Van de Pavert, Huisman, Roelofs & Klumpers (2019)

18 important questions on Van de Pavert, Huisman, Roelofs & Klumpers (2019)

How much procent of the patients are unsuccesfully treated with CBT

40-50%, they experience a return of symptoms

How can we improve the unsuccesfully treatment with some patients

By changing the focus of the treatment for anxiety disorders > by changing the cognitive expectations a patient has about the association between the object of fear and a particular outcome

Why does avoidance counteracts the effect of exposure

Because if the patient avoids, he cannot extinguish his fear by learning that the feared object or situation is now without the expected aversive outcome.
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True or false

avoidance predicts clinical outcomes better than the level of fear before therapy

True > meaning that reducing avoidance behavior appears to be vital for the succes of treatment

What will this study if tackling fearful avoidance using counterconditioning investigate

1) investigating a potential causal role of this appetitive motivation on avoidance behavior, in threatening context, may help in understanding whether manipulating appetitive appraisal could reduce subsequent avoidance behavior

2) investigate if training based on counterconditioning could reduce the negative valence of a threatening stimulus and thereby reduce avoidance behavior, even when the threat still present.

What is the difference btween counterconditioning and extinction

CC has been found to lead to less spontaneous recovery of fear and less reinstatement as compared to extinction.

CC can lead to decreased avoidance during the ecologically valid situation of acute approach avoidance conflict

What is the goal of fearful avoidance task

To quantify costly fearful avoidance behavior and increase the understanding of the mechanisms driving this behavior.

What is the focus of fearful avoidance task

Focus of the FAT is therefore on the influence of appettive motivation, manipulated through counterconditioning on avoidance behavior in mixed outcome situations

Which methods were used in this study

- shock workup procedure
- titration of monetary reward
- fearful avoidance task
- counterconditioning training
- eye blink startle

What is meant with shock workup procedure (and how is this seen in this study)

As the participants were inflicited pain by electrical shocks, the shock intensity was indicated by letting the participants rate shocks from 1 (not painful) to 5 (painful). Value 4 was taken for this experiment

What is studies with the titration of monetary reward

- monetary rewards were titrated to the individual indifference point of each subject

- titration procedure, participants could choose between two options, with one option (approach) being associated with higher probability of monetary reward and threat of shock
option 2 ; avoid, being associated with a relative avoidance of risk

Why was fearful avoidance task used

To measure avoidance behavior in approach- avoidance conflict situation.

After the decision to approach or avoid, the participant was confronted with either;

1) positive outcome; receiving money 40% approaching and 10 % when avoiding

2) negative outcome (being shot, 40% change when approaching, 10% avoidance.

3) neutral outcome

What happend with the counter conditioning training

Participants encoutered two of three threat stimuli

What is eye blink startle

Electrodes captured the eye blink movements after sound probe

What was the conclusion on CC training found in this study

The study found that CC training decreased avoidance for the appettive conditoned and negative valence was encommitanly reduced while there was no change in eye blink startle potention

What was the limitation of this study

Authors state that the sample is a limitation, due to the small size and due to the sample consisting mostly females, who generally show more or longer avoidance behavior than males.

moreover, some studies also report sex differences in conditioning performance

What are some clinical implications (CC)

Translation of counterconditioning to treatment may be especially challenging also because higher levels of anxiety would be likely require the potent appetitive stimulus

The question on the page originate from the summary of the following study material:

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