Fear extinction learning as a predictor of response to cognitive behavioral therapy for pediatric obsessive compulsive disorder

Geller, Daniel; McGuire, Joseph F.; Orr, Scott P.; Small, Brent J.; Murphy, Tanya K.; Trainor, Kathleen; Porth, Rachel; Wilhelm, Sabine; Storch, Eric A.

doi:10.1016/j.janxdis.2019.02.005

Cited by 47 publications

(35 citation statements)

References 43 publications

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“…In the context of fear learning, extinction involves the dramatic reduction in fear-related behaviours typically observed after presenting a previously established signal for an aversive event (i.e., a tone paired with shock; tone →shock) in the absence of that event (tone presented alone; tone → nothing). Given its simplicity and effectiveness in the treatment of anxiety disorders ( Schiller et al, 2010 ; Milad and Quirk, 2012 ; Craske et al, 2018 ; Ebrahimi et al, 2020 ; Geller et al, 2019 ; Hammoud et al, 2020 ), extinction has received significant attention in a quest to understand its underlying behavioural and neural mechanisms (e.g., An et al, 2017 ; Morgan et al, 1993 ; Quirk et al, 2000 ; Milad and Quirk, 2002 ; Leung and Westbrook, 2008 ; Leung and Westbrook, 2010 ; Likhtik et al, 2008 ; Herry et al, 2008 ; Monfils et al, 2009 Johansen et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Different methods of fear reduction are supported by distinct cortical substrates

Lay

Pitaru

Boulianne

et al. 2020

eLife

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Understanding how learned fear can be reduced is at the heart of treatments for anxiety disorders. Tremendous progress has been made in this regard through extinction training in which the aversive outcome is omitted. However, current progress almost entirely rests on this single paradigm, resulting in a very specialized knowledgebase at the behavioural and neural level of analysis. Here, we used a dual-paradigm approach to show that different methods that lead to reduction in learned fear in rats are dissociated in the cortex. We report that the infralimbic cortex has a very specific role in fear reduction that depends on the omission of aversive events but not on overexpectation. The orbitofrontal cortex, a structure generally overlooked in fear, is critical for downregulating fear when novel predictions about upcoming aversive events are generated, such as when fear is inflated or overexpected, but less so when an expected aversive event is omitted.

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Section: Introductionmentioning

confidence: 99%

Different methods of fear reduction are supported by distinct cortical substrates

Lay

Pitaru

Boulianne

et al. 2020

eLife

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“…never paired with aversive outcomes), and show problems reducing (extinguishing) their conditional fear responses (Duits et al, 2015). Further preliminary evidence for predictive validity, or the sensitivity of fear conditioning to known disorder treatments, derives from studies showing that pre-treatment responses during the extinction phase of fear conditioning predicts post-treatment outcome in anxious children (Geller et al, 2019; Waters & Pine, 2016), and adults with spider phobia (Forcadell et al, 2017). This task also provides insight into the mechanisms associated with pathological anxiety, in that these differences may reflect a general deficit in inhibitory learning associated with anxiety disorders (Vervliet, Craske, & Hermans, 2013).…”

Section: Introductionmentioning

confidence: 99%

Validating the use of a smartphone app for remote administration of a fear conditioning paradigm

Purves

Constantinou

McGregor

et al. 2019

Behaviour Research and Therapy

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Fear conditioning models key processes related to the development, maintenance and treatment of anxiety disorders and is associated with group differences in anxiety. However, laboratory administration of tasks is time and cost intensive, precluding assessment in large samplesnecessary for the analysis of individual differences. This study introduces a newly developed smartphone app that delivers a fear conditioning paradigm remotely using a loud human scream as an aversive stimulus. Three groups of participants (total n = 152) took part in three studies involving a differential fear conditioning experiment to assess the reliability and validity of a smartphone administered fear conditioning paradigm. This comprised of fear acquisition, generalisation, extinction, and renewal phases during which online US-expectancy ratings were collected during every trial with evaluative ratings of negative affect at three time points. We show that smartphone app delivery of a fear conditioning paradigm results in a pattern of fear learning comparable to traditional laboratory delivery and is able to detect individual differences in performance that show comparable associations with anxiety to the prior group differences literature.

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“…Evidence of predictive validity was found in each of the studies, meaning at least one index of learning (conditioning or extinction) predicted a clinical outcome, though the measures and methods for calculating such indices varied greatly. This is certainly encouraging for the utility of the extinction model, particularly since these studies used relatively basic paradigms consisting of a single, fear-irrelevant CS+ that was not conceptually connected to the US (excepting [158]), and with samples whose anxiety (e.g., OCD, public speaking anxiety, various phobias) likely had diverse origins. Nonetheless, the strength of prediction was not always especially strong, and there is likely room for improvement in predicting clinical outcomes by more closely approximating certain elements of clinical fears and their treatment, starting with the suggestions listed in Table 1.…”

Section: Limitations Of the Extinction Modelmentioning

confidence: 99%

“…Whether responses in conditioning and extinction paradigms predict clinical outcomes at all has just begun to be investigated, with only a handful of studies currently published [155,156,157,158,159]. Evidence of predictive validity was found in each of the studies, meaning at least one index of learning (conditioning or extinction) predicted a clinical outcome, though the measures and methods for calculating such indices varied greatly.…”

Section: Limitations Of the Extinction Modelmentioning

confidence: 99%

From Extinction Learning to Anxiety Treatment: Mind the Gap

2019

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Laboratory models of extinction learning in animals and humans have the potential to illuminate methods for improving clinical treatment of fear-based clinical disorders. However, such translational research often neglects important differences between threat responses in animals and fear learning in humans, particularly as it relates to the treatment of clinical disorders. Specifically, the conscious experience of fear and anxiety, along with the capacity to deliberately engage top-down cognitive processes to modulate that experience, involves distinct brain circuitry and is measured and manipulated using different methods than typically used in laboratory research. This paper will identify how translational research that investigates methods of enhancing extinction learning can more effectively model such elements of human fear learning, and how doing so will enhance the relevance of this research to the treatment of fear-based psychological disorders.

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Fear extinction learning as a predictor of response to cognitive behavioral therapy for pediatric obsessive compulsive disorder

Cited by 47 publications

References 43 publications

Different methods of fear reduction are supported by distinct cortical substrates

Different methods of fear reduction are supported by distinct cortical substrates

Validating the use of a smartphone app for remote administration of a fear conditioning paradigm

From Extinction Learning to Anxiety Treatment: Mind the Gap

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