Kristen G Benito1, Jason Machan2, Jennifer B Freeman1, Abbe M Garcia1, Michael Walther1, Hannah Frank3, Brianna Wellen4, Elyse Stewart5, Julie Edmunds6, Joshua Kemp1, Jeffrey Sapyta7, Martin Franklin8. 1. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University. 2. Lifespan Biostatistics Core, Lifespan Hospitals. 3. Department of Psychology, Temple University. 4. Department of Psychology, University of Utah. 5. Department of Psychology, State University of New York at Binghamton. 6. Massachusetts General Hospital, Harvard Medical School. 7. Department of Psychiatry and Behavioral Sciences, Duke University Medical School. 8. Perelman School of Medicine, University of Pennsylvania.
Abstract
OBJECTIVE: This study measured a variety of within-exposure fear changes and tested the relationship of each with treatment outcomes in exposure therapy. METHOD: We coded 459 videotaped exposure tasks from 111 participants in 3 clinical trials for pediatric obsessive-compulsive disorder (OCD; POTS trials). Within exposures, fear level was observed continuously and alongside exposure process. Fear change metrics of interest were selected for relevance to mechanistic theory. Fear decreases were classified by function; nonhabituation decreases were associated with observed nonlearning processes (e.g., avoidance), whereas habituation decreases appeared to result from an internal and indirect process. Outcomes were posttreatment change in symptom severity, global improvement, and treatment response. RESULTS:Greater cumulative habituation across treatment was associated with larger reductions in symptom severity, greater global improvement, and increased odds of treatment response. Fear activation, fear variability, and nonhabituation fear decreases did not predict any outcomes. Exploratory analyses examined fear changes during habituation and nonhabituation exposures; higher peak fear during nonhabituation exposures was associated with attenuated global improvement. CONCLUSIONS: Habituation is conceptually consistent with multiple mechanistic theories and should continue to be investigated as a practical marker of initial extinction learning and possible moderator of the relationship between fear activation and outcome. Results support the importance of functional and frequent fear measurement during exposures, and discussion considers implications of these findings for future studies aiming to understand learning during exposure and improve exposure delivery. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
RCT Entities:
OBJECTIVE: This study measured a variety of within-exposure fear changes and tested the relationship of each with treatment outcomes in exposure therapy. METHOD: We coded 459 videotaped exposure tasks from 111 participants in 3 clinical trials for pediatric obsessive-compulsive disorder (OCD; POTS trials). Within exposures, fear level was observed continuously and alongside exposure process. Fear change metrics of interest were selected for relevance to mechanistic theory. Fear decreases were classified by function; nonhabituation decreases were associated with observed nonlearning processes (e.g., avoidance), whereas habituation decreases appeared to result from an internal and indirect process. Outcomes were posttreatment change in symptom severity, global improvement, and treatment response. RESULTS: Greater cumulative habituation across treatment was associated with larger reductions in symptom severity, greater global improvement, and increased odds of treatment response. Fear activation, fear variability, and nonhabituation fear decreases did not predict any outcomes. Exploratory analyses examined fear changes during habituation and nonhabituation exposures; higher peak fear during nonhabituation exposures was associated with attenuated global improvement. CONCLUSIONS: Habituation is conceptually consistent with multiple mechanistic theories and should continue to be investigated as a practical marker of initial extinction learning and possible moderator of the relationship between fear activation and outcome. Results support the importance of functional and frequent fear measurement during exposures, and discussion considers implications of these findings for future studies aiming to understand learning during exposure and improve exposure delivery. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Authors: Martin E Franklin; Jeffrey Sapyta; Jennifer B Freeman; Muniya Khanna; Scott Compton; Daniel Almirall; Phoebe Moore; Molly Choate-Summers; Abbe Garcia; Aubrey L Edson; Edna B Foa; John S March Journal: JAMA Date: 2011-09-21 Impact factor: 56.272
Authors: L Scahill; M A Riddle; M McSwiggin-Hardin; S I Ort; R A King; W K Goodman; D Cicchetti; J F Leckman Journal: J Am Acad Child Adolesc Psychiatry Date: 1997-06 Impact factor: 8.829
Authors: N C R McLaughlin; D Strong; A Abrantes; S Garnaat; A Cerny; C O'Connell; R Fadok; C Spofford; S A Rasmussen; M R Milad; B D Greenberg Journal: Behav Brain Res Date: 2014-11-12 Impact factor: 3.332
Authors: Michael J Telch; Aleksandra K Bruchey; David Rosenfield; Adam R Cobb; Jasper Smits; Sandra Pahl; F Gonzalez-Lima Journal: Am J Psychiatry Date: 2014-10 Impact factor: 18.112
Authors: Kristen G Benito; Jason Machan; Jennifer B Freeman; Abbe M Garcia; Michael Walther; Hannah Frank; Brianna Wellen; Elyse Stewart; Julie Edmunds; Jeffrey Sapyta; Martin E Franklin Journal: Behav Ther Date: 2020-07-21
Authors: Stephen P H Whiteside; Leslie A Sim; Allison S Morrow; Wigdan H Farah; Daniel R Hilliker; M Hassan Murad; Zhen Wang Journal: Clin Child Fam Psychol Rev Date: 2020-03
Authors: Kristen G Benito; Jennifer Herren; Jennifer B Freeman; Abbe M Garcia; Paul Block; Elizabeth Cantor; Bruce F Chorpita; Brianna Wellen; Elyse Stewart; Christopher Georgiadis; Hannah Frank; Jason Machan Journal: Behav Ther Date: 2020-10-24