Published by Elsevier Ltd.
Invited Essay
Optimizing inhibitory learning during exposure therapy
Received 3 August 2007;
References and further reading may be available for this article. To view references and further reading you must purchase this article.
Abstract
Prevailing models of exposure therapy for phobias and anxiety disorders construe level of fear throughout exposure trials as an index of corrective learning. However, the evidence, reviewed herein, indicates that neither the degree by which fear reduces nor the ending fear level predict therapeutic outcome. Developments in the theory and science of fear extinction, and learning and memory, indicate that ‘performance during training’ is not commensurate with learning at the process level. Inhibitory learning is recognized as being central to extinction and access to secondary inhibitory associations is subject to influences such as context and time, rather than fear during extinction training. Strategies for enhancing inhibitory learning, and its retrieval over time and context, are reviewed along with their clinical implications for exposure therapy and directions for future research.
Keywords: Fears; Phobias; Exposure; Extinction; Habituation; Inhibitory learning
Article Outline
- Introduction
- Emotional processing theory
- Fear activation, within-session and between-session habituation as indices of learning
- New directions for optimizing learning
- Fear expression versus fear learning
- Fear reduction versus fear toleration
- Self-efficacy versus illusion of competency
- New directions
- Development of non-threat associations
- Mismatch with expectancies
- Multiple conditioned excitors
- Wean safety signals and safety behaviors
- Cognitive enhancers: d-cycloserine
- Enhancing inhibitory regulation
- Enhancing accessibility and retrievability of exposure-based learning
- Variability throughout exposure
- Spacing of exposure trials
- Offsetting context renewal and re-instatement effects
- Conclusions
- Acknowledgements
- References






E-mail Article
Add to my Quick Links

Cited By in Scopus (0)






