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Smith BM, Smith GS, Dymond S. Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy. J Exp Anal Behav 2019; 113:87-104. [PMID: 31875982 DOI: 10.1002/jeab.573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 12/25/2022]
Abstract
Excessive fear and avoidance in relatively safe situations can lead to a narrowing of one's behavioral repertoire and less engagement with valued aspects of living. Ultimately, these processes can reach clinical levels, as seen in anxiety, trauma, and obsessive-compulsive disorders. Research on the basic behavioral processes underlying successful treatment with exposure therapy is growing, yet little is known about the mechanisms contributing to clinical relapse. Until recently, these mechanisms have largely been conceptualized in terms of Pavlovian return of fear, with relatively little research into operant processes. In the current paper, we briefly review translational research in anxiety disorders and the connections between fear and avoidance, focusing on recent work in the acquisition, extinction, and relapse of avoidance behavior and the generalization of this learning through arbitrary symbolic relations. We then introduce one possible treatment approach to mitigating clinical relapse, acceptance and commitment therapy (ACT), and provide a conceptual analysis for why ACT may be especially well-situated to address this issue. Finally, we end with potential directions for future research on treatment and relapse of anxiety disorders.
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Affiliation(s)
| | - Gregory S Smith
- Applied Behavior Analysis Department, The Chicago School of Professional Psychology
| | - Simon Dymond
- Department of Psychology, Swansea University.,Department of Psychology, Reykjavík University
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52
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Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:1394-1415. [DOI: 10.1016/j.jpain.2019.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022]
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53
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Haaker J, Maren S, Andreatta M, Merz CJ, Richter J, Richter SH, Meir Drexler S, Lange MD, Jüngling K, Nees F, Seidenbecher T, Fullana MA, Wotjak CT, Lonsdorf TB. Making translation work: Harmonizing cross-species methodology in the behavioural neuroscience of Pavlovian fear conditioning. Neurosci Biobehav Rev 2019; 107:329-345. [PMID: 31521698 DOI: 10.1016/j.neubiorev.2019.09.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/08/2019] [Accepted: 09/11/2019] [Indexed: 12/22/2022]
Abstract
Translational neuroscience bridges insights from specific mechanisms in rodents to complex functions in humans and is key to advance our general understanding of central nervous function. A prime example of translational research is the study of cross-species mechanisms that underlie responding to learned threats, by employing Pavlovian fear conditioning protocols in rodents and humans. Hitherto, evidence for (and critique of) these cross-species comparisons in fear conditioning research was based on theoretical viewpoints. Here, we provide a perspective to substantiate these theoretical concepts with empirical considerations of cross-species methodology. This meta-research perspective is expected to foster cross-species comparability and reproducibility to ultimately facilitate successful transfer of results from basic science into clinical applications.
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Affiliation(s)
- Jan Haaker
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stephen Maren
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX, 77843, USA
| | - Marta Andreatta
- Department of Psychology, University of Würzburg, Würzburg, Germany; Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Netherlands
| | - Christian J Merz
- Ruhr University Bochum, Faculty of Psychology, Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Germany
| | - Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - S Helene Richter
- Department of Behavioural Biology, University of Münster, Münster, Germany
| | - Shira Meir Drexler
- Ruhr University Bochum, Faculty of Psychology, Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Germany
| | - Maren D Lange
- Institute of Physiology I, University of Münster, Münster, Germany
| | - Kay Jüngling
- Institute of Physiology I, University of Münster, Münster, Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Miquel A Fullana
- Institute of Neurosciences, Hospital Clinic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Carsten T Wotjak
- Neuronal Plasticity Research Group, Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, 80804, Munich, Germany
| | - Tina B Lonsdorf
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Reichenberger J, Pfaller M, Forster D, Gerczuk J, Shiban Y, Mühlberger A. Men Scare Me More: Gender Differences in Social Fear Conditioning in Virtual Reality. Front Psychol 2019; 10:1617. [PMID: 31417443 PMCID: PMC6657456 DOI: 10.3389/fpsyg.2019.01617] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Women nearly twice as often develop social anxiety disorder (SAD) compared to men. The reason for this difference is still being debated. The present study investigates gender differences and the effect of male versus female agents in low (LSA) and high socially anxious (HSA) participants regarding the acquisition and extinction of social fear in virtual reality (VR). In a social fear conditioning (SFC) paradigm, 60 participants actively approached several agents, some of which were paired with an aversive unconditioned stimulus (US) consisting of a verbal rejection and spitting simulated by an aversive air blast (CS+), or without an US (CS-). Primary outcome variables were defined for each of the 4 levels of emotional reactions including experience (fear ratings), psychophysiology (fear-potentiated startle), behavior (avoidance), and cognition (recognition task). Secondary outcome variables were personality traits, contingency ratings, heart rate (HR), and skin conductance response (SCR). As hypothesized, fear ratings for CS+ increased significantly during acquisition and the differentiation between CS+ and CS- vanished during extinction. Additionally, women reported higher fear compared to men. Furthermore, a clear difference in the fear-potentiated startle response between male CS+ and CS- at the end of acquisition indicates successful SFC to male agents in both groups. Concerning behavior, results exhibited successful SFC in both groups and a general larger distance to agents in HSA than LSA participants. Furthermore, HSA women maintained a larger distance to male compared to female agents. No such differences were found for HSA men. Regarding recognition, participants responded with higher sensitivity to agent than object stimuli, suggesting a higher ability to distinguish the target from the distractor for social cues, which were on focus during SFC. Regarding the secondary physiological outcome variables, we detected an activation in HR response during acquisition, but there were no differences between stimuli or groups. Moreover, we observed a gender but no CS+/CS- differences in SCR. SFC was successfully induced and extinguished according to the primary outcome variables. VR is an interesting tool to measure emotional learning processes on different outcome levels with enhanced ecological validity. Future research should further investigate social fear learning mechanisms for developing more efficient treatments of SAD.
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Affiliation(s)
- Jonas Reichenberger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Michael Pfaller
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Diana Forster
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Jennifer Gerczuk
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Youssef Shiban
- Department of Clinical Psychology, Institute of Psychology, Private University of Applied Science Göttingen, Göttingen, Germany
| | - Andreas Mühlberger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
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55
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Carpenter JK, Pinaire M, Hofmann SG. From Extinction Learning to Anxiety Treatment: Mind the Gap. Brain Sci 2019; 9:brainsci9070164. [PMID: 31336700 PMCID: PMC6680899 DOI: 10.3390/brainsci9070164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022] Open
Abstract
Laboratory models of extinction learning in animals and humans have the potential to illuminate methods for improving clinical treatment of fear-based clinical disorders. However, such translational research often neglects important differences between threat responses in animals and fear learning in humans, particularly as it relates to the treatment of clinical disorders. Specifically, the conscious experience of fear and anxiety, along with the capacity to deliberately engage top-down cognitive processes to modulate that experience, involves distinct brain circuitry and is measured and manipulated using different methods than typically used in laboratory research. This paper will identify how translational research that investigates methods of enhancing extinction learning can more effectively model such elements of human fear learning, and how doing so will enhance the relevance of this research to the treatment of fear-based psychological disorders.
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Affiliation(s)
- Joseph K Carpenter
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Megan Pinaire
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA.
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Chirumamilla VC, Gonzalez-Escamilla G, Koirala N, Bonertz T, von Grotthus S, Muthuraman M, Groppa S. Cortical Excitability Dynamics During Fear Processing. Front Neurosci 2019; 13:568. [PMID: 31275095 PMCID: PMC6593288 DOI: 10.3389/fnins.2019.00568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Little is known about the modulation of cortical excitability in the prefrontal cortex during fear processing in humans. Here, we aimed to transiently modulate and test the cortical excitability during fear processing using transcranial magnetic stimulation (TMS) and brain oscillations in theta and alpha frequency bands with electroencephalography (EEG). Methods: We conducted two separate experiments (no-TMS and TMS). In the no-TMS experiment, EEG recordings were performed during the instructed fear paradigm in which a visual cue (CS+) was paired with an aversive unconditioned stimulus (electric shock), while the other visual cue was unpaired (CS-). In the TMS experiment, in addition the TMS was applied on the right dorsomedial prefrontal cortex (dmPFC). The participants also underwent structural MRI (magnetic resonance imaging) scanning and were assigned pseudo-randomly to both experiments, such that age and gender were matched. The cortical excitability was evaluated by time-frequency analysis and functional connectivity with weighted phase lag index (WPLI). We further linked the excitability patterns with markers of stress coping capability. Results: After visual cue onset, we found increased theta power in the frontal lobe and decreased alpha power in the occipital lobe during CS+ relative to CS- trials. TMS of dmPFC increased theta power in the frontal lobe and reduced alpha power in the occipital lobe during CS+. The TMS pulse increased the information flow from the sensorimotor region to the prefrontal and occipital regions in the theta and alpha bands, respectively during CS+ compared to CS-. Pre-stimulation frontal theta power (0.75–1 s) predicted the magnitude of frontal theta power changes after stimulation (1–1.25 s). Finally, the increased frontal theta power during CS+ compared to CS- was positively correlated with stress coping behavior. Conclusion: Our results show that TMS over dmPFC transiently modulated the regional cortical excitability and the fronto-occipital information flows during fear processing, while the pre-stimulation frontal theta power determined the strength of achieved effects. The frontal theta power may serve as a biomarker for fear processing and stress-coping responses in individuals and could be clinically tested in mental disorders.
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Affiliation(s)
- Venkata C Chirumamilla
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nabin Koirala
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tamara Bonertz
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sarah von Grotthus
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neurosciences, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Abstract
It is generally assumed that relational knowledge is the foundation of higher cognition such as (analogical and conditional) reasoning, language, the use of relational categories, and planning. Dual-system models (e.g., Kahneman, 2011) that divide the realm of cognition into two systems with opposing properties (e.g., fast vs. slow, intentional vs. unintentional, conscious vs. unconscious, associative vs. propositional) foster the view that other psychological phenomena are not relational in nature. In this paper, I argue that the impact of relational knowledge is more widespread than dual-system models imply. More specifically, I review evidence suggesting that also Pavlovian conditioning, implicit evaluation, and habitual responding are mediated by relational knowledge. Considering the idea that relational knowledge underlies also fast, unintentional, unconscious, and seemingly associative psychological phenomena is not only theoretically important but also reveals new opportunities for influencing thinking and behavior.
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Affiliation(s)
- Jan De Houwer
- Department of Experimental Clinical and Health
Psychology, Ghent University, Belgium
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58
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Raeder F, Karbach L, Struwe H, Margraf J, Zlomuzica A. Low Perceived Self-Efficacy Impedes Discriminative Fear Learning. Front Psychol 2019; 10:1191. [PMID: 31275188 PMCID: PMC6591439 DOI: 10.3389/fpsyg.2019.01191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/06/2019] [Indexed: 11/29/2022] Open
Abstract
Perceived self-efficacy refers to a subject’s expectation about the outcomes his/her behavior will have in a challenging situation. Low self-efficacy has been implicated in the origins and maintenance of phobic behavior. Correlational studies suggest an association between perceived self-efficacy and learning. The experimental manipulation of perceived self-efficacy offers an interesting approach to examine the impact of self-efficacy beliefs on cognitive and emotional functions. Recently, a positive effect of an experimentally induced increased self-efficacy on associative learning has been demonstrated. Changes in associative learning constitute a central hallmark of pathological fear and anxiety. Such alterations in the acquisition and extinction of conditioned fear may be related to cognitive and neurobiological factors that predict a certain vulnerability to anxiety disorders. The present study builds on previous own work by investigating the effect of an experimentally induced low perceived self-efficacy on fear acquisition, extinction and extinction retrieval in a differential fear conditioning task. Our results suggest that a negative verbal feedback, which leads to a decreased self-efficacy, is associated with changes in the acquisition of conditioned fear. During fear acquisition, the negative verbal feedback group showed decreased discrimination of fear responses between the aversive and safe conditioned stimuli (CS) relative to a group receiving a neutral feedback. The effects of the negative verbal feedback on the acquisition of fear discrimination learning were indexed by an impaired ability to discriminate the probability of receiving a shock during acquisition upon presentation of the aversive (CS+) relative to the safe stimuli (CS−). However, the effects of low self-efficacy on discrimination learning were limited to fear acquisition. No differences between the groups were observed during extinction and extinction retrieval. Furthermore, analysis of other outcome measures, i.e., skin conductance responses and CS valence ratings, revealed no group differences during the different phases of fear conditioning. In conclusion, lower perceived self-efficacy alters cognitive/expectancy components of discrimination during fear learning but not evaluative components and physiological responding. The pattern of findings suggests a selective, detrimental role of low(er) self-efficacy on the subject’s ability to learn the association between ambiguous cues and threat/safety.
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Affiliation(s)
- Friederike Raeder
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Lioba Karbach
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Helena Struwe
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Jürgen Margraf
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
| | - Armin Zlomuzica
- Ruhr University Bochum, Faculty of Psychology, Mental Health Research and Treatment Center, Bochum, Germany
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Scheveneels S, Boddez Y, De Ceulaer T, Hermans D. Ruining the surprise: The effect of safety information before extinction on return of fear. J Behav Ther Exp Psychiatry 2019; 63:73-78. [PMID: 30446162 DOI: 10.1016/j.jbtep.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In psychoeducation before exposure treatment patients are sometimes provided with information about the (low) probability that the feared outcome would occur. Since it has been proposed in the literature that this might have adverse effects, the current study investigated the effect of providing participants with this type of safety information on return of fear. METHOD In an ABA-renewal paradigm, participants in the experimental group were instructed between acquisition and extinction that the probability of US-occurrence would be extremely small in the remainder of the experiment. Participants in the control group did not receive this information. RESULTS Less return of fear in US-expectancy ratings was observed in participants who received the safety information. LIMITATIONS We failed to find successful acquisition in the skin-conductance data, which prevented us from interpreting the results of this outcome measure. CONCLUSIONS These results suggest that providing safety information is not deleterious for the effects of exposure and can even be beneficial for its effects. However, further clinical research is needed.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.
| | - Yannick Boddez
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Toon De Ceulaer
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Dirk Hermans
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
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60
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How instructions shape aversive learning: higher order knowledge, reversal learning, and the role of the amygdala. Curr Opin Behav Sci 2019. [DOI: 10.1016/j.cobeha.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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De Houwer J, Mattavelli S, Van Dessel P. Dissociations between Learning Phenomena do Not Necessitate Multiple Learning Processes: Mere Instructions about Upcoming Stimulus Presentations Differentially Influence Liking and Expectancy. J Cogn 2019; 2:7. [PMID: 31517229 PMCID: PMC6634332 DOI: 10.5334/joc.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/16/2019] [Indexed: 11/20/2022] Open
Abstract
Prior research showed that the degree of statistical contingency between the presence of stimuli moderates changes in expectancies about the presence of those stimuli (i.e., expectancy learning) but not changes in the liking of those stimuli (i.e., evaluative conditioning). This dissociation is typically interpreted as evidence for dual process models of associative learning. We tested an alternative account according to which both types of learning rely on a single process propositional learning mechanism but reflect different kinds of propositional beliefs. In line with the idea that changes in liking reflect beliefs about stimulus co-occurrences whereas changes in expectancy reflect beliefs about stimulus contingency, we found that evaluative ratings depended only on instructions about whether a stimulus would co-occur with a positive or negative stimulus whereas expectancy ratings were influenced also by instructions about individual stimulus presentations.
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Does US expectancy mediate the additive effects of CS-US pairings on contingency instructions? Results from subjective, psychophysiological and neural measures. Behav Res Ther 2018; 110:41-46. [DOI: 10.1016/j.brat.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/21/2022]
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