No differences in return of pain-related fear after extinction and counterconditioning.

Abstract

Extinction-based protocols such as exposure-in-vivo successfully reduce pain-related fear in chronic pain conditions, but return of fear and clinical relapse often occur. Counterconditioning is assumed to attenuate return of fear, likely through changing the negative affective valence of the conditioned stimulus (CS). We hypothesized that counterconditioning would outperform extinction in mitigating return of pain-related fear, and decrease CS negative affective valence.Healthy participants performed a conditioning task, in which two joystick movements (CSs+) were paired with a painful electrocutaneous stimulus (unconditioned stimulus; pain-US), whereas two other movements (CSs-) were not. Subsequently, in the extinction group, one CS+ was extinguished (pain-US omission) and the other not, whereas in the counterconditioning group, one CS+ was presented with a US of opposite valence (reward-US) and the other was paired with both USs. We tested reinstatement of pain-related fear after two unsignalled pain-US presentations. Results showed no group differences in fear reduction and no differences in CS affective valence changes between the extinguished and counterconditioned CS. Remarkably, none of the groups showed reinstatement. Overall, counterconditioning did not appear to be more effective than extinction in reducing pain-related fear and its return.

What you don’t know, can’t hurt you: The differential effect of masked versus non-masked counterconditioning and mere exposure to spider pictures on women’s affective evaluation of spiders

“…There was no added benefit to pairing the masked spider with positive USs, which is inconsistent with previous studies showing that CC had a larger impact on the negative valence of stimuli than CS-only extinction procedures (Baeyens et al, 1989;Eifert et al, 1988;Engelhard et al, 2014;Kerkhof et al, 2011;van Dis et al, 2019). It is, however, consistent with studies that failed to demonstrate a superior effect of CC procedures on CS valence compared to extinction procedures (de Jong et al, 2000;Gatzounis et al, 2022;Raes & De Raedt, 2012). Since we did not include a mere repeated assessment control condition (i.e.…”

Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus

“…Update optimizing exposure therapy 28 However, there are three general approaches that seem reasonable based on laboratory research: to increase positive mood before conducting an exposure (e.g., Zbozinek, Holmes, & Craske, 2015;Zbozinek & Craske, 2017a;Zbozinek & Craske, 2017b), to discuss the positive aspects of the CS+ (Dour, Brown, & Craske, 2016), or maybe counterconditioning (though the evidence only sometimes supports counterconditioning in improving CS+ valence compared to extinction; de Jong, Vorage, & van den Hout, 2000; Gatzounis, et al, 2021;Meulders, et al, 2015;Raes & Raedt, 2012;van Dis, et al, 2019). Positive mood induction prior to extinction seems to be the most reliable approach, though this awaits further empirical testing in clinical settings.…”

Rewarded Extinction Increases Amygdalar Connectivity and Stabilizes Long-Term Memory Traces in the vmPFC

“…Research on counterconditioning dates to the earliest studies of conditioning in humans (Jones, 1924), and forms the basis for popular treatments for anxiety disorders such as systematic desensitization (Wolpe, 1954(Wolpe, , 1968(Wolpe, , 1995. Contemporary behavioral research on CC is sparse (Gatzounis et al, 2021;Keller & Dunsmoor, 2020;Koizumi et al, 2016;van Dis et al, 2019), and there are currently no neuroimaging studies directly comparing CC and extinction in humans. It remains unclear if a reduction of conditioned responses through CC is modulated by similar neural circuitry as standard extinction, and if the resulting threat attenuation is more enduring over time.…”