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Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus

Craske, Michelle G. and Treanor, Michael and Zbozinek, Tomislav D. and Vervliet, Bram (2022) Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus. Behaviour Research and Therapy, 152 . Art. No. 104069. ISSN 0005-7967. doi:10.1016/j.brat.2022.104069. https://resolver.caltech.edu/CaltechAUTHORS:20220318-999075000

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Abstract

Research from recent decades has highlighted the distinction between excitatory and inhibitory Pavlovian learning mechanisms. Based on this distinction, state-of-the-art exposure therapy for anxiety disorders emphasizes inhibitory learning and retrieval as its primary mechanism for long-term reduction in fear, anxiety, and avoidance. Seven years ago, we (Craske, et al., 2014) summarized exposure therapy from an inhibitory learning approach, focusing on eight exposure optimization strategies. Here, we update this model based on recent work and describe how to conduct exposure therapy from an inhibitory retrieval approach and encourage further empirical investigation of its basic premises. To this end, we guide the reader in the use of the OptEx Nexus: a clinician's tool for conducting exposure therapy from an inhibitory retrieval approach. We categorize exposure strategies as fundamental (expectancy violation, attention to feared stimulus/situation, removal of safety signals, and mental rehearsal after exposure), advanced (deepened extinction, occasional reinforced extinction), and promoting generalization of learning (retrieval cues, multiple contexts, stimulus variability, positive affect). We additionally discuss extinction learning with distal future feared outcomes, the role of avoidance, and alternative models/approaches to exposure therapy, including counterconditioning, novelty-enhanced extinction, latent cause models, and reconsolidation. Lastly, we illustrate clinical implementation via vignettes of exposure therapy from an inhibitory retrieval approach (see Supplemental materials).


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.1016/j.brat.2022.104069DOIArticle
ORCID:
AuthorORCID
Craske, Michelle G.0000-0002-3704-5240
Zbozinek, Tomislav D.0000-0003-0187-671X
Vervliet, Bram0000-0002-5904-4257
Additional Information:© 2022 Elsevier Ltd. Received 4 June 2021, Revised 12 January 2022, Accepted 24 February 2022, Available online 15 March 2022. Credit author statement: Michelle G. Craske: Conceptualization, Writing-Original draft preparation, Writing-Review and Editing Michael Treanor.: Conceptualization, Writing-Original draft preparation, Writing-Review and Editing Tomislav D. Zbozinek: Conceptualization, Writing-Original draft preparation, Writing-Review and Editing Bram Vervliet: Conceptualization, Writing-Original draft preparation, Writing-Review and Editing. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
DOI:10.1016/j.brat.2022.104069
Record Number:CaltechAUTHORS:20220318-999075000
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20220318-999075000
Official Citation:Michelle G. Craske, Michael Treanor, Tomislav D. Zbozinek, Bram Vervliet, Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus, Behaviour Research and Therapy, Volume 152, 2022, 104069, ISSN 0005-7967, https://doi.org/10.1016/j.brat.2022.104069.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:113971
Collection:CaltechAUTHORS
Deposited By: George Porter
Deposited On:21 Mar 2022 15:40
Last Modified:28 Mar 2022 21:28

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