ISSN 2043-8087
Journal of Experimental Psychopathology
 Volume 3, Issue 3, 322-345, 2012
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Role of Inhibition in Exposure Therapy

Authors
Michelle G. Craske (a), Betty Liao (a), Lily Brown (a) & Bram Vervliet (b)
(a) Department of Psychology, UCLA
(b) Department of Psychology, University of Leuven

Volume 3, Issue 3, 2012, Pages 322-345
DOI: http://dx.doi.org/10.5127/jep.026511

Abstract
While many researchers have largely focused on principles of systematic desensitization and habituation in explaining fear extinction, these processes have mixed evidence at best. In particular, these models do not account for spontaneous recovery or reinstatement of fear, nor do they explain the context dependency of extinction or rapid reacquisition. This may in part account for the significant number of patients who fail to respond to our available treatments which rely on these principles in designing exposure sessions. However, recent research is converging to suggest that an inhibitory model of fear reduction, in which the original feared association (CS-US) remains but is inhibited by a newly formed association (CS-noUS) representing safety, holds promise in explaining the long-term attenuation of fear and anxiety. This paper reviews research in a number of areas, including neuroimaging, psychophysiology, and psychopharmacology that all provide support for the inhibition model of anxiety. Limitations to this body of research are discussed, along with recommendations for future research and suggestions for improving exposure therapy for fear and anxiety disorders. Clinical implications discussed in this paper include incorporating random and variable practice in exposure sessions, multiple contexts, and pharmacological aides, among others.

Table of Contents
Introduction
Learning Based Models of Exposure therapy: Historical Overview
Exposure therapy: Outcomes
Inhibition Model of Extinction
Neurobiology of Fear Extinction: Evidence for Inhibitory Regulation
Deficits in Extinction Learning in Anxiety Disorders
Enhancing the Formation and Retrieval of Inhibitory Learning and Regulation in Extinction and Exposure
Enhancing Inhibitory Learning
Enhancing Inhibitory Regulation
Weakening the Fear Memory
Enhancing Retrieval of Inhibitory Learning
Summary
References

Correspondence to
Dr. Michelle Craske, UCLA Department of Psychology 405 Hilgard Avenue Los Angeles, CA 90095.

Keywords
role of inhibition, exposure therapy

Dates
Received 9 Dec 2011; Revised 14 Mar 2012; Accepted 19 Mar 2012; In Press 1 Jul 2012







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