Targeting avoidance via compound extinction

Avoidance towards innocuous cues is a key diagnostic criterion across anxiety-related disorders. Importantly, the most effective intervention for anxiety-related disorders, exposure therapy with response prevention, sometimes does not prevent the relapse of anxiety's symptomatology. We tested whether extinction effects, the experimental proxy of exposure, are enhanced by increasing the discrepancy between the prediction of an unpleasant event happening (shock presentation), and the actual event (shock omission). Forty-eight individuals first saw pictures of three stimuli. Two pictures (CSA, CSB) were followed by a shock (US) and one (CS-) was not. Next, participants learned to avoid the US by pressing a computer key. An extinction and response prevention procedure followed. In the first part of it, participants saw unreinforced presentations of all CSs. In the second part, the single group saw unreinforced presentations of the CSA and CS-. The compound group encountered compound unreinforced presentations of the CSA and CSB, and separate presentations of the CS-. Return of avoidance and fear was tested after unsignalled presentations of the US. Compound extinction resulted in comparable reduction of fear and avoidance compared to standard extinction. We discuss how future research could enhance extinction effects by adding costs to the avoidance behaviour.对无害线索的回避是各类焦虑相关障碍（anxiety-related disorders）的核心诊断标准。值得注意的是，当前针对焦虑相关障碍的最有效干预手段——反应预防暴露疗法（exposure therapy with response prevention），有时仍无法阻断焦虑症状的复发。本研究旨在检验：通过放大厌恶性事件（电击呈现，shock presentation）发生的预期与实际事件（电击缺失，shock omission）之间的差异，能否强化消退效应——即作为暴露疗法实验替代范式的消退学习效应。48名被试首先观看三种刺激对应的图片：其中两张图片（CSA、CSB）后续伴随电击（无条件刺激，unconditioned stimulus，简称US），另一张图片（CS-）则无电击伴随。随后，参与者通过按压电脑按键习得回避电击的行为。后续开展消退与反应预防程序，该程序分为两个阶段：第一阶段，参与者观看所有条件刺激的无强化呈现；第二阶段中，单一刺激组仅呈现CSA与CS-的无强化试次，复合刺激组则同时呈现CSA与CSB的复合无强化试次，以及CS-的单独无强化试次。在无条件刺激的无信号呈现后，对回避行为与恐惧的复现情况进行测试。结果表明，复合消退范式与标准消退范式相比，对恐惧与回避的抑制效果相当。最后，本文探讨了未来研究可通过增加回避行为的行为代价，进一步强化消退效应。