Hope for the Worst: Occasional Reinforced Extinction and Expectancy Violation in the Treatment of OCD

That Was Easy! Expectancy Violations During Exposure and Response Prevention for Childhood Obsessive-Compulsive Disorder

“…The finding that more variability in prediction accuracy moderated symptom reduction may have also indicated that “occasional reinforced extinction” occurred when children experienced underpredictions, or occasional pairing of the unconditioned stimulus with the conditioned stimulus during extinction learning (Woods & Bouton, 2007). It is thought this pairing followed by further presentations of the conditioned stimulus without the unconditioned stimulus protects against a “return of fear” (Krompinger, Van Kirk, Garner, Potluri, & Elias, 2018; Woods & Bouton, 2007). Thus, if children experience more distress than expected during an exposure exercise but also do several exposure exercises that are as challenging or easier than expected, they may learn that exposure rarely causes less distress than expected, and that perhaps they are able to manage them even when they do evoke a high level of distress.…”

Enhancing extinction learning: Occasional presentations of the unconditioned stimulus during extinction eliminate spontaneous recovery, but not necessarily reacquisition of fear

“…We should add, however, that the translational utility of occasionally reinforced extinction requires further examination. It was not the authors' intention to suggest that a reinforced extinction procedure is readily applicable to the clinical setting, but to enhance our understanding of the mechanisms that affect extinction learning and to provide suggestions for future pre-clinical and clinical research (for a more detailed discussion of potential clinical applications, see: Craske, 2015;Craske et al, 2014;Krompinger, Van Kirk, Garner, Potluri, & Elias, 2018;Weisman & Rodebaugh, 2018). In this regard the procedure may lend itself more readily to the treatment of some, but not all, fears, phobias, or anxiety disorders.…”

“…In this regard the procedure may lend itself more readily to the treatment of some, but not all, fears, phobias, or anxiety disorders. Conditions such as social anxiety disorder or specific phobias may benefit most from occasionally reinforced extinction, although the literature indicates the procedure may also be applicable to obsessive compulsive disorder (Krompinger et al, 2018).…”

Mixed results for exposure and response prevention therapy in mixed reality for patients with contamination‐related obsessive‐compulsive disorder: A randomized controlled pilot study

“…Session 2 provided detailed psychoeducation on MERP (e.g., describing how ERP is conducted) and explicitly preparing the following sessions (e.g., identifying difficulties that might occur during MERP; defining target behavior). In sessions 3–6, patients were guided through the exposure, such as by identifying their expectations regarding their most feared occurrence during exposure and comparing that to the actual experience afterward (Krompinger et al, 2019). Finally, the MERP was discussed in detail afterward (e.g., “How did you feel during the exposure?”).…”