Facilitating fear-opposite approach and fear extinction by behavioural interventions

• Applicant: Professor Dr. Andre Pittig
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: since 2017
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 389569971

Persistent dysfunctional avoidance is a key characteristic of clinical fear and anxiety. A reduction of avoidance is a core target of behavioural treatments, but persistent avoidance may result in treatment refusal, drop-out, or limited treatment success. Better understanding of dysfunctional avoidance and its reduction may thus optimize individual treatment outcome. Importantly, dysfunctional avoidance is linked to severe impairments and costs, which were oftentimes neglected in human fear and avoidance research. The first funding period thus examined avoidance as a behavioural response to prevent a feared outcome, but at the same time resulting in costs (i.e., costly avoidance). Subprojects established a costly avoidance paradigm to test how conditioned fear and avoidance are altered by the presence of such costs for avoidance and how these processes differ in patients with anxiety disorders. Main findings showed that (1) costs do not directly reduce conditioned fear in healthy individuals, but strongly reduced avoidance. (2) This reduction of avoidance despite high levels of fear (i.e., fear-opposite approach) can subsequently initiate fear extinction, thus indirectly reduce conditioned fear. (3) Patients with anxiety disorders showed distinct deficits in fear-opposite approach. (4) Directly targeting avoidance compared to passive fear extinction better reduced long-term avoidance and fear. Combined, our results validate the clinical relevance of costly avoidance in anxiety disorders, its bidirectional interaction with conditioned fear, and its role as an important target for interventions. Based on the findings of deficits in fear-opposite approach in patients and benefits of targeting avoidance, projects of the second funding period aim to examine how fear-opposite approach can be facilitated by behavioural interventions. Specifically, three laboratory-controlled studies will use behavioural interventions to induce high within-subject states in positive mood (A1), self-efficacy (A2), or distress tolerance (A3) and evaluate the effects on immediate and delayed fear-opposite approach and conditioned fear. In contrast to testing between-subject trait differences, focusing on the induction of within-subject state changes provides evidence how traditional exposure may be supplemented by add-on interventions. Ultimately, the anticipated findings thus aim to provide first insights how distinct behavioural interventions can optimise exposure treatments for individual patients.

• DFG Programme: Research Grants