Articles Week 3 - Specific Phobias

What are criticisms of the traditional conditioning in phobias

• Highlights CS and US association but ignores previous experiences with CS and US that might influence the acquisition of fear

• Many phobics are unable to recall trauma or experience at the time of phobia onset

• Not all pp who have trauma paired with a situation develop phobia

• Does not account for the common clinical phenomenon of incubation

• All stimuli are treated as equally likely to enter into association with aversive consequences but phobias ar not evenly distributed across stimuli

• Can be acquired through observational learning (not just direct experience)

What are the main differences of contemporary models vs contiguity-based models?

• Many other factors than experiencing pairings of CS & US can affect strength of the association between these events:

  • Verbally and culturally transmitted information about the CS-US contingency

  • Existing beliefs and expectancies about possible consequence associated with a particular CS

  • Emotional reactions currently associated with the CS

• The CR strength can be influenced by the strength of the CS- US association BUT ALSO by the way the US is evaluated

• Processes that cannot directly be observed and have to be inferred

  • Learn associations between CS and US during classical conditioning and this association mediates the CR

  • Then any processes that influence the strength of that association will also influence the magnitude of fear reaction

What does the contemporary model illustrate

Factor that may influence the strength of an association between a CS and US representation = Expectancy evaluation

And how the US representations evocation of a CR will be influenced by how the US has been evaluated or revaluated = evaluation of the US

What is expectancy evaluation and points strengthen the CS-US association?

The strength of an association between CS and US is dependent on the number of experiences pairing of the CS and US

• Situational contingency information

• Verbally and culturally transmitted information about contingency

• Existing beliefs about the CS and the contingency

• Emotions elicited by the CS

What is the situational contingency information?

The predictive significance of the CS as measured by the correlation between CS and US

What is Latent inhibition?

If the individual had many trauma-free experiences with a stimulus . it will be much harder to associate that stimulus with a trauma (dentist)

What is co-variation bias? (existing beliefs)

Distorted perception of the co-variation - usually in the direction of the prior expectation

• Subjects begin experiment with higher expectancy of aversive US following fear relevant stimuli than fear-irrelevant stimuli — US expectancy bias (umbrella term for all co-variation bias) could be reinstated by a single CS-US pairing

What is expectancy bias? (existing beliefs)

• Tend to be associated especially with fear.relevant stimuli and appear to be based on judgements about the nature of the CS and the feature that the CS shares in common with the potential US (cultural differences regarding this)

What is the US revaluation process?

AKA the performance factor: Processes by which the subjects evaluation of the US may be changes (in the strength or nature of the fear CR will be affected by any factor which changes knowledge about the US contained in the US representation)

• Info that US is less aversive than they initially perceived

What are components of the US revaluation process? - as mentioned in model

• Experience with the US alone

• Socially/Verbally transmitted information about the S

• Interpretation of interoceptive cues

• Cognitive rehearsal US

• Coping strategies which neutralise the US

What are coping startegies that neutralise the US?

• Problem-focused coping

• Emotion-focused coping

• Threat devaluation - deals with strategies to control the stressor

How is threat devaluation achieved?

• Positive comparison

• Selective ignoring

• Devaluing the importance of the stressful event

• Downward comparison

• Positive reappraisal (In every problem there is something good)

• Cognitive disengagement (The problems are not enough to be upset over)

• Optimism

• Faith in social support

• Denial

• Life perspectivee ( I can manage as long as everything else is okay)

How is phobic responding established?

• Combination of sensory precondition and US inflation

What does the model predict?

• The consequences of interaction with a stimulus or event may be inflated over time - giving the impression that no single traumatic event has ever been paired with that stimulus

• Failure to find direct conditioning processes in the aetiology of phobias does not mean that conditioning processes are not involved and are the major source of these phobias

How are phobic responses maintained explained by previous and contemporary model?

Previous

• Maintained by a significant bias towards expecting fearful or traumatic consequences following phobic stimuli

• Phobics do overestimate the level of danger

Contemporary:

• Maintained by a bias towards expecting the phobic stimulus (CS) to be followed by an aversive outcome (US)

How do overestimation of fear and US expectancy bias originate?

Contemporary:

• Possibly biases could arise form

  • Direct and vicarious conditioning trauma

  • Culturally determined belief

  • Value which favours the association

  • US revaluation experiences

What are exposure optimisation strategies? - Craske et al.

1. Expectancy violation

2. Deepened extinction

3. Occasional reinforced extinction

4. Removal of safety signals

5. Variability

6. Retrieval cues

7. Multiple context

8. Reconsolidation

What is extinction?

Where the CS is repeatedly presented in the absence of the US. Inhibitory learning is central to extinction (also habituation)

What is the inhibitory learning model?

With a pavlovian conditioning approach, the original CS-US association is not erased during extinction but rather left intact as new, secondary learning develops

• CS DOES NOT LEAD TO THE US

What meaning does the CS have after extinction?

1. It’s original excitatory meaning (CS-US)

2. The inhibitory meaning (CS-no US)

What are the names of the retention procedures of at leats part of the original associations of the CS-US?

• Spontaneous recovery

• Renewal

• Reinstatement

• Rapid reacquisition (often in combat situation)

What does the habituation model state?

Fear reduction during exposure is necessary for longer-lasting cognitive changes in the perceived threat (US) associated with the phobic stimulus (CS) - not predictive for follow up fear post exposure (retrieval etc is)

Therapeutic strategies for enhancing inhibitory learning & its retrieval - What is expectancy violation?

• Strategy to design exposures that maximally violate expectancies regarding the frequency or intensity of aversive outcomes

• Premise: Mismatch between expectancy & outcome is critical for new learning & for the development of inhibitory expectancies that will compete with excitatory expectancies

• = The more the expectancy can be violated by experience the greater the inhibitory learning

• Task: What do you need to learn rather than ‘stay in situation until fear declines’ - habituation

What is learning entered around in expectancy violation?

Whether the expected negative outcome occurred or not (as ‘bad’ as expected

What is a key aspect of the expectant v. model?

Facilitate attention to both the CS and the non-occurrence of the US

• SO important to identify the US when predicting the expectancy top be violated (not just I’ll be anxious but rather I will be judged in SA)

• End of exposure is determined by conditions that violate expectancies not by fear reduction

What strategies can negatively impact the expectancy violation model?

Strategies that reduce expectancy prior to extinction can negatively impact extinction learning

• no cognitive intervention before or during exposure ad it may reduce expectancy of negative outcome & thus lessen the mismatch between initial expectany and actual outcome:

  —> Not so bad to be rejected etc

• Use cognitive intervention only post exposure

Enhancing inhibitory learning & its retrieval - what is deepened extinction?

• Multiple fear CSs are first extinguished separately before being combined during extinction

• OR a previously extinguished cue is paired with a novel CS

What does deepened extinction reduce?

• Spontaneous recovery

• Reinstatement of fear

Give an example of deepened extinction - Panic disorder with agoraphobia

• Interoceptive exposure to feared bodily sensations (drinking coffee)

• In vivo exposure to a feared external agoraphobic situation (being in a mall)

• Exposure to one specific spider then a different one and then to both at the same time

• Procedure can be done without asking clients to identify expectancies beforehand

Strategies for maximising inhibitory learning & disconfirmation- occasional reinforced extinction?

• Occasional CS-US pairing during extinction training

• Only occasional presentations of the feared event (US) otherwise also CS-no US

• Expectancy violation effect because less likely to expect the next CS presentation to predict US

Strategy: Removal of safety signals?

They alleviate distress in the short term but when they are no longer present the fear returns

• The ability of SB to mitigate extinction learning varies depending on the ration of inhibition and excitation

Strategy - Variability

• So inhibitory learning is not limited to just one specific fear

• Not from associative conditioning but the effects that can be explained by context retrieval models of exitnction as well

• Enhances the storage capacity of newly learned information

• Exposure is conducted to items from hierarchy in random order without regarding fear levels or fear reduction

What type of exposure variabilities are there?

• Timing

• Stimuli

• Fear levels (repeated increases following decreases)

• (Variability in emotional states?)

Strategy: Retrieval cues & Multiple contexts & Reconsoliditation

• Use a cure present during extinction or imaginary reinstate previous successful exposures

• Retrieval cues of the CS-no Us association during extinction to be used in other contexts once extinction is over

• BUT: could develop in safety signals (but differ ofc)

• A cue to remind what was learned - is best employed as a relapse prevention

• Context renewal involves the return of fear to a CS when it is encountered in a context that differs from the context in which exposure was conducted

• SO do it alone, in unfamiliar places, different times of day etc

• Retrieving already stored memories induces a process of reconsolidating since the memory is written into long term memory again

• Possible to change memories during reconsolidating time frame upon retrieval

What is a strategy for enhancing inhibitory regulation

1. Linguistic processing

2. Affect labelling

   — Encouraging clients to describe their emotional experience during exposure

   • Saying negatively valanced, fear irrelevant words in the presence of CS - increases approach behaviours

What do claustrophobia and blood phobia respond to (exposure)

1. Interoceptive exposure

2. Applied muscle tension