Ruining the surprise:The effect of safety information on return of fear

Background and objectives: In psychoeducation before exposure treatment patients are sometimes provided with information about the (low) probability that the feared outcome would occur. Since it has been proposed in the literature that this might have adverse effects, the current study investigated the effect of providing participants with this type of safety information on return of fear. Method: In an ABA-renewal paradigm, participants in the experimental group were instructed between acquisition and extinction that the probability of US-occurrence would be extremely small in the remainder of the experiment. Participants in the control group did not receive this information. Results: Less return of fear in US-expectancy ratings was observed in participants who received the safety information. Limitations: We failed to find successful acquisition in the skin-conductance data, which prevented us from interpreting the results of this outcome measure. Conclusions: These results suggest that providing safety information is not deleterious for the effects of exposure and can even be beneficial for its effects. However, further clinical research is needed

Virtually Unexpected:No Role for Expectancy Violation in Virtual Reality Exposure for Public Speaking Anxiety

In the current study, we examined the role of expectancy violation and retrospective reasoning about the absence of feared outcomes in virtual reality exposure therapy (VRET). Participants fearful of public speaking were asked to give speeches in virtual reality. We asked each participant individually to report their expectancies about feared outcomes in public speaking situations and which of these could be tested in VRET. Each of the expectancies was categorized as being related to: (1) participants' own reactions, (2) (overt) reactions of the audience, or (3) (covert) negative evaluation. We examined whether the proportion of testable expectancies could predict treatment outcome and which type of expectancies were evaluated as being more testable in VRET. Additionally, we experimentally manipulated retrospective reasoning about whether or not expectancies related to the overt reactions of the audience could be violated by providing verbal information after VRET about whether or not the virtual audience was interactive. A reduction in public speaking anxiety was observed from pre- to post-VRET. Treatment effects were, however, not predicted by the individually reported proportions of testable expectancies. Participants evaluated expectancies about their own reactions as being more testable in VRET compared to expectancies about reactions of the audience or about being negatively evaluated. In addition, we did not find evidence that the experimental manipulation regarding whether or not the audience was interactive influenced treatment effects. In conclusion, the results of the current study suggest that the effects of VRET are not univocally explained by the mechanism of expectancy violation

Fear conditioning biases in anxiety disorders : a matter of interpretation?

Biases in fear conditioning and interpretation biases have both been linked to the onset, maintenance, and treatment of anxiety. This chapter starts with summarizing empirical evidence on the link between fear conditioning biases and pathological anxiety. We discuss how biased interpretational processing might mediate biased behavior in fear conditioning tasks. In particular, stimuli might become ambiguous as a result of fear conditioning procedures (e.g., generalization and extinction). A tendency to interpret these ambiguous stimuli as threatening might result in increased fear responding in anxiety-prone individuals. We make a distinction between biases as observable behaviors (e.g., in experimental tasks) and biases as underlying (latent) cognitive processes or deficits. A mediation model is proposed that explains how a combination of genetic factors and learning experiences can give rise to observable biases and how this association can be (partially) driven by biases as a latent cognitive process (including interpretation biases). Finally, we discuss the role of (fear conditioning) biases in interventions for anxiety. Remediating biases might enhance the efficacy of cognitive-behavioral treatment and exposure interventions. However, it is predicted that biased individuals might be less sensitive to corrective experiences (e.g., due to a stagnated error reduction process)

Learning mechanisms in fear and anxiety: It is still not what you think it is

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Predicting clinical outcomes via human fear conditioning : a narrative review

A common assumption in human fear conditioning research is that findings are informative for the etiology and treatment of clinical anxiety. One way to empirically evaluate the external validity of fear conditioning is by prospective studies. We review available prospective research investigating whether individual performance in fear conditioning predicts individual differences in anxiety levels and exposure-based treatment outcome. We focus on fear extinction, generalization, acquisition, and avoidance. Results suggest that reduced extinction and broader generalization predict higher anxiety levels. Results with respect to the predictive value of acquisition for anxiety levels are mixed. With regard to predicting exposurebased treatment outcome, some studies do find an association with extinction whereas others do not. The majority of studies does not find an association with acquisition. Evidence on extinction recall is limited and not consistent. The interpretation of these results requires caution. The number of available studies is limited. It is possible that not all work, in particular studies with only null effects, has found its way to publication. Future research on this topic will benefit from large sample sizes, preregistered hypotheses, full transparency about the conducted analyses and the publication of high-quality studies with null effects

Is It Safe Now? Intolerance of Uncertainty as a Pre-treatment Predictor of Exposure Outcome

Safety learning is considered to be a key aspect in attaining symptom reduction for patients with anxiety disorders. While treatment based on safety learning principles is highly effective in general, individual differences exist in the speed and retention of fear reduction. An individual difference variable that has been demonstrated to be associated with difficulties in safety learning in laboratory paradigms is intolerance of uncertainty, or the incapacity to endure the absence of key information and the corresponding perception of uncertainty. In this study, we sought to determine if intolerance of uncertainty is associated with the course and outcome of an exposure intervention. Intolerance of uncertainty was assessed in 104 subclinical spider-fearful participants, prior to a 30-minute exposure session in virtual reality. While the exposure session was found to be successful in modifying spider fear and avoidance, we failed to find significant correlations between intolerance of uncertainty and any of the outcome measures. Exploratory analyses assessed if intolerance of uncertainty was associated with reductions in physiological arousal during the exposure session itself. No significant correlations were found between intolerance of uncertainty and arousal reduction within the exposure exercises or throughout the session. In conclusion, deviating from some of the findings in extinction research, we failed to find evidence for associations between intolerance of uncertainty and the outcome and course of exposure. Still, additional research is needed to assess the replicability of these findings.</p