Mental reinstatement of context and return of fear in spider-fearful participants

Extant findings in the animal and human conditioning literature demonstrate that renewal, termed return of fear in studies with humans, occurs when reexposure to a previously feared phobic stimulus occurs in a context different than the one present during extinction. The present study investigated whether mental reinstatement of the treatment context at follow-up could attenuate context-based return of fear. Forty-eight spider-fearful individuals received exposure therapy in one of two contexts, and were followed-up 1 week later in the treatment or a new context. Half of the participants received instructions to mentally reinstate the treatment context before the follow-up test. Self-report data replicated previous research on contextually driven return of fear. Furthermore, participants who mentally reinstated the treatment context, before encountering the phobic stimulus in a new context at follow-up, had less return of fear than those who did not. Limitations of the current study, as well as implications for phobia treatment, are discussed.     

Verbal, behavioural and physiological assessment of the generalization of exposure-based fear reduction in a spider-anxious population

Clinical fear of spiders was assessed in 39 patients before and after exposure treatment and at a 3-month follow-up. The assessment included behavioral, physiological and self-report measures. Some patients were tested in the treatment context (group Same), while others were tested in a different context (group Different). Both groups demonstrated a significant fear reduction from pre- to post-treatment in all measures, which persisted at the 3-month follow-up. Contrary to our expectations, no clear difference was observed between the groups at any moment. However, a 1-year follow-up test of the self-report measure revealed a return of fear in group Same, but not in group Different. These results show (1) that the effects of exposure treatment persisted over contexts and time in the short term, and (2) that conducting treatment and tests in different contexts enhanced efficiency of exposure treatment in the long term.     

Extinction treatment in multiple contexts attenuates ABC renewal in humans

Renewal has been implicated as one of the underlying mechanisms in return of fear following exposure therapy. ABC renewal is clinically more relevant than ABA renewal and yet it is a weaker form of renewal, suggesting that conducting extinction treatment in multiple contexts may be sufficient to attenuate ABC renewal. Using self-reported expectancy of shock and startle blink responses the current study examined the effects of conducting extinction treatment in multiple contexts on ABC fear renewal. Participants (N = 68) received conditional stimulus (CS) and unconditional stimulus (US) pairings in one context (A) followed by extinction treatment (CS presentations alone) in either one other context (B) or three other contexts (BCD). Non-reinforced test trials in a novel context (E) resulted in renewal of extinguished conditioned behaviour for those who received extinction in only one context. However, renewal was attenuated for those who received extinction treatment in three contexts. No renewal was found for the control group that received the test trial in the same context as during extinction. Suggestions are provided for clinicians seeking to prevent or attenuate return of fear following exposure therapy.     

Processing of phobic stimuli and its relationship to outcome

In the present study, we explored factors related to successful treatment outcome in a sample of participants with fear of spiders. We specifically examined the relationship of general memory, memory for the phobic stimulus, memory for anxious responses, and perceived self-efficacy to treatment outcome. Forty-eight participants who were afraid of spiders participated in two sessions of in vivo exposure therapy. On day 1, participants completed measures of general memory, memory for the phobic stimulus, recall of anxiety level during exposure tasks, and self-efficacy during exposure tasks. At post-treatment, better memory for anxious responses, but not memory for the phobic stimulus, was related to lower anticipatory and actual anxiety. Greater self-efficacy, on the other hand, was related to better behavioral performance.     

The renewal of extinguished conditioned fear with fear-relevant and fear-irrelevant stimuli by a context change after extinction

The acquisition, extinction, and subsequent recovery of conditioned fear can be influenced by the nature of the conditional stimulus (CS) and the context in which the CS is presented. The combined effects of these factors were examined in a differential fear-conditioning procedure with humans. Fear-relevant or fear-irrelevant CSs were followed by a shock unconditional stimulus (US) during acquisition and presented alone during extinction. The CSs were images presented upon different background contexts. Half the participants received the same context during acquisition and extinction and the remaining received different contexts. All participants received test trials in the same context as acquisition. In Experiment 1 (N=64), a renewal of shock expectancy and skin conductance responses was found during test for fear-relevant and fear-irrelevant CSs when extinction was given in a different context. In Experiment 2 (N=72), renewal for fear-relevant stimuli was enhanced when acquisition and test was given in an indoor office context and extinction in an outdoor bush context. The opposite context configuration produced the strongest renewal for fear-irrelevant stimuli. The return of extinguished conditioned fear can occur to fear-relevant stimuli that are commonly associated with clinical fears and its strength may be enhanced when the stimuli are encountered in certain contexts after extinction.     

Guided mastery and stimulus exposure treatments for severe performance anxiety in agoraphobics

The present experiment compared two models of treatment for high performance-related anxiety in agoraphobics: the stimulus exposure model, which emphasizes extinguishing anxiety by promoting prolonged exposure to phobic stimuli, and the self-efficacy model, which emphasizes building a sense of mastery by promoting rapid proficient performance accomplishments. Subjects were 26 agoraphobics who could perform phobic activities when behaviorally tested, but who became highly anxious when doing so. Subjects were assigned at random to either (a) guided mastery treatment based on self-efficacy theory, (b) stimulus exposure treatment, or (c) delayed treatment. The results showed that guided mastery was significantly more effective than stimulus exposure in reducing performance anxiety, and this difference increased over the follow-up period. The findings indicate that therapists can implement performance-based treatment more effectively by assisting clients to achieve proficient performance than by simply encouraging them to expose themselves to phobic stimuli.     

Predicting return of fear following exposure therapy with an implicit measure of attitudes

We sought to advance understanding of the processes underlying the efficacy of exposure therapy and particularly the phenomenon of return of fear (ROF) following treatment by drawing on a social psychological view of phobias as attitudes. Specifically, a dual process theory of attitude-related behavior predicts that a positive response to exposure therapy may reflect change in either the automatic (the attitude representation itself) or controlled (skills and confidence at coping with the fear) responses to the phobic stimulus, or both. However, if the attitude representation remains negative following treatment, ROF should be more likely. We tested this hypothesis in a clinical sample of individuals with public speaking phobia using a single-session exposure therapy protocol previously shown to be efficacious but also associated with some ROF. Consistent with predictions, a post-treatment implicit measure of attitudes toward public speaking (the Personalized Implicit Association Test [PIAT]) predicted ROF at 1-month follow-up. These results suggest that change in the automatically activated attitude toward the phobic stimulus is an important goal of exposure therapy and that an implicit measure like the PIAT can provide a useful measure of such change by which to gauge the adequacy of exposure treatment and predict its long-term efficacy.     

An experimental test of stimulus estimation theory: danger and safety with snake phobic stimuli

The stimulus estimation model (Taylor & Rachman, 1994) asserts that fear overprediction stems from: (a) overprediction of the danger elements of a phobic stimulus, and (b) underprediction of existing safety resources. Using a 2x2 factorial design, with danger (high vs low) and safety (high vs low) as between-subjects variables, an experimental test of the model was conducted with 25 snake-fearful participants per condition. The four experimental conditions were matched on initial levels of snake fearfulness, as assessed by the Snake Questionnaire (SNAQ). For the 51 participants who demonstrated overprediction of fear, high danger led to reliably more fear overprediction than low danger; and low safety led to reliably more fear overprediction than high safety. The interaction between danger and safety was not statistically significant. The results offer the first convincing experimental support for the stimulus estimation model of fear overprediction.     

Using Retrieval Cues to Attenuate Return of Fear in Individuals With Public Speaking Anxiety

Even after successful exposure, relapse is not uncommon. Based on the retrieval model of fear extinction (e.g., Vervliet, Craske, & Hermans, 2013), return of fear can occur after exposure due to an elapse of time (spontaneous recovery) or change in context (contextual renewal). The use of external salient stimuli presented throughout extinction (i.e., retrieval cues [RCs]) has been suggested as a potential solution to this problem (Bouton, 2002). The current study examined whether RCs attenuated return of fear in individuals with public speaking anxiety. Sixty-five participants completed a brief exposure while presented with two RC stimuli aimed at a variety of senses (visual, tactile, olfactory, and auditory). Later, half the participants were tested for return of fear in a context different from the exposure context, and the other half in the same context. Half of each context group were presented with the same cues as in exposure, while the other half were not. Return of fear due to an elapse of time, change in context, and effects of RCs were evaluated on subjective, behavioral, and physiological measures of anxiety. Although contextual renewal was not observed, results supported effects of RCs in reducing spontaneous recovery on behavioral and physiological measures of anxiety. There was also evidence that participants who were reminded of feeling anxious during exposure by the RCs benefited more from using them at follow-up, whereas those who perceived the cues as comforting (safety signals) benefited less. Clinical implications of the findings are discussed.     

Return of fear: The role of inhibition

In a previous study investigating the relationship between subjective, physiological and behavioural changes during treatment of specific phobias, a marked between-session increase was found in subjective fear after high, but not after low intensity phobic stimulation although the groups showed similar fear ratings and heart rates immediately after treatment (Grey et al, 1979). It was hypothesized that the high intensity stimulation led to ‘treatment fatigue’; a state of deactivation, the recovery from which led to a return of fear.In this study high intensity in vivo stimulation was used for the treatment of phobic subjects under conditions of distributed and massed practice. No differences emerged between treatment conditions. A small group of Ss with a conspicuously high heart rate (mean level 120 bpm) when rating zero fear, showed a significant increase in fear after one week's interval, although they had shown similar improvement to the Ss during treatment. Subjects in both treatment conditions showed lower heart rate at all post-treatment assessments than pre-treatment. The high initial heart rate Ss continued to have higher heart rate than other Ss throughout the experiment, although they showed a decrease after treatment. It was only these Ss with desynchronously high heart rate, i.e. high heart rate with zero fear ratings, who suffered a return of fear, whereas high heart rate during high fear did not predict either response to treatment or return of fear. A further finding was a lack of correlation between the behavioural and physiological indices of fear, namely, between distance and heart rate at high levels of fear.     

条件性恐惧记忆消退返回的性别差异

采用预期判断任务考察男女性对已消退的条件性恐惧记忆是否会出现消退返回的现象。结果表明: (1)在对已习得的条件性恐惧记忆消退后4个小时进行测试, 被试整体会出现明显的消退返回现象; (2)对消退返回现象的性别差异进行比较, 女性比男性的消退返回现象更突出, 并且差异显著; (3)与男性相比, 女性对条件性恐惧记忆具有易习得难消退的趋势, 但是性别差异不显著。研究结果验证了消退返回现象存在的普遍性, 并且有着显著的性别差异, 为以后对创伤后应激障碍患者的治疗应考虑性别因素提供了心理学依据。     

Failure to condition to a cue is associated with sustained contextual fear

The acquisition of a conditioned fear response is adaptive, as it enables the organism to appropriately respond to predictors of aversive events. Consequently, the absence of predictive cues can be used as a signal for safety. We aimed to study whether deficient fear conditioning might lead to maladaptive fear. Following previous work, we predicted that failure to learn the CS-US association would result in higher contextual fear, and that participants who failed to learn would tend to exhibit higher trait anxiety. Conditioning took place in a virtual environment with two contexts. In one of the two contexts, offset of a CS (light) was associated with a shock. Each participant visited two places (a house and an apartment) in each of 12 blocks. In one of these places shocks were administered at the offset of an 8-s period of lights on (CS). The results showed that half of the participants demonstrated differential shock expectancy between situations in the shock context in which the CS was present versus absent. This indicates that these participants learned the contingencies between the shocks and both the context and the light CS. In contrast, the other half of the participants learned only the association with the context. As predicted, learning the CS-US contingency resulted in reduced self-reported fear in the absence of the CS in the danger context compared to the presence of the CS. On the other hand, participants who failed to learn the association displayed a sustained aversive state throughout the duration of the danger context. Skin conductance measures confirmed this pattern of results. Fear-potentiated startle during the threat context compared to the safe context was significant in both groups, while startle was only potentiated during the CS in the threat context in the group that learned the CS association (trend-level significant). Finally, scores on Spielberger's self-report scale of trait anxiety tended to be higher in the group of participants who did not learn the CS-shock association in the danger context compared to participants who did. In conclusion, these results confirm higher contextual fear in participants who did not acquire a conditioned response to the cue in comparison to participants who did. Also, virtual reality contexts provide a useful tool for the study of context conditioning.     

The effect of very brief exposure on experienced fear after in vivo exposure

Two experiments tested the effect of exposure to masked phobic stimuli at a very brief stimulus onset asynchrony on reducing the subjective experience of fear caused by in vivo exposure to a feared object. In the main experiment, 35 spider-fearful and 35 non-fearful participants were identified with a questionnaire and a Behavioural Avoidance Test (BAT) with a live tarantula. One week later, they were individually administered one of two continuous series of masked images: spiders or flowers. They engaged in the BAT again immediately thereafter. They provided ratings of subjective fear at the end of each BAT (pre- and post-manipulation). Very brief exposure to images of spiders reduced the fearful group's and not the non-fearful group's experience of fear at the end of the BAT. This effect was replicated with another sample of 26 spider-fearful participants from the same population. Theoretical implications are discussed.     

Reinstatement of fear in humans: autonomic and experiential responses in a differential conditioning paradigm

The present study investigated reinstatement of fear in humans using an aversive differential conditioning paradigm. Two neutral human face pictures were presented during habituation, acquisition, extinction, and postreinstatement phases. One picture served as a conditioned stimulus (CS) reinforced by an unconditioned stimulus (US) in the form of electrical stimulation (CS+) and the second picture as a control stimulus that was never reinforced (CS-). The prediction that in a reinstatement manipulation a previously extinguished fear response in humans can be reinstated in a reinstatement group by the mere presentation of three unpredicted electrical stimulations (USs) was tested. Participants in the control group were not exposed to unpredicted USs and no reinstatement effect was expected. Outcome measures included subjective US expectancy ratings and skin conductance responses. Results showed non-selective return of the fear response due to fear recovery associated with both CSs (CS+/CS-) in the reinstatement group. Unexpected fear recovery was observed for both CSs (CS+/CS-) in control participants. Results are discussed with respect to context conditioning, fear generalisation, and anxiety-related cognitive mechanisms underlying fear recovery after extinction.     

Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.     

The application of reinforcement and participant modeling procedures in the treatment of snake-phobic behavior

In Experiment I, one group of snake phobic Ss was reinforced (with tokens) for approaching a harmless snake. A second group received token reinforcement on a non-contingent basis, in the same setting, with a third group serving as non-treated controls. Although slight improvement was noted for all three groups, the groups did not differ significantly with respect to an increase in approach behavior or a reduction in subjective fear rating. A fourth group of snake phobic Ss was reinforced with money for approaching the snake, but showed no more improvement than the other three groups. In Experiment II. Ss who had participated in Experiment I were assigned to a participant modeling (P-M) group, in which they observed a fearless model interact with a snake and were subsequently guided through similar interactions with the snake, or to a non-treated control group. The P-M Ss showed a very marked decrement in snake phobic behavior (which generalized to a non-treatment snake) following the 40-min treatment, in contrast to control Ss who showed virtually no change.     

Effects of multiple contexts and context similarity on the renewal of extinguished conditioned behaviour in an ABA design with humans

The ABA renewal procedure involves pairing a conditional stimulus (CS) and an unconditional stimulus (US) in one context (A), presenting extinction trials of the CS alone in a second context (B), and nonreinforced test trials of the CS in the acquisition context (A). The renewal of extinguished conditioned behaviour is observed during test. The current study tested the effects of multiple extinction contexts and context similarity in attenuating renewal. Participants (N = 99) took part in a fear conditioning ABA renewal procedure. Using a measure of self-reported expectancy of the US, ABA renewal was observed when a single extinction context that was dissimilar to the test context was used. Renewal was attenuated, though still present, when extinction occurred in multiple dissimilar extinction contexts or in a single extinction context that was similar to the test context. Renewal was completely abolished when multiple extinction contexts that were similar to the test context were combined. Multiple extinction contexts and context similarity act additively in their effect on attenuating renewal. The results are discussed in relation to the design of exposure therapy programs that seek to reduce relapse that can occur via renewal.     

Serpent versus surrogate and other determinants of runway fear differences

Avoidance behavior and fear ratings by snake-fearful college volunteers were studied as a function of live vs stuffed snake stimuli, order of presenting the snakes, accompanied (participant modeling format) or unaccompanied social context in the runway test, high or moderate initial fear level and sex of subject. The live snake sponsored more avoidance and rated fear than the specimen, and type of snake stimulus interacted with students' initial fear levels, thus raising questions about previous research using specimens instead of live phobic animal stimuli. Accompanied social context produced generally less fear and avoidance than unaccompanied approach. Numerous complex interactions were found among the type of snake, presentation sequence, social context, sex and fear level variables, raising methodological cautions for future research.     

The resistance of renewal to instructions that devalue the role of contextual cues in a conditioned suppression task with humans

The renewal of extinguished conditioned behaviour appears to reflect context-dependent learning. The present research used a conditioned suppression task with humans to examine whether instructions concerning the context could influence renewal. Pairings of a conditional stimulus (CS) and unconditional stimulus (US) were made in one context, followed by extinction trials of CS alone in a second context, and test trials of CS alone upon return to the original learning context. Four experiments tested whether the renewal of conditioned suppression observed during test would be attenuated if participants were instructed that the context changes were irrelevant to the predictive relationship between the CS and US. Using a differential conditioning design, no attenuation was found when the instructions were given prior to conditioning (Experiment 1) or immediately prior to the test trials (Experiment 2). The latter result was replicated with a single-cue conditioning design and further controls for exposure to the extinction contexts (Experiment 3). The collection of on-line ratings about the relationship between the contextual changes and the predictive nature of the CS indicated that participants did attend to and believe the instructions (Experiment 4). The results point to the resistance of renewal to explicit instructions that attempt to devalue the role of the contextual cues.     

Hippocampal regulation of context-dependent neuronal activity in the lateral amygdala

Pavlovian fear conditioning is a robust and enduring form of emotional learning that provides an ideal model system for studying contextual regulation of memory retrieval. After extinction the expression of fear conditional responses (CRs) is context-specific: A conditional stimulus (CS) elicits greater conditional responding outside compared with inside the extinction context. Dorsal hippocampal inactivation with muscimol attenuates context-specific CR expression. We have previously shown that CS-elicited spike firing in the lateral nucleus of the amygdala is context-specific after extinction. The present study examines whether dorsal hippocampal inactivation with muscimol disrupts context-specific firing in the lateral amygdala. We conditioned rats to two separate auditory CSs and then extinguished each CS in separate and distinct contexts. Thereafter, single-unit activity and conditional freezing were tested to one CS in both extinction contexts after saline or muscimol infusion into the dorsal hippocampus. After saline infusion, rats froze more to the CS when it was presented outside of its extinction context, but froze equally in both contexts after muscimol infusion. In parallel with the behavior, lateral nucleus neurons exhibited context-dependent firing to extinguished CSs, and hippocampal inactivation disrupted this activity pattern. These data reveal a novel role for the hippocampus in regulating the context-specific firing of lateral amygdala neurons after fear memory extinction.