Post-extinction conditional stimulus valence predicts reinstatement fear: Relevance for long-term outcomes of exposure therapy

Abstract

Exposure therapy for anxiety disorders is translated from fear conditioning and extinction. While exposure therapy is effective in treating anxiety, fear sometimes returns after exposure. One pathway for return of fear is reinstatement: unsignaled unconditional stimuli following completion of extinction. The present study investigated the extent to which valence of the conditional stimulus (CS+) after extinction predicts return of CS+ fear after reinstatement. Participants (N = 84) engaged in a differential fear conditioning paradigm and were randomised to reinstatement or non-reinstatement. We hypothesised that more negative post-extinction CS+ valence would predict higher CS+ fear after reinstatement relative to non-reinstatement and relative to extinction retest. Results supported the hypotheses and suggest that strategies designed to decrease negative valence of the CS+ may reduce the return of fear via reinstatement following exposure therapy.

Keywords:

• Fear conditioning
• Exposure therapy
• Anxiety
• Reinstatement
• Extinction
• Return of fear

The research reported and the preparation of this article were supported by National Institute of Mental Health Grants [R21 MH722 59-01] to Michelle G. Craske and Mark Barad, by support from the Virginia Friedhofer Charitable Trust to Edward M. Ornitz and by support from the National Science Foundation to Jason M. Prenoveau.

The research reported and the preparation of this article were supported by National Institute of Mental Health Grants [R21 MH722 59-01] to Michelle G. Craske and Mark Barad, by support from the Virginia Friedhofer Charitable Trust to Edward M. Ornitz and by support from the National Science Foundation to Jason M. Prenoveau.