Optimizing inhibitory learning during exposure therapy

Cognitive-behavioral treatments for chronic pain typically target pain-related fear -exposure in vivo is a common treatment focusing on disconfirming harm expectancy of feared movements. Exposure therapy is tailored on Pavlovian extinction; an alternative fear reduction technique that also alters stimulus valence is counterconditioning. We compared both procedures to reduce pain-related fear using a Voluntary Joystick Movement Paradigm.Participants were randomly allocated to the Counterconditioning or Extinction Group. During fear acquisition, moving the joystick in two directions (CS+) was followed by a painful electrocutaneous stimulus (pain-US), while moving the joystick in two other directions was not (CS-). During fear reduction, one CS+ was extinguished, but another CS+ was still followed by pain in the Extinction Group; in the Counterconditioning Group one CS+ was extinguished and followed by a monetary reward-US, and another CS+ was followed by both USs (pain-US and reward-US). Results indicate that counterconditioning effectively reducespain-related fear but that it does not produce deeper fear reduction than extinction. Adding a reward-US to a painful movement did neither attenuate fear nor the intensity/unpleasantness of the pain itself. Both procedures changed stimulus valence. We contend that changing the affective valence of feared movements might improve fear reduction and may prevent relapse.

Background: Trauma-focused treatments (TFTs) for patients with post-traumatic stress disorder (PTSD) are highly effective, yet underused by therapists.Objective: To describe a new way of implementing (adequate use of) TFTs, using a therapist rotation model in which one patient is treated by several therapists.Method: In this article, we will present two examples of working with therapist rotation teams in two treatment settings for TFT of PTSD patients. We explore the experiences with this model from both a therapist and a patient perspective.Results: Our findings were promising in that they suggested that this novel approach reduced the therapists’ fear of providing TFT to PTSD patients, increased perceived readiness for TFT, and decreased avoidance behaviour within TFT sessions, possibly leading to better implementation of TFT. In addition, the therapeutic relationship as rated by patients was good, even by patients with insecure attachment styles.Conclusions: We suggest that therapist rotation is a promising novel approach to improve implementation of TFT for PTSD.

No abstract