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

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Publisher: Elsevier Science Publishers
Document Type: Brief article
Length: 371 words

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Highlights * Scientific updates on neural and behavioral features that support inhibitory retrieval model of extinction. * Application of inhibitory retrieval model to exposure therapy. * Associative network, exposure planning and exposure therapy worksheets. * Case vignettes. 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). Author Affiliation: (a) Department of Psychology, University of California, Los Angeles, CA, United States (b) Department of Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States (c) California Institute of Technology, Division of Humanities and Social Sciences, 1200 E. California Blvd, MC 228-77, Pasadena, CA, 91125, United States (d) Laboratory for Biological Psychology, Faculty of Psychology and Educational Sciences, KU, Leuven, Belgium (e) Leuven Brain Institute, KU, Leuven, Belgium * Corresponding author. University of California Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, 90095-1563, United States. Article History: Received 4 June 2021; Revised 12 January 2022; Accepted 24 February 2022 (footnote)1 co-first author. Byline: Michelle G. Craske [mcraske@mednet.ucla.edu] (a,b,1,*), Michael Treanor (a,1), Tomislav D. Zbozinek (c), Bram Vervliet (d,e)

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Gale Document Number: GALE|A699667855