Counteracting the Context-Dependence of Extinction: Relapse and Tests of Some Relapse Prevention Methods.

Abstract

It is reasonably well established that extinction involves new learning rather than merely destruction of the old (e.g., Bouton, 2002Bouton, , 2004 Myers & Davis, 2002), and several chapters in this book further attest to this (chaps. 8, 10, 11, this volume). In the animal laboratory, after tone-shock pairings have caused the tone to evoke fear, repeated presentations of the tone alone can eliminate that fear. Although fear behavior goes away, the result does not imply that extinction has destroyed the original learning, which remains in the memory system and brain, ready to return to performance under the right conditions. The fact that the original performance can recover after extinction may be an important insight into understanding relapse after therapy (e.g.

Strategies for Improving Long-Term Outcomes in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Insights From Learning Theory

“…It turns out that mental rehearsal of the original extinction context can also help patients link the original extinction context and novel contexts (Bouton et al, 2006). For example, when Mystkowski, Craske, Echiverri, and Labus (2006) treated spider phobics and then reexposed them to spiders in a novel context, those who had been instructed to mentally rehearse the treatment context (including what they had learned during treatment) showed less return of fear than did those instructed to recall a neutral scenario.…”

“…Translating this to the treatment of OCD, practice with ERP could be conducted in as many different contexts as possible (e.g., therapist's office, home, workplace, school, public locations, etc.). We recommend an emphasis on conducting exposures outside the therapist's office, especially under real-world circumstances where the patient is likely to encounter obsessional cues (e.g., Bouton et al, 2006).…”

Behavioural therapy based on distraction alleviates impaired fear extinction in male serotonin transporter knockout rats

“…It has been well established that fear extinction is context-dependent, and that re-exposure to the fear-conditioning context leads to the return of the conditioned freezing response after extinction in another context. 29 It therefore remains to be tested whether the present distraction-based cognitive approach is effective when presented in the fear-conditioning context. Nonetheless, our data clearly show that fear extinction is impaired in 5-HTT -/-rats in a context that is distinctive from fear conditioning.…”

Exposure therapy for obsessive–compulsive disorder: An optimizing inhibitory learning approach

“…As we will see, emotional processing theory fails to incorporate numerous developments in basic learning and memory processes strongly relevant to exposure and extinction. These developments point toward inhibitory learning as the core mechanism of extinction (Bouton, 1993;Bouton, Woods, Moody, Sunsay, & Garcia-Gutierrez, 2006;Vervliet, Craske, & Hermans, 2013) -the process driving long-term exposure therapy outcomes for OCD and other anxiety disorders (Craske, Kircanski, et al, 2008;Craske et al, 2012).…”