Mechanisms of action in exposure-based treatments

Psychological treatments include a variety of mechanisms of action, i.e., mechanisms that drive therapeutic change during psychotherapy. Extinction learning, threat expectancy violation, facilitating fear-opponent action, or plausible rationales are all believed to be mechanisms involved in exposure therapy. In a combined approach of experimentally controlled and naturalistic clinical assessments, our lab aims to uncover the contribution of these mechanisms to therapeutic change. In line with our experimental work, we focus on fear extinction learning and fear-opponent action. To combine experimental and clinical approaches, we currently conduct a naturalistic exposure trials along with controlled laboratory and real-life assessments (e.g., Smartphone-based Ecological Momentary Assessment). Patients with anxiety disorders are treated at our Institute’s outpatient clinic by therapist who are trained and supervised by our group members (Andre Pittig, Kristina Dickhöver). Before, during, and after treatment, we closely track patients’ emotional states and behaviors in daily life. We also examine whether or not excessive habitual avoidance, threat discounting, or generalization of fear are pathogenic markers of anxiety disorders. Combined, we aim to improve treatment outcomes and understanding of what is necessary for individual treatment success (i.e., theranostic markers).

 

 

Exemplary publications:

Pittig, A., van den Berg, L., & Vervliet, B. (2016). The key role of extinction learning in anxiety disorders: Behavioral strategies to enhance exposure-based treatments. Current Opinion in Psychiatry, 29, 39-47. doi:10.1097/YCO.0000000000000220

*Heinig, I., *Pittig, A., Richter, J., Hummel, K., Alt, I., Dickhöver, K., ... & Wittchen, H.-U. (2017). Optimising exposure-based CBT for anxiety disorders via enhanced extinction: Design and methods of a multicentre randomised clinical trial. International Journal of Methods in Psychiatric Research, 2017, e1560. * shared first authorship.

Wieder, G., Heinig, I., Wittchen, H.U., & Pittig, A. (submitted). The effects of cognitive preparation on self-directed exposure and symptom reduction in CBT for panic disorder and agoraphobia.