Translating Language-Emotion Interactions in Exposure Therapy

描述（由申请人提供）：本研究的广泛目标是将语言-情感相互作用基础科学的进展转化为恐惧症和其他焦虑症暴露疗法的创新和改进。焦虑症最常见的行为治疗需要反复暴露于恐惧的刺激。尽管暴露疗法的有效性得到了证明，但它并不是完全可靠的，因为它并不能使每个病人受益，而且可能由于许多原因而无法减少恐惧反应。类似于灭绝，暴露疗法被认为是唤起抑制性学习，而不是完全消除原始的恐惧学习，如人类和动物研究所示，诱导恐惧消退/暴露疗法后的恐惧回归。因此，评估新的策略，以提高获得或检索的抑制性学习在重新测试和保持长期的恐惧减少是至关重要的。基础行为科学和神经科学的进展表明，受控的语言处理可能是增强暴露中抑制性学习的一种方式。有两种特殊的语言表达方式，即标记和重新评价，被证明可以激活前额叶皮层的某些区域，然后这些区域会减弱与杏仁核和自主神经激活相关的自动情感过程。因此，涉及言语化的抑制途径可以增强暴露疗法中的抑制过程，并且更有效地减弱跨临床相关指数的恐惧反应。为此，提出了一项研究，以评估这些方法的verbalization暴露在蜘蛛恐惧的样本。首先，该研究旨在评估使用变量编码的两种语言化条件（标记、重新评价）是否相对于单独的焦虑条件和分心条件减少恐惧反应，从基线到立即重新测试和一周重新测试，跨越恐惧反应的自主（心率、皮肤电导）、自我报告（情感、认知）和行为（接近距离）指数。其次，该研究旨在评估重新评估是否比标记这些指标更全面地减少恐惧反应。第三，本研究的目的是评估是否言语化在重新测试减少恐惧反应相对于单独的恐惧在重新测试，是必要的，更长的时间维持恐惧减少。公共卫生相关性：这项研究旨在加速将有关语言-情感互动的基础科学发现转化为更有效的恐惧症和其他焦虑症行为治疗方法。这些方法和发现可能会产生重大影响，为临床医生和患者提供新的工具，直接将语言处理纳入暴露疗法。这项研究也对理解恐惧和焦虑的过程以及语言化改善长期健康的方式有影响。

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.