threat expectancies. Thus, targeting avoidance instead of fear better reduced long-term avoidance and, for incentives, the return of fear. Especially, incentives could be a promising add-on to exposure.</p

Threat belief determines the degree of costly safety behavior:Assessing rule-based generalization of safety behavior with a dimensional measure of avoidance

Excessive generalization of safety behavior to innocuous stimuli that resemble a feared stimulus is oftentimes pathological especially with inflicted impairments. Safety behavior is conventionally assessed dichotomously, requiring multiple presentations of each test stimulus for assessing the proportion of safety behavior executed. Thus, the generalization gradient confounds with ongoing extinction learning during non-reinforced test trials. The present study employed a recently developed dimensional measure of avoidance to examine the extent of safety behavior generalization. We found that a dimensional measure of avoidance was able to assess the generalization gradients of safety behavior even when each test stimulus was presented once, thus minimizing the effect of ongoing extinction learning. Of equal importance is whether higher-order cognitive processes shape generalization of safety behavior. We found a range of distinct generalization gradients in safety behavior, which were highly consistent with participants’ verbally reported relational rules. This rule-based generalization parallels to how clinically anxious individuals develop different threat beliefs after trauma exposure, and models how these distinct threat beliefs determine the extent of safety behavior engagement.</p