Enhancing Inhibitory Learning: The Utility of Variability in Exposure

Abstract

Exposure therapy has strong empirical support as a treatment for anxiety and related disorders, yet not all participants see clinically meaningful reduction in symptoms, and some experience return of fear. In this review, we examine the theoretical models of exposure therapy, from early precursors to the contemporary inhibitory learning model. The inhibitory learning model is applied to examine one potential method of improving outcomes in exposure therapy: increasing variability in the progression of the exposure hierarchy. We explore mechanisms that support the use of variability in exposure, including the violation of expectancies to enhance learning. In addition, the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders. Suggestions for future research are then offered.

Acceptance and Commitment Therapy (ACT) for HIV-infected Hazardous Drinkers: A Qualitative Study of Acceptability

“…Several participants expressed difficulty with the self-compassion exercise, describing it as “emotionally exhaust(ing).” Although participants acknowledged the therapeutic utility of being exposed to the feelings the exercise evoked, the intensity of the exercise was described as aversive, and some participants expressed concern that it could increase risk for substance use. These responses are consistent with the initial increase in negative affect characteristic of exposure-based treatments, which can be mitigated by increasing variability in the context and order in which aversive stimuli are presented (Knowles & Olatunji, 2018). Future ACT-based work with HIV-infected drinkers could be initiated in-person with a trained therapist, tailored to gradually introduce acceptance and self-compassion via metaphors before moving on to experiential exercises, and focused explicitly on acceptance strategies related to alcohol use.…”

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

“…What is more, from a cognitive behavioural point of view, this therapist rotation model provides a good opportunity for patients to learn new associations in a variety of therapeutic contexts, i.e. different therapists and different therapy rooms, which may strengthen these learning experiences (Craske et al, 2008; Knowles & Olatunji, 2018). However, these results must be interpreted with caution, given the explorative nature of our study.…”

I feel safe when i know: Contingency instruction promotes threat extinction in high intolerance of uncertainty individuals

“…putting more weight on information that leads to positive outcomes). It will be important to conduct future research with a focus on developing experimental and clinical interventions that use other types of information to speed up or prolong extinction in high IU individuals across disorders with an anxiety component (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014;Knowles & Olatunji, 2018).…”