Occasional reinforced trials during extinction can slow the rate of rapid reacquisition

Extinction in multiple contexts reduces the return of extinguished responses: A multilevel meta-analysis

Extinguished responses have been shown to reappear under several circumstances, and this reappearance is considered to model behaviors such as relapse after exposure therapy. Conducting extinction in multiple contexts has been explored as a technique to decrease the recovery of extinguished responses. The present meta-analysis aimed to examine whether extinction in multiple contexts can consistently reduce the recovery of extinguished responses. After searching in several databases, experiments were included in the analysis if they presented extinction in multiple contexts, an experimental design, and an adequate statistical report. Cohen's d was obtained for each critical comparison and weighted to obtain the sample's average weighted effect size. Analyses were then performed using a multilevel meta-analytic approach. Twenty-five studies were included, with a total sample of 37 experiments or critical comparisons. The analyses showed a large effect size for the sample, moderated by the length of conditioned stimulus exposure, type of experimental subject, and type of recovery. The robust effect of extinction in multiple contexts on relapse should encourage clinicians to consider extinction in multiple contexts as a useful technique in therapy and research.

A model for recovery-from-extinction effects in Pavlovian conditioning and exposure therapy

Exposure therapy is an effective intervention for anxiety-related problems. The mechanism of this intervention has been the extinction procedure in Pavlovian conditioning, and this application has provided many successful instances for the prevention of relapse. However, traditional associative theories cannot comprehensively explain many findings. In particular, it is difficult to explain the recovery-from-extinction effects, which is the reappearance of the conditioned response following extinction. In this paper, we propose an associative model that is a mathematical extension of Bouton's (1993, Psychological Bulletin, 114, 80-99) model for the extinction procedure. The core of our model is that the asymptotic strength of the inhibitory association depends on the degree of excitatory association retrieved in a context in which a conditioned stimulus (CS) is presented and that the retrieval is determined by the similarity between contexts during both reinforcement and non-reinforcement and the retrieval context. Our model provides an explanation of the recovery-from-extinction effects, and implications for exposure therapy.

A comparison of renewal, spontaneous recovery, and reacquisition after punishment and extinction

Punishment and extinction are both effective methods of reducing instrumental responding and may involve similar learning mechanisms. To characterize the similarities and differences between them, we examined three well-established recovery or "relapse" effects -renewal, spontaneous recovery, and reacquisition - following either punishment or extinction of an instrumental response. In Experiment 1a, both punished and extinguished responses renewed to similar degrees following a context change at test (ABA renewal). In Experiment 1b, responding spontaneously recovered to similar degrees following punishment or extinction. In Experiment 2, responding was rapidly reacquired when the response was reinforced again following extinction but not following punishment, as predicted by the idea that the reinforcer delivered in reacquisition is part of the context of punishment, but not extinction. The results collectively suggest that both punishment and extinction produce similar context-dependent retroactive interference effects. More broadly, they also suggest that punished and extinguished responses may be equally likely to return following a change of context despite the intuition that punishment might provide a more extreme and effective means of suppressing behavior. To our knowledge, this is the first direct behavioral comparison of response recovery after punishment and extinction within individual experiments.

Inhibitory Learning during Exposure Treatment in Anorexia Nervosa: A Practical Guide

Exposure therapy is known to be an effective intervention in the treatment of anxiety-related disorders. In eating disorders, such as anorexia nervosa, anxiety and avoidance are identified as maintenance factors. Therefore, they may constitute an important treatment target, suitable for the use of exposure therapy. Remarkably, exposure techniques to target fears and avoidance behaviors are not commonly used in the treatment of anorexia nervosa. We present a practical guide for the implementation of exposure therapy in the treatment of anorexia nervosa. We outline how exposure therapy is supposed to work according to the inhibitory learning model and how the exposure intervention can be designed for individuals with anorexia nervosa. Practical examples are provided through the case presentation of a patient with anorexia nervosa who completed 31 exposure sessions that focused on her fears of food, eating, weight, weight gain, their feared social consequences and the associated safety behaviors.

Using expectation violation models to improve the outcome of psychological treatments

Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.

Effects of confronting the feared outcome during exposure therapy on the return of fear: An analogue study

BACKGROUND AND OBJECTIVES

Although exposure therapy is an efficacious treatment for anxiety disorders, fear often returns after treatment. From an inhibitory learning perspective, long-term improvement depends not only on learning that feared stimuli are safe, but also that it is safe to experience the emotional response triggered by these stimuli. Accordingly, the current study examined the effects of occasional threat reinforcement during repeated exposure to multiple cues on the return of fear in snake phobia by incorporating reminders of the feared outcome.

METHODS

Snake fearful community adults (N = 74) were randomized to either repeated exposure to multiple cues or exposure to multiple cues that also explicitly depicted the feared outcome (snake biting someone). A measure of self-reported threat expectancy and a threat-relevant behavioral approach task (BAT) were administered pre-exposure, post-exposure, and at a one-week follow-up.

RESULTS

Compared to the multiple-cue exposure group, the multiple-cue + fear-outcome group showed significantly less subjective expectancy for a snake to bite and increased behavioral approach of snake images at one-week follow-up. The fear-outcome group also reported significantly greater variability in distress during exposure than the multiple-cue exposure group and this difference mediated the intervention effect on behavioral approach at follow-up.

LIMITATIONS

Findings are limited by the use of videos as an analogue to exposure and a computer-delivered BAT.

CONCLUSIONS

These findings suggest presentation of the feared outcome may result in more variability in distress during exposure therapy and this may partially explain the maintenance of behavioral gains.

Limitations of occasional reinforced extinction to alleviate spontaneous recovery and reinstatement effects: Evidence for a trial-signalling mechanism

Fear extinction is not permanent but is instead more vulnerable than the original fear memory, as traditionally shown by the return of fear phenomena. Because of this, techniques to mitigate the return of fear are needed in the clinical treatment of related psychological conditions. One promising strategy is the occasional reinforced extinction treatment, introducing a gradual and sparse number of conditioned stimulus-unconditioned stimulus (CS-US) pairings within the extinction treatment. We present the results of three experiments in which we used a threat conditioning procedure in humans. Our main aim was to evaluate whether occasional reinforced extinction could reduce two different forms of relapse: spontaneous recovery (Experiments 1 and 2) and reinstatement (Experiment 3). Contrary to our predictions and previous literature, the results indicate that an occasional reinforcement treatment did not mitigate relapse compared with standard extinction. From a theoretical standpoint, these results are more consistent with the idea that extinction entails the acquisition of new knowledge than with the idea that there are conditions in which extinction leads to a weakening of the original fear memory. These findings also question the generality of the potential benefits of using occasional reinforced extinction in clinical settings.

Presentation of unpaired unconditional stimuli during extinction reduces renewal of conditional fear and slows re-acquisition

Past research has shown that presenting unconditional stimuli (US) during extinction training, either paired with the conditional stimulus (CS) or explicitly unpaired, can reduce spontaneous recovery and slow the re-acquisition of conditional fear. Whether contextual renewal of conditioned fear as indexed by electrodermal responses and self-report measures of anxiety and CS evaluations is also reduced after presentation of paired or unpaired USs during extinction training is currently unclear. Three groups of participants (Paired, Unpaired, Standard Extinction) completed a sequence of habituation, acquisition, extinction, renewal, and re-acquisition phases. During extinction, five CS-US pairings were presented in group Paired, whereas five US were presented alone in group Unpaired. No US were presented during standard extinction. For all groups, extinction was conducted in a context that was different from that of the other phases. Extinction of differential electrodermal responding was evident in groups Unpaired and Standard, but not in group Paired. Contextual renewal and fast re-acquisition, as indexed by differential electrodermal responding, were evident in group Standard, but not in group Unpaired and differential electrodermal responding persisted in group Paired. After extinction, self-reported anxiety was higher in groups Paired and Unpaired, but differential CS evaluations were evident in group Paired only. The current results suggest that presenting additional unpaired USs during extinction training strengthens extinction and protects against the renewal of differential electrodermal responding.

Effects of delay of reinforcement on ABA renewal

ABA renewal was assessed by decreasing response rates by means of extinction or a 12-s delay of reinforcement in one experiment with rats. In a first phase, rats were trained to lever press for water in Context A. Rats were exposed to a second phase in Context B, where lever-pressing decreased for all rats; for one group of rats, lever-pressing decreased by means of extinction, while lever-pressing decreased by means of a 12-s delay for the other group. During a third phase, both groups were once again exposed to Context A with no reinforcer deliveries for lever-pressing. Once rats were exposed to the latter phase, renewal was observed for both groups. Results suggest that delay of reinforcement can be used as an alternative procedure to help reduce behavior and mitigate relapse.

Merging Our Understanding of Anxiety and Exposure: Using Inhibitory Learning to Target Anxiety Sensitivity in Exposure Therapy

Exposure-based therapies are the gold standard treatment for anxiety disorders, and recent advancements in basic and clinical research point to the need to update the implementation of exposure. Recent research has highlighted the importance of transdiagnostic factors such as anxiety sensitivity (AS), or fear of anxiety-related sensations. Elevated AS is common among all anxiety disorders and contains three dimensions, or expectancies, that can be used to guide treatment. Recently, treatments directly targeting AS have shown potential in reducing symptoms of anxiety. In addition, inhibitory learning theory (ILT) provides an alternative explanation of exposure processes based on basic learning research. ILT extends the current framework by accounting for renewal of fear, which is important given the substantial number of individuals who experience a return of symptoms following treatment. The current paper will provide an overview of ILT and discuss several ILT techniques that can be used to target AS. These two converging bodies of research hold strong potential for optimizing treatment for anxiety.

Reexposure to a sensorimotor perturbation produces opposite effects on explicit and implicit learning processes

The motor system demonstrates an exquisite ability to adapt to changes in the environment and to quickly reset when these changes prove transient. If similar environmental changes are encountered in the future, learning may be faster, a phenomenon known as savings. In studies of sensorimotor learning, a central component of savings is attributed to the explicit recall of the task structure and appropriate compensatory strategies. Whether implicit adaptation also contributes to savings remains subject to debate. We tackled this question by measuring, in parallel, explicit and implicit adaptive responses in a visuomotor rotation task, employing a protocol that typically elicits savings. While the initial rate of learning was faster in the second exposure to the perturbation, an analysis decomposing the 2 processes showed the benefit to be solely associated with explicit re-aiming. Surprisingly, we found a significant decrease after relearning in aftereffect magnitudes during no-feedback trials, a direct measure of implicit adaptation. In a second experiment, we isolated implicit adaptation using clamped visual feedback, a method known to eliminate the contribution of explicit learning processes. Consistent with the results of the first experiment, participants exhibited a marked reduction in the adaptation function, as well as an attenuated aftereffect when relearning from the clamped feedback. Motivated by these results, we reanalyzed data from prior studies and observed a consistent, yet unappreciated pattern of attenuation of implicit adaptation during relearning. These results indicate that explicit and implicit sensorimotor processes exhibit opposite effects upon relearning: Explicit learning shows savings, while implicit adaptation becomes attenuated.

Exposure therapy vs lifestyle intervention to reduce food cue reactivity and binge eating in obesity: A pilot study

BACKGROUND AND OBJECTIVES

Learning models of overeating predict that exposure therapy is effective in reducing food cue reactivity and overeating. This pilot study tested an eight-session exposure therapy aimed at inhibitory learning vs. an active control condition aimed at lifestyle improvement for obesity (treatment-as-usual). Main outcomes are snacking behavior, eating psychopathology, food cue reactivity, and weight loss. Change in overeating expectancies was assessed as mediator for outcomes, and the associations between habituation of eating desires and outcomes were investigated in the exposure condition. Sleep quality was investigated as moderator for outcomes.

METHODS

45 overweight women were randomly assigned to the exposure intervention or control condition. The main outcomes, overeating expectancies and sleep quality were re-assessed at post-treatment and three-month follow-up. Habituation of eating desires was measured during exposure sessions.

RESULTS

Compared to the control intervention, exposure led to a significantly stronger reduction in snacking behavior of exposed foods, though this effect did not generalize to non-exposed foods, and stronger binge eating frequency. The exposure condition lost significantly more weight at post-treatment and follow-up than the lifestyle condition. Changes of expectancies mediated the effect of condition on kcal consumption of exposed foods, while habituation during exposure was not related to better treatment outcome. Sleep quality did not moderate the effect of condition on treatment outcome.

LIMITATIONS

Small sample size and limited follow-up period.

CONCLUSIONS

This short exposure therapy reduced snacking behavior, binge eating and weight more than a lifestyle intervention and is therefore a recommendable intervention for obesity and overeating disorders.

Behavioral and immunohistochemical characterization of rapid reconditioning following extinction of contextual fear

A fundamental property of extinction is that the behavior that is suppressed during extinction can be unmasked through a number of postextinction procedures. Of the commonly studied unmasking procedures (spontaneous recovery, reinstatement, contextual renewal, and rapid reacquisition), rapid reacquisition is the only approach that allows a direct comparison between the impact of a conditioning trial before or after extinction. Thus, it provides an opportunity to evaluate the ways in which extinction changes a subsequent learning experience. In five experiments, we investigate the behavioral and neurobiological mechanisms of postextinction reconditioning. We show that rapid reconditioning of unsignaled contextual fear after extinction in male Long-Evans rats is associative and not affected by the number or duration of extinction sessions that we examined. We then evaluate c-Fos expression and histone acetylation (H4K8) in the hippocampus, amygdala, prefrontal cortex, and bed nucleus of the stria terminalis. We find that in general, initial conditioning has a stronger impact on c-Fos expression and acetylation than does reconditioning after extinction. We discuss implications of these results for theories of extinction and the neurobiology of conditioning and extinction.

Rapid reacquisition of contextual fear following extinction in mice: effects of amount of extinction, acute ethanol withdrawal, and ethanol intoxication

RATIONALE

Many studies have found that ethanol intoxication and withdrawal impair initial acquisition or extinction of learned behaviors. Rapid reconditioning following extinction is a form of post-extinction re-emergence of conditioned behavior that has not been studied for its interaction with ethanol intoxication or withdrawal.

OBJECTIVES

The goals of this paper were to define the parameters that allow rapid post-extinction reacquisition of fear in mice and investigate the effect of acute ethanol withdrawal and intoxication on acquisition, extinction, and post-extinction reconditioning.

METHODS

We examined acquisition, extinction, and post-extinction reconditioning of contextual fear in male C57BL/6 mice. Acute ethanol withdrawal occurred 6 h following a 4 g/kg injection of 20% ethanol and acute ethanol intoxication occurred 5 min following a 1.5 g/kg injection of 20% ethanol.

RESULTS

A weak context-shock pairing caused rapid reacquisition of conditioned freezing following moderate, but not extensive extinction. Acute ethanol intoxication impaired initial conditioning and acute ethanol withdrawal impaired rapid reacquisition after extinction, but not reconditioning or extinction itself.

CONCLUSIONS

These findings show that rapid reconditioning occurs following moderate but not extensive extinction in C57BL/6J mice. Additionally, acute ethanol withdrawal and intoxication may differentially affect different phases of conditioning. Results are discussed in terms of current ideas about post-extinction behavior and ethanol's effects on memory.

Learned Overeating: Applying Principles of Pavlovian Conditioning to Explain and Treat Overeating

PURPOSE OF REVIEW

This review provides an overview of recent findings relating to the role of Pavlovian conditioning in food cue reactivity, including its application to overeating and weight loss interventions.

RECENT FINDINGS

Both in the laboratory and in real life, cue-elicited appetitive reactivity (e.g., eating desires) can be easily learned, but (long-term) extinction is more difficult. New findings suggest impaired appetitive learning in obesity, which might be causally related to overeating. The clinical analogue of extinction-cue exposure therapy-effectively reduces cue-elicited cravings and overeating. While its working mechanisms are still unclear, some studies suggest that reducing overeating expectancies is important.

SUMMARY

Pavlovian learning theory provides a still undervalued theoretical framework of how cravings and overeating can be learned and how they might be effectively tackled. Future studies should aim to elucidate inter-individual differences in Pavlovian conditioning, study ways to strengthen (long-term) extinction, and investigate the working mechanisms of cue exposure therapy.

State-of-the-art and future directions for extinction as a translational model for fear and anxiety

Through advances in both basic and clinical scientific research, Pavlovian fear conditioning and extinction have become an exemplary translational model for understanding and treating anxiety disorders. Discoveries in associative and neurobiological mechanisms underlying extinction have informed techniques for optimizing exposure therapy that enhance the formation of inhibitory associations and their consolidation and retrieval over time and context. Strategies that enhance formation include maximizing prediction-error correction by violating expectancies, deepened extinction, occasional reinforced extinction, attentional control and removal of safety signals/behaviours. Strategies that enhance consolidation include pharmacological agonists of NMDA (i.e. d-cycloserine) and mental rehearsal. Strategies that enhance retrieval include multiple contexts, retrieval cues, and pharmacological blockade of contextual encoding. Stimulus variability and positive affect are posited to influence the formation and the retrieval of inhibitory associations. Inhibitory regulation through affect labelling is considered a complement to extinction. The translational value of extinction will be increased by more investigation of elements central to extinction itself, such as extinction generalization, and interactions with other learning processes, such as instrumental avoidance reward learning, and with other clinically relevant cognitive-emotional processes, such as self-efficacy, threat appraisal and emotion regulation, will add translational value. Moreover, framing fear extinction and related processes within a developmental context will increase their clinical relevance.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.

Building physiological toughness: Some aversive events during extinction may attenuate return of fear

BACKGROUND AND OBJECTIVES

Although exposure therapy is an effective treatment for anxiety disorders, fear sometimes returns following successful therapy. Recent literature in animal models indicates that incorporating some aversive events into extinction training may offset these return of fear effects.

METHODS

The effect of occasional reinforced extinction trials was investigated in a sample of thirty-nine participants using a fear conditioning and extinction paradigm. Participants either underwent traditional extinction procedures during which the conditional stimulus which had been paired with the unconditional stimulus (US) during acquisition training (CS+) was presented alone with no presentations of the US or partially reinforced extinction during which there were several unpredicted CS+/US pairings.

RESULTS

As measured by skin conductance responses, physiological fear responding remained elevated during extinction for participants who experienced partially reinforced extinction; however, these participants demonstrated protection from rapid reacquisition effects. Results from the subjective US-expectancy ratings did not provide evidence of protection against rapid reacquisition in the partially reinforced extinction group; however, there was evidence of protection from spontaneous recovery effects. Lastly, as measured by valence ratings, it was unclear whether partially reinforced extinction provided protection from fear recovery effects.

LIMITATIONS

Although participants who experienced partially reinforced extinction demonstrated protection from rapid reacquisition as measured by skin conductance responses, they also demonstrated significantly higher levels of physiological fear responding during extinction which made the results of the spontaneous recovery test more difficult to interpret.

CONCLUSIONS

Occasional CS-US pairings during extinction may protect against return of fear effects. Clinical implications are discussed.

Tackling maladaptive memories through reconsolidation: From neural to clinical science

Behavioral neuroscience has greatly informed how we understand the formation, persistence, and plasticity of memory. Research has demonstrated that memory reactivation can induce a labile period, during which previously consolidated memories are sensitive to change, and in need of restabilization. This process is known as reconsolidation. Such findings have advanced not only our basic understanding of memory processes, but also hint at the prospect of harnessing these insights for the development of a new generation of treatments for disorders of emotional memory. However, even in simple experimental models, the conditions for inducing memory reconsolidation are complex: memory labilization appears to result from the interplay of learning history, reactivation, and also individual differences, posing difficulties for the translation of basic experimental research into effective clinical interventions. In this paper, we review a selection of influential animal and human research on memory reconsolidation to illustrate key insights these studies afford. We then consider how these findings can inform the development of new treatment approaches, with a particular focus on the transition of memory from reactivation, to reconsolidation, to new memory formation, as well as highlighting possible limitations of experimental models. If the challenges of translational research can be overcome, and if reconsolidation-based procedures become a viable treatment option, then they would be one of the first mental health treatments to be directly derived from basic neuroscience research. This would surely be a triumph for the scientific study of mind and brain.

Enhancing inhibitory learning to reduce overeating: Design and rationale of a cue exposure therapy trial in overweight and obese women

The prevalence of overweight and obesity has increased substantially over the last decades. Weight loss attempts in overweight individuals are common, though they seldom result in successful long-term weight loss. One very promising treatment is food cue exposure therapy, during which overweight individuals are repeatedly exposed to food-associated cues (e.g., the sight, smell and taste of high-calorie foods, overeating environments) without eating in order to extinguish cue-elicited appetitive responses to food cues. However, only few studies have tested the effectiveness of cue exposure, especially with regards to weight loss. For exposure treatment of anxiety disorders, it has been proposed that inhibitory learning is critical for exposure to be effective. In this RCT, we translated techniques proposed by Craske et al. (2014) to the appetitive domain and developed a novel cue exposure therapy for overeating aimed at maximizing inhibitory learning. The current RCT tested the effectiveness of this 8-session cue exposure intervention relative to a control intervention in 45 overweight adult (aged 18-60) females at post-treatment and 3-month follow-up, of which 39 participants completed the study. Weight loss, eating psychopathology, food cue reactivity, and snacking behaviour were studied as main treatment outcomes, and mediators and moderators of treatment effects were studied. The presented study design represents an innovative effort to provide valuable clinical recommendations for the treatment of overeating and obesity.

Implications of learning theory for developing programs to decrease overeating

Childhood obesity is associated with medical and psychological comorbidities, and interventions targeting overeating could be pragmatic and have a significant impact on weight. Calorically dense foods are easily available, variable, and tasty which allows for effective opportunities to learn to associate behaviors and cues in the environment with food through fundamental conditioning processes, resulting in measurable psychological and physiological food cue reactivity in vulnerable children. Basic research suggests that initial learning is difficult to erase, and that it is vulnerable to a number of phenomena that will allow the original learning to re-emerge after it is suppressed or replaced. These processes may help explain why it may be difficult to change food cue reactivity and overeating over the long term. Extinction theory may be used to develop effective cue-exposure treatments to decrease food cue reactivity through inhibitory learning, although these processes are complex and require an integral understanding of the theory and individual differences. Additionally, learning theory can be used to develop other interventions that may prove to be useful. Through an integration of learning theory, basic and translational research, it may be possible to develop interventions that can decrease the urges to overeat, and improve the weight status of children.

Effects of occasional reinforced trials during extinction on the reacquisition of conditioned responses to food cues

BACKGROUND AND OBJECTIVES

Successful long-term dieting appears to be difficult, and part of its difficulty might be explained by processes related to classical appetitive conditioning. Increasing the speed of extinction of appetitive responses to food cues and decreasing the magnitude of returns of these responses could help increase the long-term effectiveness of weight loss attempts. Two extinction techniques hypothesized to slow down rapid reacquisition of conditioned appetitive responses were investigated: the provision of 1) occasional reinforced extinction trials (OR) and 2) unpaired unconditioned stimuli (USs) during extinction (UNP).

METHODS

After acquisition, participants (N = 90) received one of three extinction trainings: OR, UNP, or normal extinction (control), followed by a reacquisition phase. Their desire to eat, US expectancy, and salivation were measured. Effects of impulsivity on different phases of appetitive conditioning were also assessed.

RESULTS

It was found that both extinction techniques were successful in reducing the rate of reacquisition of US expectancies. Participants in the OR condition also demonstrated a slower extinction of US expectancies and desires to eat. However, the reacquisition of conditioned desires was not affected by either extinction technique. Impulsivity did not moderate responses during acquisition or extinction, but appeared to slow down the reacquisition of conditioned desires.

LIMITATIONS

US expectancies and eating desires were not completely extinguished, and a few differences in baseline responses caused difficulty in interpreting some of the findings.

CONCLUSIONS

It is concluded that the provision of occasional reinforced extinction trials and unpaired USs seem promising techniques to slow down reacquisition, but that additional studies are needed.

Relapse of extinguished fear after exposure to a dangerous context is mitigated by testing in a safe context

Aversive events can trigger relapse of extinguished fear memories, presenting a major challenge to the long-term efficacy of therapeutic interventions. Here, we examined factors regulating the relapse of extinguished fear after exposure of rats to a dangerous context. Rats received unsignaled shock in a distinct context ("dangerous" context) 24 h prior to auditory fear conditioning in another context. Fear to the auditory conditioned stimulus (CS) was subsequently extinguished either in the conditioning context ("ambiguous" context) or in a third novel context ("safe" context). Exposure to the dangerous context 30 min before a CS retention test caused relapse to the CS in the ambiguous and safe test contexts relative to nonextinguished controls. When rats were tested 24 h later (with or without short-term testing), rats tested in the ambiguous context continued to exhibit relapse, whereas rats tested in the safe context did not. Additionally, exposure of rats to the conditioning context--in place of the unsignaled shock context--did not result in relapse of fear to the CS in the safe testing context. Our work highlights the vulnerabilities of extinction recall to interference, and demonstrates the importance of context associations in the relapse of fear after extinction.

Why behavior change is difficult to sustain

Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs.

Maximizing exposure therapy: an inhibitory learning approach

Exposure therapy is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear after treatment. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure-based procedures. Although evidence supports an inhibitory learning model of extinction, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a 'fear habituation' approach and 'belief disconfirmation' approach within standard cognitive-behavior therapy. Exposure optimization strategies include (1) expectancy violation, (2) deepened extinction, (3) occasional reinforced extinction, (4) removal of safety signals, (5) variability, (6) retrieval cues, (7) multiple contexts, and (8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, specific phobia, and panic disorder.

Associative Accounts of Recovery-from-Extinction Effects

Recovery-from-extinction effects (e.g., spontaneous recovery, renewal, reinstatement, and facilitated reacquisition) have become the focus of much research in recent years. However, despite a great deal of empirical data, there are few theoretical explanations for these effects. This paucity poses a severe limitation on our understanding of these behavioral effects, impedes advances in uncovering neural mechanisms of response recovery, and reduces our potential to prevent relapse after exposure therapy. Towards correcting this oversight, this review takes prominent models of associative learning that have been used in the past and continue to be used today to explain Pavlovian conditioning and extinction, and assesses how each model can be applied to account for recovery-from-extinction effects. The models include the Rescorla-Wagner (1972) model, Mackintosh's (1975) attentional model, Pearce and Hall's (1980) attentional model, Wagner's (1981) SOP model, Pearce's (1987) configural model, McLaren and Mackintosh's (2002) elemental model, and Stout and Miller's (2007) SOCR (comparator hypothesis) model. Each model is assessed for how well it explains or does not explain the various recovery-from-extinction phenomena. We offer some suggestions for how the models might be modified to account for these effects in those instances in which they initially fail.

Behavioral and neurobiological mechanisms of extinction in Pavlovian and instrumental learning

This article reviews research on the behavioral and neural mechanisms of extinction as it is represented in both Pavlovian and instrumental learning. In Pavlovian extinction, repeated presentation of a signal without its reinforcer weakens behavior evoked by the signal; in instrumental extinction, repeated occurrence of a voluntary action without its reinforcer weakens the strength of the action. In either case, contemporary research at both the behavioral and neural levels of analysis has been guided by a set of extinction principles that were first generated by research conducted at the behavioral level. The review discusses these principles and illustrates how they have informed the study of both Pavlovian and instrumental extinction. It shows that behavioral and neurobiological research efforts have been tightly linked and that their results are readily integrated. Pavlovian and instrumental extinction are also controlled by compatible behavioral and neural processes. Since many behavioral effects observed in extinction can be multiply determined, we suggest that the current close connection between behavioral-level and neural-level analyses will need to continue.

Context change and associative learning

This article reviews the effects of changing the background context on performance in associative learning tasks in humans and animals. The findings are complementary and consistent over animal conditioning (Pavlovian and instrumental learning) and human predictive learning and memory paradigms. In many cases, a context change after learning can have surprisingly little disruptive influence on performance. Extinction, or retroactive interference treatments more generally, is more context-specific than the initial learning. Contexts become important if the participant is exposed to any of several treatments that involve prediction error, which may serve to increase attention to the context. Contexts also become important if they are given predictive or informational value. Studies of instrumental (operant) learning are further consistent with the idea that the context might also influence affordances that support voluntary actions. Context switch effects are not universal, but mainly occur when certain attention and perception processes can come into play. WIREs Cogn Sci 2013, 4:237-244. doi: 10.1002/wcs.1225 This article is categorized under: Psychology > Learning.

Relapse processes after the extinction of instrumental learning: renewal, resurgence, and reacquisition

It is widely recognized that extinction (the procedure in which a Pavlovian conditioned stimulus or an instrumental action is repeatedly presented without its reinforcer) weakens behavior without erasing the original learning. Most of the experiments that support this claim have focused on several "relapse" effects that occur after Pavlovian extinction, which collectively suggest that the original learning is saved through extinction. However, although such effects do occur after instrumental extinction, they have not been explored there in as much detail. This article reviews recent research in our laboratory that has investigated three relapse effects that occur after the extinction of instrumental (operant) learning. In renewal, responding returns after extinction when the behavior is tested in a different context; in resurgence, responding recovers when a second response that has been reinforced during extinction of the first is itself put on extinction; and in rapid reacquisition, extinguished responding returns rapidly when the response is reinforced again. The results provide new insights into extinction and relapse, and are consistent with principles that have been developed to explain extinction and relapse as they occur after Pavlovian conditioning. Extinction of instrumental learning, like Pavlovian learning, involves new learning that is relatively dependent on the context for expression.

Reversal Without Remapping

The “cognitive revolution” in psychology is often framed as a departure from associationist principles rooted in animal learning research, yet it is clear that these principles have immediate relevance for contemporary questions in cognitive and social psychology. Intuitions about the consequences of learning procedures can easily be misleading, making these principles particularly important. To illustrate this point, we identified recent examples of studies applying a particular learning paradigm—response-reversal training—to the study of three different psychological problems (e.g., why objects in the right side of space are preferred to those in the left in right-handed people). The strategy of each study was to alter a typically encountered contingency once in the laboratory, in order to reverse a hypothesized learned response. Yet, contrary to intuitions, we demonstrate that behavior changes can be observed without the reversal of a prior association. Further, many different associative changes can underlie response reversals. We focus on these examples of response-reversal training, but our broader aim is to help connect the animal learning literature to problems in cognitive and social psychology in an effort to strengthen the inferences that might be drawn about learned associations in these contexts.

Mechanisms of resurgence II: Response-contingent reinforcers can reinstate a second extinguished behavior

Three experiments with rat subjects examined resurgence of an extinguished instrumental response using the procedure introduced by Epstein (1983) with pigeons. There were three phases: (1) initial acquisition of pressing on a lever (L1) for pellet reward, (2) extinction of L1, and (3) a test session in which a second lever (L2) was inserted, briefly reinforced, and then extinguished. Experiment 1 confirmed that if pressing L2 delivered 20 pellets followed by extinction, rats would resume L1 responding in the final test. Experiment 2 compared the effects of response-contingent and non-contingent rewards delivered upon insertion of L2. Although insertion of L2 alone did not increase L1 responding, response-contingent and non-contingent rewards led to comparable increases in L1 responding. Experiment 3 found that the delivery of non-contingent pellets during extinction of L1, which would be expected to reduce the ability of pellets to set the occasion for the L1 response, also reduced the effects of both response-contingent and non-contingent rewards during the final test. The results indicate that in this method, the resurgence treatment leads to an increase in L1 pressing due to simple presentation of the pellet; delivering the reinforcer after extinction of L1 reinstates L1 responding by setting the occasion for the L1 response.

Learning and the persistence of appetite: extinction and the motivation to eat and overeat

The modern world is saturated with highly palatable and highly available food, providing many opportunities to associate food with environmental cues and actions (through Pavlovian and operant or instrumental learning, respectively). Basic learning processes can often increase the tendency to approach and consume food, whereas extinction, in which Pavlovian and operant behaviors decline when the reinforcer is withheld, weakens but does not erase those tendencies. Contemporary research suggests that extinction involves an inhibitory form of new learning that appears fragile because it is highly dependent on the context for expression. These ideas are supported by the phenomena of renewal, spontaneous recovery, resurgence, reinstatement, and rapid reacquisition in appetitive learning, which together may help explain why overeating may be difficult to suppress permanently, and why appetitive behavior may seem so persistent.

The conditional stimulus effects of nicotine vary as a function of training dose

Although past research has shown that the interoceptive effects of nicotine serve as a conditional stimulus using sucrose as the unconditioned stimulus, very little is known about the importance of dose. Accordingly, rats were assigned to 0.1, 0.2, or 0.4 mg nicotine base/kg as the training dose. Sucrose (4-s access) was delivered 36 times on nicotine sessions; sucrose was withheld on intermixed saline sessions. The discrimination was acquired for all groups, as measured by more photobeam breaks in the dipper receptacle before the first sucrose delivery on nicotine sessions, compared with a similar interval on saline sessions. Thirty nicotine sessions without sucrose deliveries (extinction) decreased conditioned responding with the 0.4 mg/kg dose maintaining higher responding than the lower doses. After reestablishing discrimination performance, rats were tested with their training dose at various injection-to-placement intervals. Conditioned responding diminished with longer intervals; 0.4 mg/kg nicotine-evoked conditioned responding at longer intervals. Subsequent generalization testing with nicotine or saline at the 5-min training interval found that conditioned responding was evoked by lower test doses in the 0.1 mg/kg group than in the other groups. Combined, this research demonstrates that the nicotine conditional stimulus shows some variation with training dose.

Memories and anticipations control responding by rats (Rattus norvegicus) in a Pavlovian procedure

In Experiment 1 each rat received two different fixed series of three trials each. The unconditioned stimulus occurred on Trial 1 of one series and on Trial 3 of the other series, all other trials being nonreinforced. Previous Pavlovian investigations have shown that rats can remember the immediately prior reward outcome and anticipate the immediately subsequent reward outcome. Experiment 1 demonstrated that rats could remember and anticipate even more remote reward outcomes. In Experiment 2 two groups received a series of two nonrewarded trials followed by a rewarded trial. It was demonstrated that a change in the conditioned stimulus (CS) from Trial 2 to Trial 3, which occurred in one group, produced weaker responding than in the other group that did not experience such CS change. On the basis of these findings it was suggested that the rats organized the trials of a series into a unit or chunk. This was concluded for two reasons. First, remembering and anticipating remote reward outcomes strongly suggests that responding is being controlled by events extending beyond the current trial. Secondly, the experimental manipulations employed in the Pavlovian situation here are similar to those used in prior human learning and animal instrumental learning investigations concerned with chunking. Thus, it would appear that chunking is a ubiquitous phenomenon appearing in human serial learning (e.g., Bower and Winzenz 1969; Crowder 1976), in animal instrumental learning (e.g., Capaldi 1992; Hulse and Dorsky 1977; Terrace 1987), and now in Pavlovian learning.

Occasional Reinforced Responses During Extinction Can Slow the Rate of Reacquisition of an Operant Response

Three experiments with rats examined reacquisition of an operant response after either extinction or a response-elimination procedure that included occasional reinforced responses during extinction. In each experiment, reacquisition was slower when response elimination had included occasional reinforced responses, although the effect was especially evident when responding was examined immediately following each response-reinforcer pairing during reacquisition (Experiments 2 and 3). An extinction procedure with added noncontingent reinforcers also slowed reacquisition (Experiment 3). The results are consistent with research in classical conditioning (Bouton, Woods, & Pineño, 2004) and suggest that rapid reacquisition after extinction is analogous to a renewal effect that occurs when reinforced responses signal a return to the conditioning context. Clinical implications are also discussed.

Contextual and temporal modulation of extinction: behavioral and biological mechanisms

Extinction depends, at least partly, on new learning that is specific to the context in which it is learned. Several behavioral phenomena (renewal, reinstatement, spontaneous recovery, and rapid reacquisition) suggest the importance of context in extinction. The present article reviews research on the behavioral and neurobiological mechanisms of contextual influences on extinction learning and retrieval. Contexts appear to select or retrieve the current relationship of the conditional stimulus (CS) with the unconditional stimulus (US), and they are provided by physical background cues, interoceptive drug cues, emotions, recent trials, and the passage of time. The current article pays particular attention to the effects of recent trials and trial spacing. Control of fear extinction by physical context involves interactions between the dorsal hippocampus and the lateral nucleus of the amygdala. This interaction may be mediated by gamma-aminobutyric acid (GABA)-ergic and adrenergic mechanisms.

Different mechanisms of fear extinction dependent on length of time since fear acquisition

Fear extinction is defined as a decline in conditioned fear responses (CRs) following nonreinforced exposure to a feared conditioned stimulus (CS). Behavioral evidence indicates that extinction is a form of inhibitory learning: Extinguished fear responses reappear with the passage of time (spontaneous recovery), a shift of context (renewal), and unsignaled presentations of the unconditioned stimulus (reinstatement). However, there also is evidence to suggest that extinction is an "unlearning" process corresponding to depotentiation of potentiated synapses within the amygdala. Because depotentiation is induced more readily at short intervals following LTP induction and is not inducible at all at a sufficient delay, it may be that extinction initiated shortly following fear acquisition preferentially engages depotentiation/"unlearning," whereas extinction initiated at longer delays recruits a different mechanism. We investigated this possibility through a series of behavioral experiments examining the recoverability of conditioned fear following extinction. Consistent with an inhibitory learning mechanism of extinction, rats extinguished 24-72 h following acquisition exhibited moderate to strong reinstatement, renewal, and spontaneous recovery. In contrast, and consistent with an erasure mechanism, rats extinguished 10 min to 1 h after acquisition exhibited little or no reinstatement, renewal, or spontaneous recovery. These data support a model in which different neural mechanisms are recruited depending on the temporal delay of fear extinction.

Context and behavioral processes in extinction

This article provides a selective review and integration of the behavioral literature on Pavlovian extinction. The first part reviews evidence that extinction does not destroy the original learning, but instead generates new learning that is especially context-dependent. The second part examines insights provided by research on several related behavioral phenomena (the interference paradigms, conditioned inhibition, and inhibition despite reinforcement). The final part examines four potential causes of extinction: the discrimination of a new reinforcement rate, generalization decrement, response inhibition, and violation of a reinforcer expectation. The data are consistent with behavioral models that emphasize the role of generalization decrement and expectation violation, but would be more so if those models were expanded to better accommodate the finding that extinction involves a context-modulated form of inhibitory learning.