![]() If NFE were to have similar effects in individuals with pathological anxiety it would provide specific suggestions on how to modify exposures to reduce relapse.Īssociative learning literature provides potential explanations for why pairing a CS with a novel outcome might have advantages over standard extinction procedures. (2019) found that NFE may lead to more durable extinction via activating the ventromedial prefrontal cortex during extinction trials. (2018) demonstrated that NFE was effective at diminishing reinstatement (response to CS following return of aversive stimulus) in healthy humans, and Dunsmoor et al. This work has been replicated and extended in healthy humans: Lucas et al. This procedure, referred to as novelty-facilitated extinction (NFE), was effective at decreasing return of fear responses 24-h after extinction in rats and healthy humans. (2015) developed an extinction paradigm in which the US was replaced with a novel neutral stimulus (i.e., a tone). One method to enhance extinction is by replacing, rather than merely omitting, the expected aversive outcome. However, fear responses to the CS often return following a delay ( Vervliet et al., 2013). The participants are then exposed to the CS multiple times without the US, leading to a reduction in defensive responses (often operationalized as “fear”) to the CS (e.g., reduced freezing in rodents, reduced skin conductance in humans). In typical lab-based extinction paradigms, participants learn that a conditioned stimulus (CS e.g., a light) predicts an aversive unconditioned stimulus (US e.g., a shock). The current study is a preliminary test of whether an augmented behavioral extinction strategy enhances fear extinction in individuals with pathological anxiety during a laboratory paradigm. Under standard extinction protocols, some studies (albeit not all) find that anxiety and OCD samples show deficits in learning and retaining extinction memories ( Michael et al., 2007 Milad et al., 2013 Duits et al., 2016 Rabinak et al., 2017). ![]() ![]() Pavlovian fear conditioning and extinction is a valuable model to develop and test innovative treatments for psychopathology. There is a pressing need to determine ways to reduce relapse. However, following exposure therapy, while some individuals maintain their gains, many others (e.g., up to 62%) experience a return of fear ( Craske and Mystkowski, 2006 Craske et al., 2008). Findings underscore the importance of translating paradigms from healthy humans to clinical samples, to ensure that new treatment ideas based on advances in basic neuroscience are relevant to patients.Įxposure therapy, in which individuals confront feared stimuli in a gradual manner to reduce fear, is a proven treatment for individuals with anxiety disorders and obsessive-compulsive disorder (OCD Deacon and Abramowitz, 2004). Novelty did not facilitate extinction in this preliminary trial. Participants in both groups learned the fear association but variably extinguished it. Skin conductance responses (SCR) were the dependent measure of conditioned fear. Participants returned 24 h later to test extinction recall and fear reinstatement. In this preliminary test of novelty-facilitated extinction, 51 unmedicated individuals with pathological anxiety were randomized to standard extinction ( n = 27) or novelty-facilitated extinction ( n = 24). Because of the potential clinical implications of this finding for exposure-based anxiety treatments, this study tested whether the same was true in individuals with pathological anxiety (i.e., met DSM-5 diagnostic criteria for an anxiety disorder and/or obsessive-compulsive disorder (OCD). Studies with rodents and healthy humans suggest that replacing the expected threat with a novel outcome improves extinction and reduces the return of conditioned fear more effectively than threat omission alone. 7Department of Psychology, Harvard University, New York, NY, United States.Cohen Military Family Center, New York University Langone Health, New York, NY, United States ![]() 5Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.4New York State Psychiatric Institute, Division of Clinical Therapeutics, New York, NY, United States.3The Graduate Center, City University of New York, New York, NY, United States.2Department of Psychiatry and Behavioral Science, University of Texas at Austin, Austin, TX, United States.1Department of Psychology, West Virginia University, Morgantown, WV, United States.Dunsmoor 2, Zhamilya Gazman 3, Yael Stovezky 4, Olivia Pascucci 5, Justin Pomerenke 6, Elizabeth A.
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