Therapies — 17 October 2012
Build safety learning into exposure therapy

Safety learning paired with repeated exposure to fear producing stimuli increases the effectiveness of therapies used to combat fears and anxiety disorders, says a visiting international expert.

Repeated exposure to fear stimuli may be best practice, but around half of anxiety disorder patients don’t respond, according to Professor Michelle Craske, Professor of Psychology and Psychiatry and Biobehavioural Sciences at the University of California.

Modifying exposure therapy with safety learning may prove more effective by fostering an individual’s ability to lay down new safety memories that override fear memories, said Professor Craske, who presented her paper at the 47th Australian Psychological Society Annual Conference in Perth.

“It’s about learning to recognise that objects that used to be threatening are no longer threatening or objects that are associated with something threatening are themselves not actually threatening,”
she told Psychiatry Update.

“The problem is that individuals with anxiety have deficits in that kind of learning and that might be the very reason that they have anxiety in the first place. They’re not inhibiting their fear cues to
things in their environment”.

The question becomes, “how do we design exposure to help overcome that deficit in inhibitory learning?”

Professor Craske and her colleagues are focused on fear reduction in the long term.

“Sometimes the methods that we use elicit more fear in the short term but the end goal is to reduce fear in the long term,” she said.

Professor Craske’s research supports a paradigm shift from thinking in terms of fear reduction through exposure therapy as a primary measure of successful outcomes to enhancing safety learning independent of fear reduction.

“The difficulty is patients come in wanting to get rid of their fear and therapists want to get rid of their fear and what we’re saying is fear reduction in the moment doesn’t help you in the long term.”

As first appeared in Psychiatry Update

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