Translating Language-Emotion Interactions in Exposure Therapy

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DESCRIPTION (provided by applicant): The broad goal of this research is to translate advances made in the basic science of language-emotion interactions to innovations and improvements in exposure therapy for phobias and other anxiety disorders. The most common behavioral treatment for anxiety disorders entails repeated exposure to feared stimuli. Despite demonstrations of its effectiveness, exposure therapy is not full-proof, in that it does not benefit every patient and may fail to reduce fear responding for many reasons. Akin to extinction, exposure therapy is presumed to evoke inhibitory learning rather than a complete erasure of original fear learning, as indicated by human and animal research inducing return of fear following fear extinction/exposure therapy. As such, it is critical to evaluate novel strategies to enhance the access to or retrievability of inhibitory learning at re-test and maintain long-term fear reduction. Advances in basic behavioral science and neuroscience suggest that controlled verbal processing may be one way to enhance inhibitory learning in exposure. Two specific types of verbalization, labeling and reappraisal, have been shown to activate regions of the prefrontal cortex that then attenuate automatic affective processes associated with the amygdala and autonomic activation. Thus, an inhibitory pathway involving verbalization may enhance inhibitory processes in exposure therapy and more effectively attenuate fear responding across clinically-relevant indices. To this end,a study is proposed to evaluate these methods of verbalization during exposure within a spider-fearful sample. First, the study aims to evaluate whether two verbalization conditions (labeling, reappraisal) using variable encoding reduce fear responding relative to an exposure-alone condition and a distraction condition, from baseline to immediate re-test and one-week re-test, across autonomic (heart rate, skin conductance), self- report (affect, cognitions), and behavioral (approach distance) indices of fear responding. Second, the study aims to evaluate whether reappraisal more comprehensively reduces fear responding than labeling across these indices. Third, the study aims to evaluate whether verbalization at re-test reduces fear responding relative to exposure-alone at re-test, and is necessary for longer maintenance of fear reduction. PUBLIC HEALTH RELEVANCE: This study aims to hasten the translation of basic science discoveries regarding language-emotion interactions to more effective behavioral treatments for phobias and other anxiety disorders. The methods and findings could have a significant impact by providing new tools to clinicians and patients that directly incorporate verbal processing in exposure therapy. This research also has implications for understanding of fear and anxiety processes and ways in which verbalization improves long-term health.