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BACKGROUND AND OBJECTIVES: Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops a stress-related disorder. To examine risk factors for the development of stress-related symptoms, such as intrusions and avoidance, analogue trauma studies are necessary. The often-used trauma film paradigm has proven to be valuable to examine intrusions, but inherently to its technique is less suitable for assessing behavioral avoidance, a core symptom of stress-related disorders. The aim of the present study was twofold, first to further develop an analogue that explicitly addresses behavioral avoidance and second, to link previously-established risk factors for the development of stress-related symptoms.METHOD: Eighty-two healthy participants were subjected to a trauma induction using virtual reality (VR). At follow-up, participants were placed in a similar VR environment and could approach or avoid the trauma-scene, a trauma-related scene or a neutral, unrelated scene. Several pre- and peri-trauma risk factors were measured.RESULTS: The VR paradigm increased negative mood and heart rate, decreased positive mood and heart rate variability, and resulted in stress-related symptoms as trauma-related thoughts and beliefs, intrusions and avoidance behavior. The most prominent risk factors that contributed to the stress-related symptoms were negative emotions during the trauma induction, trait anxiety, and avoidant coping strategies.LIMITATIONS: The stress-related symptoms were mild, resulting in a vast amount of participants without intrusions and limited avoidance behavior.CONCLUSION: The current VR paradigm can elicit stress-related symptoms, including avoidance; risk factors contributing to these symptoms were similar to those observed in clinical research, indicating the potential of the general set up.

BACKGROUND AND OBJECTIVES: It is assumed that fear responses can be altered by changing the contingency between a conditioned stimulus (CS) and an unconditioned stimulus (US), or by devaluing the present mental representation of the US. The aim of the present study was to compare the efficacy of contingency- and devaluation-based intervention techniques on the diminishment in - and return of fear. We hypothesized that extinction (EXT, contingency-based) would outperform devaluation-based techniques regarding contingency measures, but that devaluation-based techniques would be most effective in reducing the mental representation of the US. Additionally, we expected that incorporations of the US during devaluation would result in less reinstatement of the US averseness.METHODS: Healthy participants received a fear conditioning paradigm followed by one of three interventions: extinction (EXT, contingency-based), imagery rescripting (ImRs, devaluation-based) or eye movement desensitization and reprocessing (EMDR, devaluation-based). A reinstatement procedure and test followed the next day.RESULTS: EXT was indeed most successful in diminishing contingency-based US expectancies and skin conductance responses (SCRs), but all interventions were equally successful in reducing the averseness of the mental US representation. After reinstatement EXT showed lowest expectancies and SCRs; no differences were observed between the conditions concerning the mental US representation.LIMITATIONS: A partial reinforcement schedule was used, resulting in a vast amount of contingency unaware participants. Additionally, a non-clinical sample was used, which may limit the generalizability to clinical populations.CONCLUSION: EXT is most effective in reducing conditioned fear responses.

Background and objectives Exposure therapy is often used as treatment for anxiety disorders. However, a change in context after exposure can result in fear renewal. This renewal can be attenuated by using retrieval cues stemming from the exposure context. The present study investigated the effect of such a cue in spider-fearful persons. Methods Thirty-three participants underwent an in vivo exposure session while wearing a bracelet (retrieval cue). After exposure, half of the participants continued to wear the bracelet at home until follow-up (cue groups); the other half handed over the bracelet after exposure (no cue groups). Half of the participants in each group received the follow-up in the exposure context (AAcue and AAnocue); for the other half follow-up was conducted in a novel environment (ABcue and ABnocue). Results A switch in context at follow-up resulted in more self-reported anxiety and arousal compared to no switch. However, the retrieval cue did not attenuate this renewed responding. Limitations The number of participant per condition was limited, which might have obscured possible retrieval cue effects due to a lack of power. Additionally, information about the retrieval cue was provided after exposure, which might have weakened the association between the cue and exposure therapy. Furthermore, no autonomic measures were incorporated, restricting the effect to self-report measures. For future studies we would recommend to explicitly link the retrieval cue before onset of the exposure session and to incorporate autonomic measures. Conclusions Our findings indicate that a switch in context resulted in more self-reported anxiety and arousal, but that a cue stemming from the exposure context did not attenuate this renewal.

Objective: Although extinction is highly effective in reducing a conditioned fear response, return of the fear response (renewal) outside the extinction context often occurs. The present study investigated whether US devaluation, through imagery rescripting during extinction, resulted in less renewal than mere extinction. Method: Seventy psychology students were subjected to a fear conditioning paradigm. During fear acquisition CS+ was always followed by the US, whereas CS- was never followed by the US. For all groups the acquisition phase took place in context A. During extinction both CS+ and CS- were offered, but no US was presented. For three groups extinction was conducted in a different context, context B (ABA groups). The fourth group received extinction in the acquisition context (AAA group) in order to demonstrate that renewal indeed took place. During extinction, participants received either an imagery rescripting (IR) instruction to devaluate the US (ABAir), a US-unrelated imagination instruction to assess the general influence of imagination (ABAcont), or no instruction at all (ABAno and AAAno). Subsequently, testing occurred for all groups in the acquisition context A. Results: The results indicated that renewal of the US expectancy ratings was reduced if imagery rescripting (ABAir) was added to mere extinction (ABAno). Next to the reduction in renewal, imagery rescripting (ABAir) also resulted in the devaluation of the US valence, indicating that the mental representation of the US had changed. These findings are not only in line with contemporary conditioning theories, but also suggest that adding imagery rescripting to extinction might be beneficial in the treatment of anxiety problems. (C) 2011 Elsevier Ltd. All rights reserved.