Iris M. Engelhard

Utrecht University | UU · Clinical Psychology

Panic disorder (PD) is a debilitating mental health condition, characterized by a preoccupation with the occurrence of panic attacks. Previous research has found that PD patients display increased fear generalization, which entails inflated fear responses to ambiguous stimuli (e.g., intermediate size circles) following fear conditioning wherein a n...

Exposure-based therapy for anxiety disorders involves confrontations with feared but innocuous stimuli to promote inhibitory safety learning and fear extinction. Little is known about factors that may impede generalization of fear extinction memory from stimuli used during exposure therapy to similar stimuli later encountered. Trait anxiety is a vu...

Contextual overgeneralization of emotional memory is a core aspect of anxiety disorders. Identifying methods to enhance contextual dependency of emotional memory is therefore of significant clinical interest. Animal research points to a promising approach: reexposure to the context in which fear is acquired reduces generalization to other contexts....

Negative anticipatory biases can affect the way we interpret and subjectively experience events. Through its role in emotion regulation, positive future thinking may provide an accessible way to attenuate these biases. However, it is unclear whether positive future thinking works ubiquitously, independent of contextual relevance. Here, we used a po...

Fear is an emotion triggered by the perception of danger and motivates safety behaviors. Within the context of the COVID-19 pandemic, there were ample danger cues (e.g., images of patients on ventilators) and a high need for people to use appropriate safety behaviors (e.g., social distancing). Given this central role of fear within the context of a...

Background Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization...

Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other. Obj...

Background and objectives Negative mental imagery appears to play a role in anxiety disorders and can involve aversive memories or anticipated future threats. Modulating aversive memories through imagery rescripting generally reduces negative memory appraisals and associated anxiety. This pre-registered two-day analog study investigated whether ima...

The authors regret to inform that an error was made in the data analysis syntax for the analyses reported in the referenced article. Particularly, we included the "Behavioral Inhibition Scale" (BIS) in this study and correlated the scores on this questionnaire to generalization gradients in a fear generalization paradigm. Accidentally, we used item...

Safety behaviors can prevent or minimize a feared outcome. However, in relatively safe situations, they may be less adaptive, presumably because people will misattribute safety to these behaviors. This research aimed to investigate whether safety behaviors in safe situations can lead to increased threat beliefs. In Study 1, we aimed to replicate a...

Background The use of oral contraceptives (OCs) has been associated with increased incidences of anxiety and depression, for which adolescents seem to be particularly vulnerable. Rather than looking at singular outcomes, we examined whether OC use is associated with depressive and anxiety symptom trajectories from early adolescence into early adult...

Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test...

Despite being considered a valid model for the etiology of anxiety disorders, the fear conditioning paradigm does not always show clear correlations with anxious personality traits that constitute risk factors for the development of anxiety disorders. This may in part due to error variance and the fact that fear conditioning studies are typically u...

Generalization of conditioned fear is adaptive in some situations but maladaptive when fear excessively generalizes to innocuous stimuli with incidental resemblance to a genuine threat cue. Recently, empirical interest in fear generalization as a transdiagnostic explanatory mechanism underlying anxiety-related disorders has accelerated. As there ar...

Objective Fatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological f...

Expectations have an important role in guiding behavior and the interpretation of novel information, but can contain negative biases such as is the case in anxiety disorders. Positive future thinking may provide an accessible way to attenuate these negatively biases. However, much is still unclear about the optimal form of such positive interventio...

Questionable research practices (QRPs), such as p-hacking (i.e., the inappropriate manipulation of data analysis to find statistical significance) and post hoc hypothesizing, are threats to the replicability of research findings. One key solution to the problem of QRPs is preregistration. This refers to time-stamped documentation that describes the...

A hallmark symptom of fear and anxiety disorder is generalization of fear to essentially innocuous stimuli and situations. Such generalization can occur through both perceptual and conceptually similarities. Recent studies indicate that perceptual generalization is inflated in anxiety patients and individuals prone to develop anxiety disorders, sug...

Dual-tasks (e.g., making horizontal eye-movements) while recollecting a memory are often used both in the lab and the clinic (such as in EMDR therapy) to attenuate emotional memories and intrusive mental images. According to working memory theory, dual-task interventions are effective because they limit cognitive resources available for the process...

Objective: Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative eva...

Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticip...

Research has demonstrated that disgust can be installed through classical conditioning by pairing neutral conditioned stimuli (CSs) with disgusting unconditioned stimuli (USs). Disgust has been argued to play an important role in maintaining fear-related disorders. This maintaining role may be explained by conditioned disgust being less sensitive t...

Background and objectives: For many psychotherapies, like Eye Movement and Desensitization Reprocessing (EMDR) therapy, there is an ongoing discussion about the role of specific versus non-specific mechanisms in their effectiveness However, experimental research directly examining the potential role of non-specific mechanisms is scarce. Here, we ad...

Background: Partners of burn survivors may develop posttraumatic stress disorder (PTSD) symptoms in response to the potential life threatening nature of the burn event and the burn survivor’s medical treatment. Objective: This longitudinal study examined the prevalence, course and potential predictors of partners’ PTSD symptoms up to 18 months post...

Trauma memories can appear dissociated from their original temporal context, and are often relived as they occur in the here-and-now. Potentially these temporal distortions already occur during encoding of the aversive experience as a consequence of stress. Here, 86 participants were subjected to either a stress or control induction, after which th...

Negative thoughts about future events are a central aspect of anxiety disorders. It is important to gain a deeper understanding of how these imagined events are retained over time when considering the impact of negative future thoughts on anxiety. Prior research indicates that emotional intensity fades faster for negative than positive memories in...

Purpose This study explored the individual trajectories of health-related quality of life (HRQL) compared to recalled pre-burn level of HRQL and investigated whether burn severity and post-traumatic stress disorder (PTSD) symptoms increase the risk of not returning to pre-burn level of HRQL. Methods Data were obtained from 309 adult patients with...

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants receive...

Background and Objectives In dual-tasking, individuals recall a threat-related memory while performing a demanding dual-task. This is a fruitful approach to reduce the unpleasantness and vividness of aversive memories and to reduce conditioned fear responses. Crucially, it remains unclear whether dual-tasking can also reduce conditioned fear respon...

Recent meta-analyses indicated differences in fear acquisition and extinction between patients with anxiety-related disorders and comparison subjects. However, these effects are small and may hold for only a subsample of patients. To investigate individual trajectories in fear acquisition and extinction across patients with anxiety-related disorder...

Recent research findings indicate that human fear conditioning is affected by instructions, particularly those concerning the contingency between the conditioned stimulus (CS) and the unconditioned stimulus (US). However, whether or not such instructions were provided to participants often remains unsaid in fear conditioning studies. In the current...

Background Partners of burn survivors may develop posttraumatic stress disorder (PTSD) symptoms in the aftermath of the burn event. This longitudinal study examined the prevalence, course and potential predictors of partners’ PTSD symptoms up to 18 months postburn.Methods Participants were 111 partners of adult burn survivors. In a multicenter stud...

Background and objectives Maladaptive avoidance is a core characteristic of anxiety-related disorders. Its reduction is often promoted using extinction with response prevention (ExRP) procedures, but these effects are often short-lived. Research has shown that pairing a feared stimulus with a stimulus of an incompatible valence (i.e., countercondit...

Omgaan met bezorgdheid en angst vanwege het coronavirus 'Bezorgdheid en angst zijn normale reacties op dreiging' 30 | NVLE magazine De overheid plaatst mensen met reu-matische aandoeningen in de hoog-risicogroep voor het coronavirus. Ze moeten meer dan anderen opletten door thuis te blijven, hygiënemaat-regelen in acht te nemen en mensen met koorts...

Background: As for many psychotherapies, there is ongoing discussion about the role of specific versus unspecific mechanisms in the effectiveness of Eye-Movement and Desensitization Reprocessing (EMDR) therapy for post-traumatic stress disorder. However, research directly examining the potential role of non-specific mechanisms in EMDR is scarce. O...

Pavlovian-to-Instrumental transfer (PIT) refers to the effect of stimuli that have been associated with a pleasant or aversive event to on instrumental behaviors. Given that Obsessive-Compulsive disorder (OCD) is linked to excessive compulsions, which in the laboratory can be tested via testing instrumental responses, we assessed PIT effects in ind...

There is a growing interest on how mental imagery may be involved in the onset and maintenance of anxiety-related disorders. Here, we used an experimental design to investigate whether a key symptom across anxiety-related disorders, namely avoidance, can be induced via mental imagery. Healthy participants first learned that one neutral stimulus (A)...

Fear is an adaptive response in the presence of danger. However, when threat is uncertain and continuous, as in the current coronavirus disease (COVID-19) pandemic, fear can become chronic and burdensome. To identify predictors of fear of the coronavirus, we conducted an online survey (N = 439) three days after the World Health Organization declare...

Fear is an adaptive response in the presence of danger. However, when threat is uncertain and continuous, as in the current coronavirus disease (COVID-19) pandemic, fear can become chronic and burdensome. To better understand predictors of fear of the coronavirus, we conducted an online survey (N = 439) between March 14 and 17, 2020, which started...

Background and objectives Eye Movement Desensitization and Reprocessing (EMDR) is a treatment for posttraumatic stress disorder. It uses a dual-task approach, in which patients recall an aversive memory while making lateral eye movements. Research has shown that this ‘eye movements’ intervention reduces subjective memory vividness and emotionality....

Persistent emotional memories and intrusive mental images can be weakened by executing a demanding dual-task during recollection of those images and memories. According to working memory (WM) theories, such dual-task interventions are effective because they limit the amount of cognitive resources available for the processing of emotional memories....

Human fear conditioning is often seen as the result of a highly automatic process that is independent of higher cognitive functions and verbal instructions. However, cumulative research findings call this view into question. In the current preregistered study (N = 102), we investigated whether the number of participants who successfully show condit...

There is an increased interest in how excessive avoidance can diminish. Avoidance reduction is typically tested by using Extinction with Response Prevention (ExRP) protocols, where feared stimuli are presented without any aversive outcome while avoidance is prevented. These e↵ects, however, often do not persist. Here, we tested whether pairing an a...

Since the seminal ‘Little Albert’ study by Watson and Rayner (1920), fear conditioning has become one of the most commonly used paradigms for studying the etiology of anxiety-related disorders. In a fear conditioning procedure, a (neutral) conditioned stimulus (CS) is paired with an aversive unconditioned stimulus (US), resulting in fear-related co...

Importance Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited. Objective This systematic review and meta-analysis aimed to assess the long-term outcomes after cognitive behavioral therapy (compared with care as usual, relaxation, psychoeducation, pill placebo, supportive the...

Whether fear conditioning can take place without contingency awareness is a topic of continuing debate and conflicting findings have been reported in the literature. This systematic review provides a critical assessment of the available evidence. Specifically, a search was conducted to identify articles reporting fear conditioning studies in which...

Background: various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers’ trauma-related emotions with posttraumatic str...

Clinical and laboratory studies have demonstrated that executing a demanding dual-task while recollecting emotional memories weakens the emotional intensity and vividness of these memories. While this approach is generally effective, there is room for improvement. According to multi-component working memory theories, the effectiveness of dual-tasks...

Many patients who benefit from exposure-based therapy for anxiety disorders fail to maintain their gains. Learned fear may return when they encounter phobic stimuli in a different context than the one in which extinction occurred. In the current preregistered experiment, we tested whether threat memory devaluation reduces context renewal of fear. A...

Data analysis in psychopathology research typically entails multiple stages of data preprocessing (e.g., coding of physiological measures), statistical decisions (e.g., inclusion of covariates), and reporting (e.g., selecting which variables best answer the research questions). The complexity and lack of transparency of these procedures have result...

Background and objectives: Approach-avoidance training (AAT) is a procedure for changing people's likes and dislikes that involves executing repeated approach (e.g., pulling a joystick towards yourself) and avoidance actions (e.g., pushing a joystick away from yourself) in response to target stimuli. Typically, this leads to approached stimuli bein...

Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents’ memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents’ (intrusive) memories and a...

Background and objectives. Pavlovian fear conditioning paradigms are valuable to investigate fear learning and the return of extinguished fear in the lab. However, their validity is limited, because the aversive stimuli (e.g., electric shocks) typically lack the modalities and complexity of real-world aversive experiences. To overcome this limitati...

Exposure-based treatment for anxiety disorders is effective for many patients, but relapse is not uncommon. One predictor of the return of fear is the negative valence of fear-relevant stimuli. The aim of the current experiments was to examine whether counterconditioning with positive film clips reduces this negative stimulus valence as well as the...

Whether fear conditioning can take place without awareness remains a topic of continuing debate. Some researchers have claimed that contingency awareness is not a requirement for conditioned fear acquisition, but others have questioned this claim. The current review critically integrates the available evidence with meta-analytic tools. Specifically...

A hallmark symptom of fear and anxiety disorder is generalization of fear to essentially innocuous stimuli and situations. Such generalization can occur through both perceptual and conceptually similarities. Recent studies indicate that perceptual generalization is inflated in anxiety patients and individuals prone to develop anxiety disorders, sug...

Background and Objectives: Several treatments are effective in reducing symptoms of post-traumatic stress disorder. We tested the effectiveness of an experimental intervention that consists of elements from two of these: virtual reality (VR) exposure therapy and eye movement desensitization and reprocessing. The latter is characterized by a dual-ta...

Background and objectives: A plethora of eye movement desensitization and reprocessing (EMDR) analogue studies has shown that, in the short term, making eye movements (EM) during brief imaginal exposure ("recall + EM") blurs memories more than just imaginal exposure ("recall only"). Yet, results of the few studies that included a follow-up test ar...

Avoidance towards innocuous cues is a key diagnostic criterion across anxiety-related disorders. Importantly, the most effective intervention for anxiety-related disorders, exposure therapy with response prevention, sometimes does not prevent the relapse of anxiety's symptomatology. We tested whether extinction effects, the experimental proxy of ex...

The purpose of this article is to review recent research that is relevant to three controversies concerning memory for trauma. First, we briefly review the debate about recovered memories of childhood sexual abuse, summarizing a third interpretation distinct from both the repression and false-memory accounts. Second, we address new findings related...

Excessive avoidance towards innocuous cues is a central diagnostic criterion across anxiety-related disorders. Relevant laboratory paradigms typically include instrumental learning procedures, where the presentation of an aversive cue (e.g., a shock) can be prevented by executing an experimenter-defined response (e.g., a button press) during the pr...

Background and objectives: Secondary extinction refers to the phenomenon that extinction of one conditioned stimulus (CS) results in the reduction of conditioned responses for other CSs conditioned with the same unconditioned stimulus (US). Previous research with rats has demonstrated that secondary extinction can interfere with the return of condi...

The fear conditioning paradigm is one of the most commonly used procedures to examine the etiology and treatment of anxiety disorders in laboratories. However, findings with this procedure often do not generalize to clinical settings. Virtual reality (VR) is a promising tool for improving the ecological and predictive validity of fear conditioning....