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4 - Mechanisms of Fear Extinction: Toward Improved Treatment for Anxiety

Published online by Cambridge University Press:  27 July 2009

By
Mark Barad  and
Christopher K. Cain
Edited by
Laurence J. Kirmayer ,
Robert Lemelson  and
Mark Barad
Mark Barad
Affiliation:
Associate Professor Psychiatry and Behavioral Sciences, University of California, Los Angeles
Christopher K. Cain
Affiliation:
Postdoctoral Fellow Center for Neural Science, New York University
Laurence J. Kirmayer
Affiliation:
McGill University, Montréal
Robert Lemelson
Affiliation:
University of California, Los Angeles
Mark Barad
Affiliation:
University of California, Los Angeles
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Summary

INTRODUCTION

Extinction is the explicit model for the treatment of human anxiety disorders by behavior and cognitive behavior therapy (Craske, 1999). These therapies depend crucially on deliberate exposure to cues that generate fear or anxiety in patients in order to reduce gradually the amount of distress such cues cause when encountered during the course of the patient's usual activities, and they are extremely effective. They are also based directly on scientific studies of extinction. The first to use such a protocol for a human subject was Mary Cover Jones in 1924. Jones's successful treatment of little Peter, a two-year-old boy with phobias of rabbits, dogs, cats, stuffed animals, and even of shawls, was inspired by Pavlov's extinction of conditioned salivary responses in dogs (Jones, 1924). Later, Joseph Wolpe based his gradual desensitization method of behavior therapy on his own experiments on fear-conditioned cats (Wolpe, 1969). Wolpe's model of behavior therapy remains in active and successful use to this day.

Nevertheless, although behavior therapy is effective, it still suffers from the limitations of all forms of psychotherapy. That is, it is slow, it requires great effort from the patient and therapist, and it does not always work. Even when it does work, patients remain subject to relapses. These drawbacks are only intensified in the context of PTSD, which is notoriously difficult to treat (McFarlane, 1994).

Type
Chapter
Information
Understanding Trauma
Integrating Biological, Clinical, and Cultural Perspectives
 , pp. 78 - 97
Publisher: Cambridge University Press
Print publication year: 2007

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