Resurgence is greater following a return to the training context than remaining in the extinction context

A systematic review of enhanced resurgence paradigms

Following successful treatment in which problem behavior is reduced, it may reemerge as a function of changes in contextual stimuli or the worsening of reinforcement conditions for an alternative response. Although understudied, preliminary research suggests that simultaneous changes in contextual stimuli and reinforcement conditions may represent particularly exigent treatment challenges that create the condition for additive or superadditive relapse. The purpose of the present review was to systematically examine the relapse literature involving simultaneous changes in contextual stimuli and reinforcement conditions in relapse tests and experimental preparations arranged to evaluate their effect on response recovery. We identified 16 empirical articles spanning 27 experiments. Although all experiments included at least one condition that experienced a change in contextual stimuli and worsening of alternative reinforcement conditions, only two experiments included the comparison conditions needed to precisely evaluate additive and superadditive relapse. Our findings establish the preclinical generality of relapse effects associated with simultaneous changes to reinforcement conditions and contextual stimuli across a range of subjects, schedule arrangements, response topographies, reinforcers, and types of contextual changes. We make several recommendations for future research based on our findings from this nascent and clinically relevant subdomain of the relapse literature.

Incubation of methamphetamine craving in punishment-resistant individuals is associated with activation of specific gene networks in the rat dorsal striatum

Methamphetamine use disorder (MUD) is characterized by loss of control over compulsive drug use. Here, we used a self-administration (SA) model to investigate transcriptional changes associated with the development of early and late compulsivity during contingent footshocks. Punishment initially separated methamphetamine taking rats into always shock-resistant (ASR) rats that continued active lever pressing and shock-sensitive (SS) rats that reduced their lever pressing. At the end of the punishment phase, rats underwent 15 days of forced abstinence at the end of which they were re-introduced to the SA paradigm followed by SA plus contingent shocks. Interestingly, 36 percent of the initial SS rats developed delayed shock-resistance (DSR). Of translational relevance, ASR rats showed more incubation of methamphetamine craving than DSR and always sensitive (AS) rats. RNA sequencing revealed increased striatal Rab37 and Dipk2b mRNA levels that correlated with incubation of methamphetamine craving. Interestingly, Bdnf mRNA levels showed HDAC2-dependent decreased expression in the AS rats. The present SA paradigm should help to elucidate the molecular substrates of early and late addiction-like behaviors.

Relapse and its mitigation: Toward behavioral inoculation

Relapse following the successful treatment of problem behavior can increase the likelihood of injury and the need for more intensive care. Current research offers some predictions of how treatment procedures may contribute to relapse, and conversely, how the risk of relapse can be mitigated. This review describes relapse-mitigation procedures with varying levels of support, the quantitative models that have influenced the research on relapse mitigation, different experimental methods for measuring relapse mitigation, and directions for future research. We propose that by viewing the implementation of relapse-mitigation procedures as a means of producing behavioral inoculation, clinicians are placed in the proactive and intentional role of exposing their client's behavior to an array of reinforcement and stimulus conditions during treatment with the goal of decreasing the detrimental impact of future treatment challenges.

A Comprehensive Systematic Review of Procedures and Analyses Used in Basic and Preclinical Studies of Resurgence, 1970-2020

Resurgence is the return of a previously reinforced response as conditions worsen for an alternative response, such as the introduction of extinction, reductions in reinforcement, or punishment. As a procedure, resurgence has been used to model behavioral treatments and understand behavioral processes contributing both to relapse of problem behavior and flexibility during problem-solving. Identifying existing procedural and analytic methods arranged in basic/preclinical research could be used by basic and preclinical researchers to develop novel approaches to study resurgence, whereas translational and clinical researchers could identify potential approaches to combating relapse during behavioral interventions. Despite the study of resurgence for over half a century, there have been no systematic reviews of the basic/preclinical research on resurgence. To characterize the procedural and analytic methods used in basic/preclinical research on resurgence, we performed a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We identified 120 articles consisting of 200 experiments that presented novel empirical research, examined operant behavior, and included standard elements of a resurgence procedure. We reported prevalence and trends in over 60 categories, including participant characteristics (e.g., species, sample size, disability), designs (e.g., single subject, group), procedural characteristics (e.g., responses, reinforcer types, control conditions), criteria defining resurgence (e.g., single test, multiple tests, relative to control), and analytic strategies (e.g., inferential statistics, quantitative analysis, visual inspection). We make some recommendations for future basic, preclinical, and clinical research based on our findings of this expanding literature.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-022-00361-y.

Assessing human performance during contingency changes and extinction tests in reversal-learning tasks

Serial reversal-learning procedures are simple preparations that allow for a better understanding of how animals learn about environmental changes, including flexibly shifting responding to adapt to changing reinforcement contingencies. The present study examined serial reversal learning with humans by arranging both midsession and variable contingency reversals across two experiments. We also examined the effects of extinction by adding nonreinforced trials at the end of later sessions and provided the first evaluation of effects of win-stay/lose-shift versus counting strategies on accuracy and response latency of humans' reversal-learning performance. In each experiment, responding tracked contingency reversals, primarily with participants using either win-stay/lose-shift or counting strategies. Introducing variable reversal points in the second experiment resulted in near-exclusive win-stay/lose-shift responding among participants and eliminated counting of trials. Each experiment also revealed an immediate shift from S2 to S1 after experiencing extinction during the initial test trial, indicating resurgence of the initial response through a win-stay/lose-shift response pattern. Therefore, the present study replicates and extends prior findings of a win-stay/lose shift response pattern in situations of greater uncertainty. These findings suggest that differences in environmental certainty induce qualitatively different decision-making strategies.

Evaluating effects of context changes on resurgence in humans

Laboratory models of relapse provide methods for evaluating challenges to behavioral treatments with differential reinforcement of an alternative response (DRA). Resurgence occurs with the worsening of conditions of reinforcement for appropriate behavior and renewal occurs when transitioning out of a treatment context. Across five experiments, participants recruited via online crowdsourcing pressed onscreen buttons to earn points exchangeable for money and contexts sometimes changed through changes in the background image. Returning to the training context (ABA, Experiment 1) and transitioning to a novel context (ABC, Experiment 2) produced greater resurgence when removing alternative reinforcement in comparison with remaining in the treatment context (ABB). In contrast, we observed little difference in resurgence among AAA, ABB, and AAC context manipulations (Experiment 3) and ABA, ABC, and AAC context manipulations (Experiment 4). In Experiment 5, we evaluated relative contributions of the presence versus absence of context changes (ABA vs. ABB) in combination with or without the removal of alternative reinforcement. Both changing context and removing alternative reinforcement increased responding in isolation and the combination produced greater-than-additive effects. Overall, the present findings demonstrate a consistent effect of removing alternative reinforcement on relapse that, under certain conditions, can be enhanced by context change.

Empirically Deriving Omission and Commission Errors for Relapse Tests: A Demonstration of Reverse Translation

Most studies examine treatment relapse by programming contextual changes with perfect treatment integrity or with omission errors in the absence of a context change (i.e., all alternative responses placed on extinction). Recently, Mitteer et al. (2018) examined caregiver behavior in response to a confederate playing the role of a child with destructive behavior, providing the opportunity for researchers to empirically derive reinforcement schedules and test caregiver error patterns within future relapse tests with children. The present study represents a pilot demonstration of methods for reverse translating findings from caregivers to relapse preparations with children. We used a human-operant arrangement with three children with autism spectrum disorder in which they (a) emitted a target response (i.e., pad touch) for a preferred item in a home-like context, (b) emitted an alternative response (e.g., card touch) for the item in a clinic context while the target response was extinguished, and (c) experienced a relapse test in which the experimenter programmed the same low-rate omission and commission errors that caregivers made in the prior study within the home-like context. During the relapse test, target responding approximated or exceeded baseline ranges for all cases, and alternative behavior extinguished for two of the three cases. We discuss how researchers might incorporate similar translation processes in future relapse research.

Evaluating Extinction, Renewal, and Resurgence of Operant Behavior in Humans with Amazon Mechanical Turk

Amazon Mechanical Turk (MTurk) is a crowdsourcing marketplace providing researchers with the opportunity to collect behavioral data from remote participants at a low cost. Recent research demonstrated reliable extinction effects, as well as renewal and resurgence of button pressing with MTurk participants. To further examine the generality of these findings, we replicated and extended these methods across six experiments arranging reinforcement and extinction of a target button press. In contrast to previous findings, we did not observe as reliable of decreases in button pressing during extinction (1) after training with VR or VI schedules of reinforcement, (2) in the presence or absence of context changes, or (3) with an added response cost for button pressing. However, we found that that a 1-point response cost for all button presses facilitated extinction to a greater extent than the absence of response cost. Nevertheless, we observed ABA renewal of button pressing when changing background contexts across phases and resurgence when extinguishing presses on an alternative button. Our findings suggest that MTurk could be a viable platform from which to ask and address questions about extinction and relapse processes, but further procedural refinements will be necessary to improve the replicability of control by experimental contingencies.

Repeated resurgence with and without a context change

Resurgence is the reoccurrence of a target response when reinforcement for a more recently reinforced alternative response is eliminated or reduced. The present study arranged two successive three-phase procedures to assess whether resurgence decreases with repeated assessments. Moreover, we arranged a contextual change from the first to second assessment for some groups. Phase 1 reinforced a target response on a touchscreen computer with typically developing adults as participants according to either variable-ratio or variable-interval schedules of reinforcement. Phase 2 extinguished target responding and reinforced alternative responding. Phase 3 tested for resurgence by extinguishing alternative responding. Resurgence reliably occurred in all tests and decreased from the first to second exposure to the procedures but there were no effects of context change. Therefore, repeated exposures to resurgence tests reduced those effects but contextual changes had no effect.

Resurgence of previously taught academic responses

Resurgence is often discussed in relation to the relapse of undesirable behavior. However, resurgence may also describe the recurrence of socially appropriate behavior, including academic responding. The recurrence of academic responses following periods of extinction may aid in the solution of novel problems. The aims of this study were to evaluate the resurgence of complex, desirable behavior related to college-level instruction and to explore problem form as an aspect of environmental context. Each participant was taught 2 response chains to solve quadratic equations across experimental phases, followed by a phase in which neither chain resulted in the correct solution (extinction). During Experiment 1, the equations presented during extinction resembled those presented during reinforcement of the alternative response. Of the 8 participants in Experiment 1, 4 attempted to use the first-taught chain to solve an equation in the extinction phase. During Experiment 2, the equations presented during extinction resembled those presented during reinforcement of the target response. Of the 8 participants in Experiment 2, 6 attempted to use the first-taught chain to solve an equation in the extinction phase. Results demonstrate the resurgence of academic responses and suggest that the form of the problem may constitute a context that affects resurgence.

Context affects resurgence of negatively reinforced human behavior

The effects of context on the resurgence of negatively reinforced (escape) responding was studied in an experiment with undergraduate students in which resurgence and renewal procedures were combined. Across conditions, in baseline (BL), key-pressing produced 3-s timeouts from pressing a force cell on a variable-ratio schedule of reinforcement; in the Alternative-Reinforcement and Test phases, a differential-reinforcement-of-other-behavior schedule and extinction were in effect, respectively. Conditions differed according to the context (the computer-screen color) in effect in each phase: ABA vs. ABB (with each letter representing a context; order of exposure to conditions was counterbalanced across participants). For each of six participants, independent of (a) order of exposure to conditions, (b) slight differences in BL reinforcement, and (c) differences in BL key-pressing rates, resurgence of greater magnitude occurred in the ABA than in the ABB condition. These results replicate and extend to contingencies of negative reinforcement previous findings with nonhumans and humans showing that context modulates the magnitude of resurgence.

A review of investigations of operant renewal with human participants: Implications for theory and practice

Operant renewal is the recurrence of a previously eliminated target behavior as a function of changing stimulus contexts. Renewal as a model of treatment relapse in humans suggests that a change in stimulus conditions or context is sufficient to produce relapse of a previously eliminated maladaptive behavior. The extent to which general findings from operant renewal studies involving nonhuman animal subjects are supported by relapse studies involving human participants is unknown. We conducted a systematic review of studies demonstrating or mitigating operant renewal in human participants in peer-reviewed studies found in PsycINFO, ERIC, PubMed, and Scopus between 1980 and 2019. We identified 12 studies involving 61 participants and 93 cases of operant renewal. We coded descriptive data on participant and study characteristics and calculated summary statistics. Results indicated that the renewal effect was a robust phenomenon, supported by demonstrations in both clinical and human-laboratory studies, and across a variety of variables and experimental preparations. However, there were relatively few studies involving human participants that attempted to reduce or eliminate renewal of clinically meaningful behavior. We discuss variables relevant for studying renewal in socially meaningful contexts, practical limitations of observing the renewal effect in real-world settings, implications for theoretical models of renewal, and identify barriers to methodology unique to human participants. We provide directions for future research related to implementing and translating nonhuman animal studies of renewal to applied settings.