Predicting return of fear following exposure therapy with an implicit measure of attitudes

Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210-1222, USA. Electronic address: .
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2012; 50(12):767-774. DOI: 10.1016/j.brat.2012.08.007
Source: PubMed


We sought to advance understanding of the processes underlying the efficacy of exposure therapy and particularly the phenomenon of return of fear (ROF) following treatment by drawing on a social psychological view of phobias as attitudes. Specifically, a dual process theory of attitude-related behavior predicts that a positive response to exposure therapy may reflect change in either the automatic (the attitude representation itself) or controlled (skills and confidence at coping with the fear) responses to the phobic stimulus, or both. However, if the attitude representation remains negative following treatment, ROF should be more likely. We tested this hypothesis in a clinical sample of individuals with public speaking phobia using a single-session exposure therapy protocol previously shown to be efficacious but also associated with some ROF. Consistent with predictions, a post-treatment implicit measure of attitudes toward public speaking (the Personalized Implicit Association Test [PIAT]) predicted ROF at 1-month follow-up. These results suggest that change in the automatically activated attitude toward the phobic stimulus is an important goal of exposure therapy and that an implicit measure like the PIAT can provide a useful measure of such change by which to gauge the adequacy of exposure treatment and predict its long-term efficacy.

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    • "In conclusion, the present study suggests that CS+ valence at the end of extinction is a reliable and robust predictor of CS+ fear at reinstatement. Vasey et al. (2012) demonstrated this effect in a clinical setting, which has implications for predicting and preventing relapse after treatment. Future studies would benefit both the basic scientific fear conditioning literature and CS+ Valence and Reinstatement 20 clinical anxiety literature by further elucidating this relationship and investigating methods of increasing the positive valence of the CS+ at the end of extinction. "
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    • "Another important domain of dyscontrol consists of relapse after treatment. Early work has shown that automatic attentional biases predict treatment outcome for alcohol (Cox et al., 2002), and other drugs (Waters et al., 2003) but little research has used an implicit measure of associations (Marhe et al., 2013; Ostafin and Palfai, 2012; for an example with fear, see Vasey et al., 2012). The findings from the present study indicate that the IAT holds promise for addressing such clinically relevant questions. "
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    • "The clinical implication is that, if left untreated, the return of fear through reinstatement is very likely to spread out and trigger a full-blown relapse. Accordingly, a clinical study found that unextinguished negative valence at posttreatment predicted individual levels of return of fear (Vasey et al. 2012). "
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