PDF(Pubmed)
Abstract：
Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven\'t been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.
摘要：
面对你的恐惧，或者暴露疗法，是焦虑症的有效心理干预，通常被认为通过恐惧灭绝学习起作用。恐惧灭绝学习是一种联想学习，在没有厌恶结果的情况下，通过反复遇到恐惧的情况或刺激来减少恐惧。实验室研究表明，恐惧灭绝学习是由威胁预测错误驱动的，定义为恐惧的预测不会最终发生。在实际治疗环境中，威胁预测误差及其与暴露治疗结果的关系尚未得到足够的研究。目前尚不清楚预测误差和灭绝学习是否是暴露疗法的核心机制。我们正在进行一项纵向和观察性研究，研究社交焦虑症（SAD）治疗中暴露期间的威胁预测误差如何与每个会话的症状变化和治疗结果相关，以及暴露惊喜和学习结果。我们的目标是通过门诊心理诊所招募65名初步诊断为SAD的成年人。参与者将接受12次个人手动认知行为疗法（CBT），改编自有效的小组协议，包括分级曝光。曝光过程，包括焦虑的自我报告测量，威胁预测,威胁结果,惊喜,和学习成果，将通过治疗期间完成的所有行为实验的基于智能手机的事件应急生态瞬时评估（EMA）进行测量。临床结果包括自我报告的社交焦虑症状和社会威胁评估，在每次会议上，治疗后和治疗后3个月。预测误差将被操作为威胁预测和威胁结果之间的不匹配。威胁预测和威胁结果对会话症状变化的共同影响，治疗结果,曝光惊喜,学习结果将使用多层次建模进行探索。本研究将有助于确定SAD治疗暴露期间的威胁预测误差是否与理论上暗示的临床结果有关。这将有助于阐明暴露治疗机制的更大研究目标。
