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Extinction Verhaltenstherapie Beispiel Essay

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With these resources in hand, we work diligently to develop high quality graphics for converters, multinational brands, and CPCs. Our plates are the best tool available – anywhere – to reproduce graphics on corrugated containers and displays. We ensure the fidelity of graphics reproduction and consistently deliver the reliability companies need to communicate their messages and bolster and protect brand identity in the marketplace.

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Utilizing the most advanced digital imaging technology available, VT Graphics produces large format (52” x 80”) optimized flat-top dot digital plates allowing broader tonal range reproduction, softer transitions in the highlights and reduced fluting when printing on combined board. Conventional analog imaging is also available in support of liquid/modified in-position plate requirements. These state-of-the-art technologies produce the highest level of graphic reproduction while reducing flow times and cost.

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Der vorliegende Übersichtsartikel belegt zunächst, warum das Extinktionslernen als ein zentraler Wirkmechanismus der Expositionsbehandlung angesehen wird. Nach Darstellung der lerntheoretischen Grundlagen wird ein Modell präsentiert, das die Grundlagen der Ausformung, Konsolidierung und des Abrufs des Extinktionsgedächtnisses beschreibt. Dieses Gedächtnismodell der Extinktion liefert die Basis für die Diskussion der aktuellen neurowissenschaftlichen Erkenntnisse zum Extinktionslernen. Durch diese Befunde im Tier-, aber auch im Humanbereich ist es gelungen, die neuronalen Schaltkreise der Extinktion relativ gut zu beschreiben. Der Übersichtsartikel gibt eine Zusammenfassung dieser aktuellen Befunde und geht außerdem auf einige Neurotransmittersysteme dieser Schaltkreise ein, zumindest in dem Maße, wie sie für die Befunde zur pharmakologischen Unterstützung des Extinktionslernens relevant sind. Anschließend wird ein integratives Modell vorgestellt, das den Ausgangspunkt für die Optimierung der Extinktion in der Expositionstherapie liefert. Den Abschluss bildet eine Kasuistik, in der diese Optimierungsstrategien nochmals am Beispiel der Behandlung einer Patientin mit Emetophobie für die Praxis verdeutlicht werden.

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Literatur

  1. Bouton ME: Conditioning, remembering, and forgetting. J Exp Psychol Anim Behav Process 1994;20:219-231.
  2. Bouton ME, García-Gutiérrez A, Zilski J, Moody EW: Extinction in multiple contexts does not necessarily make extinction less vulnerable to relapse. Behav Res Ther 2006;44:983-994.
  3. Bouton ME, King DA: Contextual control of the extinction of conditioned fear: tests for the associative value of the context. J Exp Psychol Anim Behav Process 1983;9:248-265.
  4. Choy Y, Fyer AJ, Lipsitz JD: Treatment of specific phobia in adults. Clin Psychol Rev 2007;27:266-286.
  5. Corcoran KA, Desmond TJ, Frey KA, Maren S: Hippocampal inactivation disrupts the acquisition and contextual encoding of fear extinction. J Neurosci 2005;25:8978-8987.
  6. Craske MG: Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. Verhaltenstherapie 2015;25:134-143.
  7. Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A: Optimizing inhibitory learning during exposure therapy. Behav Res Ther 2008;46:5-27.
  8. Craske MG, Mystkowski JL: Exposure therapy and extinction: clinical studies; in Craske MG, Hermans D, Vansteenwegen D (eds): Fear and Learning: Basic Science to Clinical Application. Washington DC, APA Books, 2006, pp 217-233.
  9. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B: Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 2014;58:10-23.
  10. Davis M, Ressler K, Rothbaum BO, Richardson R: Effects of D-cycloserine on extinction: translation from preclinical to clinical work. Biol Psychiatry 2006;60:369-375.
  11. Grey SJ, Rachman S, Sartory G: Return of fear: the role of inhibition. Behav Res Ther 1981;19:135-143.
  12. Guastella AJ, Richardson R, Lovibond PF, Rapee RM, Gaston JE, Mitchell P, et al: A randomized controlled trial of D-cycloserine enhancement of exposure therapy for social anxiety disorder. Biol Psychiatry 2008;63:544-549.
  13. Hamm AO: Furcht und Phobien. Göttingen, Hogrefe, 1997.
  14. Hamm AO: Specific phobias: assessment and treatment; in Emmelkamp PMG, Ehring T (eds): The Wiley Handbook of Anxiety Disorders, vol II. Chichester, Wiley-Blackwell, 2014, pp 897-923.
  15. Herry C, Ciocchi S, Senn V, Demmou L, Müller C, Lüthi A: Switching on and off fear by distinct neuronal circuits. Nature 2008;454:600-606.
  16. Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, et al: Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Arch Gen Psychiatry 2006;63:298-304.
  17. Ji J, Maren S: Hippocampal involvement in contextual modulation of fear extinction. Hippocampus 2007;17:749-758.
  18. Kalisch R, Korenfeld E, Stephan KE, Weiskopf N, Seymour B, Dolan RJ: Context-dependent human extinction memory is mediated by a ventromedial prefrontal and hippocampal network. J Neurosci 2006;26:9503-9511.
  19. Kushner MG, Kim SW, Donahue C, Thuras P, Adson D, Kotlyar M, et al: D-Cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry 2007;62:835-838.
  20. Lader MH, Mathews AM: A physiological model of phobic anxiety and desensitization. Behav Res Ther 1968;6:411-421.
  21. Lang PJ: A bio-informational theory of emotional imagery. Psychophysiology 1979;16:495-512.
  22. Lang PJ: The motivational organization of emotion: affect-reflex connections; in Van Goozen S, Van de Poll NE, Sergeant JA (eds): Emotions: Essays of Current Issues in the Field of Emotion Theory. Hillsdale, Erlbaum, 1994, pp 61-93.
  23. Lee JLC, Milton AL, Everitt BJ: Reconsolidation and extinction of conditioned fear: inhibition and potentiation. J Neurosci 2006;26:10051-10056.
  24. Lindner K, Neubert J, Pfannmöller J, Lotze M, Hamm AO, Wendt J: Fear-potentiated startle processing in humans: parallel fMRI and orbicularis EMG assessment during cue conditioning and extinction. Int J Psychophysiol 2015;98:535-545.
  25. Lovibond PF, Shanks DR: The role of awareness in Pavlovian conditioning: empirical evidence and theoretical implications. J Exp Psychol Anim Behav Process 2002;28:3-26.
  26. Milad MR, Quirk GJ: Fear extinction as a model for translational neuroscience: ten years of progress. Annu Rev Psychol 2012;63:129-151.
  27. Milad MR, Wright CI, Orr SP, Pitman RK, Quirk GJ, Rauch SL: Recall of fear extinction in humans activates the ventromedial prefrontal cortex and hippocampus in concert. Biol Psychiatry 2007;62:446-454.
  28. Mohr C, Schneider S: Zur Rolle der Exposition bei der Therapie von Angststörungen. Verhaltenstherapie 2015;25:32-39.
  29. Morgan MA, Romanski LM, LeDoux JE: Extinction of emotional learning: contribution of medial prefrontal cortex. Neurosci Lett 1993;163:109-113.
  30. Myers KM, Carlezon WA, Davis M: Glutamate receptors in extinction and extinction-based therapies for psychiatric illness. Neuropsychopharmacology 2011;36:274-293.
  31. Otto MW, Tolin DF, Simon NM, Pearlson GD, Basden S, Meunier SA, et al: Efficacy of D-cycloserine for enhancing response to cognitive-behavior therapy for panic disorder. Biol Psychiatry 2010;67:365-370.
  32. Pavlov IP: Conditioned Reflexes. Oxford, Oxford University Press, 1927.
  33. Phelps EA, Delgado MR, Nearing KI, LeDoux JE: Extinction learning in humans: role of the amygdala and vmPFC. Neuron 2004;43:897-905.
  34. Quirk GJ, Garcia R, González-Lima F: Prefrontal mechanisms in extinction of conditioned fear. Biol Psychiatry 2006;60:337-343.
  35. Quirk GJ, Mueller D: Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology 2008;33:56-72.
  36. Rescorla RA, Wagner AR: A theory of Pavlovian conditioning: variations in the effectiveness of reinforcement and nonreinforcement; in Black AH, Prokasy WF (eds): Classical Conditioning II, Current Research and Theory. New York, Appleton-Century-Crofts, 1972, pp 64-99.
  37. Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, et al: Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 2004;61:1136-1144.
  38. Ruhmland M, Margraf J: Effektivität psychologischer Therapien von spezifischer Phobie und Zwangsstörung: Meta-Analysen auf Störungsebene. Verhaltenstherapie 2001;11:14-26.
  39. Singewald N, Schmuckermair C, Whittle N, Holmes A, Ressler KJ: Pharmacology of cognitive enhancers for exposure-based therapy of fear, anxiety and trauma-related disorders. Pharmacol Ther 2015;149:150-190.
  40. Storch EA, Merlo LJ, Bengtson M, Murphy TK, Lewis MH, Yang MC, et al: D-Cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder. Int Clin Psychopharmacol 2007;22:230-237.
  41. Vertes RP: Differential projections of the infralimbic and prelimbic cortex in the rat. Synapse 2004;51:32-58.
  42. Vervliet B, Craske MG, Hermans D: Fear extinction and relapse: state of the art. Annu Rev Clin Psychol 2013;9:215-248.
  43. Walker DL, Ressler KJ, Lu K-T, Davis M: Facilitation of conditioned fear extinction by systemic administration or intra-amygdala infusions of D-cycloserine as assessed with fear-potentiated startle in rats. J Neurosci 2002;22:2343-2351.
  44. Watson JP, Gaind R, Marks IM: Physiological habituation to continuous phobic stimulation. Behav Res Ther 1972;10:269-278.
  45. Wendt J, Schmidt LE, Lotze M, Hamm AO: Mechanisms of change: effects of repetitive exposure to feared stimuli on the brain's fear network. Psychophysiology 2012;49:1319-1329.
  46. Wilhelm S, Buhlmann U, Tolin DF, Meunier SA, Pearlson GD, Reese HE, et al: Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder. Am J Psychiatry 2008;165:335-341.
  47. Wolitzky-Taylor KB, Horowitz JD, Powers MB, Telch MJ: Psychological approaches in the treatment of specific phobias: a meta-analysis. Clin Psychol Rev 2008;28:1021-1037.
  48. Wolpe J: Psychotherapy by Reciprocal Inhibition. Stanford, Stanford University Press, 1958.

Article / Publication Details

Published online: February 14, 2017
Issue release date: February 2017

Number of Print Pages: 11
Number of Figures: 5
Number of Tables: 0

ISSN: 1016-6262 (Print)
eISSN: 1423-0402 (Online)

For additional information: https://www.karger.com/VER

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References

  1. Bouton ME: Conditioning, remembering, and forgetting. J Exp Psychol Anim Behav Process 1994;20:219-231.
  2. Bouton ME, García-Gutiérrez A, Zilski J, Moody EW: Extinction in multiple contexts does not necessarily make extinction less vulnerable to relapse. Behav Res Ther 2006;44:983-994.
  3. Bouton ME, King DA: Contextual control of the extinction of conditioned fear: tests for the associative value of the context. J Exp Psychol Anim Behav Process 1983;9:248-265.
  4. Choy Y, Fyer AJ, Lipsitz JD: Treatment of specific phobia in adults. Clin Psychol Rev 2007;27:266-286.
  5. Corcoran KA, Desmond TJ, Frey KA, Maren S: Hippocampal inactivation disrupts the acquisition and contextual encoding of fear extinction. J Neurosci 2005;25:8978-8987.
  6. Craske MG: Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. Verhaltenstherapie 2015;25:134-143.
  7. Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A: Optimizing inhibitory learning during exposure therapy. Behav Res Ther 2008;46:5-27.
  8. Craske MG, Mystkowski JL: Exposure therapy and extinction: clinical studies; in Craske MG, Hermans D, Vansteenwegen D (eds): Fear and Learning: Basic Science to Clinical Application. Washington DC, APA Books, 2006, pp 217-233.
  9. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B: Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 2014;58:10-23.
  10. Davis M, Ressler K, Rothbaum BO, Richardson R: Effects of D-cycloserine on extinction: translation from preclinical to clinical work. Biol Psychiatry 2006;60:369-375.
  11. Grey SJ, Rachman S, Sartory G: Return of fear: the role of inhibition. Behav Res Ther 1981;19:135-143.
  12. Guastella AJ, Richardson R, Lovibond PF, Rapee RM, Gaston JE, Mitchell P, et al: A randomized controlled trial of D-cycloserine enhancement of exposure therapy for social anxiety disorder. Biol Psychiatry 2008;63:544-549.
  13. Hamm AO: Furcht und Phobien. Göttingen, Hogrefe, 1997.
  14. Hamm AO: Specific phobias: assessment and treatment; in Emmelkamp PMG, Ehring T (eds): The Wiley Handbook of Anxiety Disorders, vol II. Chichester, Wiley-Blackwell, 2014, pp 897-923.
  15. Herry C, Ciocchi S, Senn V, Demmou L, Müller C, Lüthi A: Switching on and off fear by distinct neuronal circuits. Nature 2008;454:600-606.
  16. Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, et al: Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. Arch Gen Psychiatry 2006;63:298-304.
  17. Ji J, Maren S: Hippocampal involvement in contextual modulation of fear extinction. Hippocampus 2007;17:749-758.
  18. Kalisch R, Korenfeld E, Stephan KE, Weiskopf N, Seymour B, Dolan RJ: Context-dependent human extinction memory is mediated by a ventromedial prefrontal and hippocampal network. J Neurosci 2006;26:9503-9511.
  19. Kushner MG, Kim SW, Donahue C, Thuras P, Adson D, Kotlyar M, et al: D-Cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry 2007;62:835-838.
  20. Lader MH, Mathews AM: A physiological model of phobic anxiety and desensitization. Behav Res Ther 1968;6:411-421.
  21. Lang PJ: A bio-informational theory of emotional imagery. Psychophysiology 1979;16:495-512.
  22. Lang PJ: The motivational organization of emotion: affect-reflex connections; in Van Goozen S, Van de Poll NE, Sergeant JA (eds): Emotions: Essays of Current Issues in the Field of Emotion Theory. Hillsdale, Erlbaum, 1994, pp 61-93.
  23. Lee JLC, Milton AL, Everitt BJ: Reconsolidation and extinction of conditioned fear: inhibition and potentiation. J Neurosci 2006;26:10051-10056.
  24. Lindner K, Neubert J, Pfannmöller J, Lotze M, Hamm AO, Wendt J: Fear-potentiated startle processing in humans: parallel fMRI and orbicularis EMG assessment during cue conditioning and extinction. Int J Psychophysiol 2015;98:535-545.
  25. Lovibond PF, Shanks DR: The role of awareness in Pavlovian conditioning: empirical evidence and theoretical implications. J Exp Psychol Anim Behav Process 2002;28:3-26.
  26. Milad MR, Quirk GJ: Fear extinction as a model for translational neuroscience: ten years of progress. Annu Rev Psychol 2012;63:129-151.
  27. Milad MR, Wright CI, Orr SP, Pitman RK, Quirk GJ, Rauch SL: Recall of fear extinction in humans activates the ventromedial prefrontal cortex and hippocampus in concert. Biol Psychiatry 2007;62:446-454.
  28. Mohr C, Schneider S: Zur Rolle der Exposition bei der Therapie von Angststörungen. Verhaltenstherapie 2015;25:32-39.
  29. Morgan MA, Romanski LM, LeDoux JE: Extinction of emotional learning: contribution of medial prefrontal cortex. Neurosci Lett 1993;163:109-113.
  30. Myers KM, Carlezon WA, Davis M: Glutamate receptors in extinction and extinction-based therapies for psychiatric illness. Neuropsychopharmacology 2011;36:274-293.
  31. Otto MW, Tolin DF, Simon NM, Pearlson GD, Basden S, Meunier SA, et al: Efficacy of D-cycloserine for enhancing response to cognitive-behavior therapy for panic disorder. Biol Psychiatry 2010;67:365-370.
  32. Pavlov IP: Conditioned Reflexes. Oxford, Oxford University Press, 1927.
  33. Phelps EA, Delgado MR, Nearing KI, LeDoux JE: Extinction learning in humans: role of the amygdala and vmPFC. Neuron 2004;43:897-905.
  34. Quirk GJ, Garcia R, González-Lima F: Prefrontal mechanisms in extinction of conditioned fear. Biol Psychiatry 2006;60:337-343.
  35. Quirk GJ, Mueller D: Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology 2008;33:56-72.
  36. Rescorla RA, Wagner AR: A theory of Pavlovian conditioning: variations in the effectiveness of reinforcement and nonreinforcement; in Black AH, Prokasy WF (eds): Classical Conditioning II, Current Research and Theory. New York, Appleton-Century-Crofts, 1972, pp 64-99.
  37. Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, et al: Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 2004;61:1136-1144.
  38. Ruhmland M, Margraf J: Effektivität psychologischer Therapien von spezifischer Phobie und Zwangsstörung: Meta-Analysen auf Störungsebene. Verhaltenstherapie 2001;11:14-26.
  39. Singewald N, Schmuckermair C, Whittle N, Holmes A, Ressler KJ: Pharmacology of cognitive enhancers for exposure-based therapy of fear, anxiety and trauma-related disorders. Pharmacol Ther 2015;149:150-190.
  40. Storch EA, Merlo LJ, Bengtson M, Murphy TK, Lewis MH, Yang MC, et al: D-Cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder. Int Clin Psychopharmacol 2007;22:230-237.
  41. Vertes RP: Differential projections of the infralimbic and prelimbic cortex in the rat. Synapse 2004;51:32-58.
  42. Vervliet B, Craske MG, Hermans D: Fear extinction and relapse: state of the art. Annu Rev Clin Psychol 2013;9:215-248.
  43. Walker DL, Ressler KJ, Lu K-T, Davis M: Facilitation of conditioned fear extinction by systemic administration or intra-amygdala infusions of D-cycloserine as assessed with fear-potentiated startle in rats. J Neurosci 2002;22:2343-2351.
  44. Watson JP, Gaind R, Marks IM: Physiological habituation to continuous phobic stimulation. Behav Res Ther 1972;10:269-278.
  45. Wendt J, Schmidt LE, Lotze M, Hamm AO: Mechanisms of change: effects of repetitive exposure to feared stimuli on the brain's fear network. Psychophysiology 2012;49:1319-1329.
  46. Wilhelm S, Buhlmann U, Tolin DF, Meunier SA, Pearlson GD, Reese HE, et al: Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder. Am J Psychiatry 2008;165:335-341.
  47. Wolitzky-Taylor KB, Horowitz JD, Powers MB, Telch MJ: Psychological approaches in the treatment of specific phobias: a meta-analysis. Clin Psychol Rev 2008;28:1021-1037.
  48. Wolpe J: Psychotherapy by Reciprocal Inhibition. Stanford, Stanford University Press, 1958.

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