1. Reward processes in extinction learning and applications to exposure therapy
- Author
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Rosenberg, Benjamin M, Barnes-Horowitz, Nora M, Zbozinek, Tomislav D, and Craske, Michelle G
- Subjects
Clinical and Health Psychology ,Psychology ,Brain Disorders ,Behavioral and Social Science ,Neurosciences ,Basic Behavioral and Social Science ,Mental Health ,Mental health ,Good Health and Well Being ,Pavlovian fear extinction ,Exposure therapy ,Reward ,Positive affect ,Clinical Sciences ,Clinical Psychology ,Clinical and health psychology - Abstract
Anxiety disorders are common and highly distressing mental health conditions. Exposure therapy is a gold-standard treatment for anxiety disorders. Mechanisms of Pavlovian fear learning, and particularly fear extinction, are central to exposure therapy. A growing body of evidence suggests an important role of reward processes during Pavlovian fear extinction. Nonetheless, predominant models of exposure therapy do not currently incorporate reward processes. Herein, we present a theoretical model of reward processes in relation to Pavlovian mechanisms of exposure therapy, including a focus on dopaminergic prediction error signaling, coinciding positive emotional experiences (i.e., relief), and unexpected positive outcomes. We then highlight avenues for further research and discuss potential strategies to leverage reward processes to maximize exposure therapy response, such as pre-exposure interventions to increase reward sensitivity or post-exposure rehearsal (e.g., savoring, imaginal recounting strategies) to enhance retrieval and retention of learned associations.
- Published
- 2024