Translating Language-Emotion Interactions in Exposure Therapy

描述(由申请人提供)：这项研究的广泛目标是将语言-情感相互作用基础科学中取得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。治疗焦虑症最常见的行为疗法是反复暴露在令人恐惧的刺激下。尽管暴露疗法的有效性得到了证明，但它并不是完全有效的，因为它并不能惠及每一位患者，而且可能由于许多原因而无法减少恐惧反应。与恐惧消退类似，暴露疗法被认为是引起抑制性学习，而不是完全消除最初的恐惧学习，人类和动物的研究表明，在恐惧消退/暴露疗法之后，诱发恐惧的回归。因此，评估新的策略以提高重测时抑制性学习的可获得性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在暴露中增强抑制性学习的一种方式。两种特定类型的言语表达，标记和重新评估，已经被证明激活了前额叶皮质的区域，然后减弱了与杏仁核和自主神经激活相关的自动情感过程。因此，涉及言语的抑制通路可能会加强暴露治疗中的抑制过程，并更有效地减弱临床相关指标的恐惧反应。为此，提出了一项研究，以评估在暴露期间在害怕蜘蛛的样本中使用这些言语的方法。首先，本研究旨在评估使用可变编码的两种言语条件(标记和重新评估)相对于单独暴露条件和分心条件是否降低恐惧反应，从基线到立即重测和一周重测，跨越恐惧反应的自主神经(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，这项研究旨在评估重新评估是否比在这些指标上贴标签更全面地减少恐惧反应。第三，这项研究的目的是评估重测时的言语表达是否比重测时单独使用时减少恐惧反应，并且对于更长时间地维持减少恐惧是必要的。公共卫生相关性：这项研究旨在加速将有关语言-情感相互作用的基础科学发现转化为更有效的行为疗法，以治疗恐惧症和其他焦虑症。这些方法和发现可以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治疗中，从而产生重大影响。这项研究对理解恐惧和焦虑的过程以及言语改善长期健康的方式也有意义。

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.