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Reactivation and Evaluation of Mastery Experiences Promotes Exposure Benefit in Height Phobia

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Abstract

The retrieval of personal mastery experiences has been linked to adaptive functions, such as increased perceived self-efficacy and coping capability. Successful exposure leads to an increased mastery experience with respect to anxiety provoking situations, possibly due to a violation of expected negative outcomes. We investigated whether the reactivation and evaluation of mastery experiences after a brief virtual reality exposure (VRE) training can enhance self-efficacy and promote exposure therapy benefit in patients with acrophobia. Acrophobic participants (N = 56) were randomly assigned to a memory reactivation and evaluation (= VRE–MRE) intervention, a control (= memory reactivation; VRE–MR), or no intervention (= VRE) after VRE. The VRE–MRE condition involved the evaluation of mastery experiences associated with exposure and related events from the past. The effects of the VRE–MRE intervention were assessed on the level of behavioral avoidance and subjective fear at post-treatment and one-month follow-up. Relative to both the VRE–MR and VRE conditions, the VRE–MRE group showed an increase in self-efficacy and exhibited more pronounced reductions in behavioral avoidance, subjective fear at the initial approach distance, as well as scores on the acrophobia questionnaire (AQ) from pre- to post-treatment. The superior effects of the VRE–MRE intervention remained evident on the level of behavioral avoidance and associated subjective fear at the initial approach distance, but not on the AQ, from pre-treatment to follow-up. These findings indicate that the reactivation and evaluation of mastery experiences could be used as a strategy to increase exposure-based therapy in anxiety disorders.

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Notes

  1. One participant in the VRE condition missed to provide a fear rating at the initial approach distance. Hence, this analysis is based on N = 55 participants.

References

  • Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry, 3, 257–260.

    Article  Google Scholar 

  • Breeden, P., Dere, D., Zlomuzica, A., & Dere, E. (2016). The mental time travel continuum: On the architecture, capacity, versatility and extension of the mental bridge into the past and future. Reviews in the Neurosciences, 27, 421–434.

    Article  PubMed  Google Scholar 

  • Brown, A. D., Dorfman, M. L., Marmar, C. R., & Bryant, R. A. (2012). The impact of perceived self-efficacy on mental time travel and social problem solving. Consciousness and Cognition, 21, 299–306.

    Article  PubMed  Google Scholar 

  • Brown, A. D., Kouri, N. A., Rahman, N., Joscelyne, A., Bryant, R. A., & Marmar, C. R. (2016). Enhancing self-efficacy improves episodic future thinking and social-decision making in combat veterans with posttraumatic stress disorder. Psychiatry Research, 242, 19–25.

    Article  PubMed  Google Scholar 

  • Brown, L. A., Wiley, J. F., Wolitzky-Taylor, K., Roy-Byrne, P., Sherbourne, C., Stein, M. B., et al. (2014). Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study. Depression and Anxiety, 31, 678–689.

    Article  PubMed  PubMed Central  Google Scholar 

  • Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.

    Article  Google Scholar 

  • Carl, J. R., Soskin, D. P., Kerns, C., & Barlow, D. H. (2013). Positive emotion regulation in emotional disorders: A theoretical review. Clinical Psychology Review, 33, 343–360.

    Article  PubMed  Google Scholar 

  • Coelho, C. M., Waters, A. M., Hine, T. J., & Wallis, G. (2009). The use of virtual reality in acrophobia research and treatment. Journal of Anxiety Disorders, 23, 563–574.

    Article  PubMed  Google Scholar 

  • Cohen, D. C. (1977). Comparison of self-report and overt-behavioral procedures for assessing acrophobia. Behavior Therapy, 8, 17–23.

    Article  Google Scholar 

  • Craske, M. G., Hermans, D., & Vervliet, B. (2018). State-of-the-art and future directions for extinction as a translational model for fear and anxiety (p. 373). Biological Sciences: Philosophical Transactions of the Royal Society B.

    Google Scholar 

  • Craske, M. G., & Mystkowski, J. (2006). Exposure therapy and extinction: Clinical studies. In M. G. Craske, D. Hermans, & D. Vansteenwegen (Eds.), Fear and learning: From basic processes to clinical implications (pp. 217–233). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.

    Article  PubMed  PubMed Central  Google Scholar 

  • de Quervain, D. J.-F., Bentz, D., Michael, T., Bolt, O. C., Wiederhold, B. K., Margraf, J., et al. (2011). Glucocorticoids enhance extinction-based psychotherapy. Proceedings of the National Academy of Sciences of the United States of America, 108, 6621–6625.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dere, E., Dere, D., de Souza Silva, M. A., Huston, J. P., & Zlomuzica, A. (2018). Fellow travellers: Working memory and mental time travel in rodents. Behavioural Brain Research, 352, 2–7.

    Article  PubMed  Google Scholar 

  • Durham, R. C., Higgins, C., Chambers, J. A., Swan, J. S., & Dow, M. G. T. (2012). Long-term outcome of eight clinical trials of CBT for anxiety disorders: Symptom profile of sustained recovery and treatment-resistant groups. Journal of Affective Disorders, 136, 875–881.

    Article  PubMed  Google Scholar 

  • Emmelkamp, P. M., Krijn, M., Hulsbosch, A. M., de Vries, S., Schuemie, M. J., & van der Mast, C. A. (2002). Virtual reality treatment versus exposure in vivo: A comparative evaluation in acrophobia. Behaviour Reseach and Therapy, 40, 509–516.

    Article  CAS  Google Scholar 

  • Gallagher, M. W., Payne, L. A., White, K. S., Shear, K. M., Woods, S. W., Gorman, J. M., et al. (2013). Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity. Behaviour Research and Therapy, 51, 767–777.

    Article  PubMed  Google Scholar 

  • Goldin, P. R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H., Heimberg, R. G., et al. (2012). Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder. Journal of Consulting and Clinical Psychology, 80, 1034.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hautzinger, M., Keller, F., & Kühner, C. (2006). Das Beck Depressions inventar II. Deutsche Bearbeitung und Handbuch zum BDI II. Frankfurt: Harcourt Test Services.

    Google Scholar 

  • Hofmann, S. G. (2007). Enhancing exposure-based therapy from a translational research perspective. Behaviour Research and Therapy, 45, 1987–2001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jerusalem, M., & Schwarzer, R. (1999). Skala zur Allgemeinen Selbstwirksamkeitserwartung (SWE). In R. Schwarzer & M. Jerusalem (Eds.), Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der Wissenschaftlichen Begleitung des Modellversuchs Selbstwirksame Schulen. Berlin: Freie Universität Berlin.

    Google Scholar 

  • Kleim, B., Graham, B., Fihosy, S., Stott, R., & Ehlers, A. (2014). Reduced specificity in episodic future thinking in posttraumatic stress disorder. Clinical Psychological Science, 2, 165–173.

    Article  PubMed  PubMed Central  Google Scholar 

  • Laux, L., Glanzmann, P., Schaffner, P., & Spielberger, C. (1981). Das State-Trait-Angstinventar. Theoretische Grundlagen und Handanweisung. Weinheim: Beltz Test GmbH.

    Google Scholar 

  • Lempert, K. M., Speer, M. E., Delgado, M. R., & Phelps, E. A. (2017). Positive autobiographical memory retrieval reduces temporal discounting. Social Cognitive and Affective Neuroscience, 12, 1584–1593.

    Article  PubMed  PubMed Central  Google Scholar 

  • Margraf, J. (1994). Diagnostisches Kurzinterview bei psychischen Störungen [Diagnostic interview for mental disorders](Mini-DIPS). Berlin: Springer.

    Book  Google Scholar 

  • Margraf, J., & Zlomuzica, A. (2015). Changing the future, not the past: A translational paradigm shift in treating anxiety. EMBO Reports, 16, 259–260.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morina, N., Bryant, R. A., Doolan, E. L., Martin-Solch, C., Plichta, M. M., Pfaltz, M. C., et al. (2017). The impact of enhancing perceived self-efficacy in torture survivors. Depression and Anxiety, 35, 58–64.

    Article  PubMed  Google Scholar 

  • Mystkowski, J. L., Craske, M. G., & Echiverri, A. M. (2002). Treatment context and return of fear in spider phobia. Behavior Therapy, 33, 399–416.

    Article  Google Scholar 

  • Norton, P. J., & Price, E. C. (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease, 195, 521–531.

    Article  PubMed  Google Scholar 

  • Pause, B. M., Zlomuzica, A., Kinugawa, K., Mariani, J., Pietrowsky, R., & Dere, E. (2013). Perspectives on episodic-like and episodic memory. Frontiers in Behavioral Neuroscience, 7, 33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Phan, K. L., Wager, T., Taylor, S. F., & Liberzon, I. (2002). Functional neuroanatomy of emotion: A meta-analysis of emotion activation studies in PET and fMRI. Neuroimage, 16, 331–348.

    Article  PubMed  Google Scholar 

  • Preusser, F., Margraf, J., & Zlomuzica, A. (2017). Generalization of extinguished fear to untreated fear stimuli after exposure. Neuropsychopharmacology, 42, 2545–2552.

    Article  PubMed  PubMed Central  Google Scholar 

  • Raeder, F., Merz, C. J., Tegenthoff, M., Wolf, O. T., Margraf, J., & Zlomuzica, A. (2019). Post-exposure cortisol administration does not augment the success of exposure therapy: A randomized placebo-controlled study. Psychoneuroendocrinology, 99, 174–182.

    Article  CAS  PubMed  Google Scholar 

  • Rodriguez, B. I., Craske, M. G., Mineka, S., & Hladek, D. (1999). Context-specificity of relapse: Effects of therapist and environmental context on return of fear. Behaviour Research and Therapy, 37, 845–862.

    Article  CAS  PubMed  Google Scholar 

  • Rodriguez-Romaguera, J., Do Monte, F. H., & Quirk, G. J. (2012). Deep brain stimulation of the ventral striatum enhances extinction of conditioned fear. Proceedings of the National academy of Sciences of the United States of America, 109, 8764–8769.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ruhmland, M., & Margraf, J. (2001). Effektivität psychologischer Therapien von spezifischer Phobie und Zwangsstörung: Meta-Analysen auf Störungsebene. Verhaltenstherapie, 11, 14–26.

    Article  Google Scholar 

  • Schönfeld, P., Preusser, F., & Margraf, J. (2017). Costs and benefits of self-efficacy: Differences of the stress response and clinical implications. Neuroscience and Biobehavioral Reviews, 75, 40–52.

    Article  PubMed  Google Scholar 

  • Schubert, T., Friedmann, F., & Regenbrecht, H. (2001). The experience of presence: Factor analytic insights. Presence: Teleoperators and Virtual Environments, 10, 266–281.

    Article  Google Scholar 

  • Speer, M. E., & Delgado, M. R. (2017). Reminiscing about positive memories buffers acute stress responses. Nature Human Behaviour, 1, 0093.

    Article  Google Scholar 

  • Titcombe-Parekh, R. F., Chen, J., Rahman, N., Kouri, N., Qian, M., Li, M., et al. (2018). Neural circuitry changes associated with increasing self-efficacy in posttraumatic stress disorder. Journal of Psychiatric Research, 104, 58–64.

    Article  PubMed  Google Scholar 

  • Vervliet, B., Craske, M. G., & Hermans, D. (2013). Fear extinction and relapse: State of the art. Annual Review of Clinical Psychology, 9, 215–248.

    Article  PubMed  Google Scholar 

  • Williams, S. L., Turner, S. M., & Peer, D. F. (1985). Guided mastery and performance desensitization treatments for severe acrophobia. Journal of Consulting and Clinical Psychology, 53, 237–247.

    Article  CAS  PubMed  Google Scholar 

  • Williams, S. L., & Watson, N. (1985). Perceived danger and perceived self-efficacy as cognitive determinants of acrophobic behavior. Behavior Therapy, 16, 136–146.

    Article  Google Scholar 

  • Wolpe, J. (1973). The practice of behavior therapy. New York: Pergamon.

    Google Scholar 

  • Zbozinek, T. D., Holmes, E. A., & Craske, M. G. (2015). The effect of positive mood induction on reducing reinstatement fear: Relevance for long term outcomes of exposure therapy. Behaviour Research and Therapy, 71, 65–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zlomuzica, A., Dere, D., Machulska, A., Adolph, D., Dere, E., & Margraf, J. (2014). Episodic memories in anxiety disorders: Clinical implications. Frontiers in Behavioral Neuroscience, 8, 131.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zlomuzica, A., Preusser, F., Schneider, S., & Margraf, J. (2015). Increased perceived self-efficacy facilitates the extinction of fear in healthy participants. Frontiers in Behavioral Neuroscience, 9, 270.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zlomuzica, A., Preusser, F., Totzeck, C., Dere, E., & Margraf, J. (2016). The impact of different emotional states on the memory for what, where and when features of specific events. Behavioural Brain Research, 298, 181–187.

    Article  PubMed  Google Scholar 

  • Zlomuzica, A., Woud, M. L., Machulska, A., Kleimt, K., Dietrich, L., Wolf, O. T., et al. (2018). Deficits in episodic memory and mental time travel in patients with post-traumatic stress disorder. Progress in Neuropsychopharmacology & Biological Psychiatry, 83, 42–54.

    Article  Google Scholar 

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Funding

This study was funded by Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - Projektnummer 316803389 - SFB1280 (Project A13 awarded to A.Z. and J.M). The funders had no role in study design, data collection, manuscript preparation and decision to publish.

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Correspondence to Armin Zlomuzica.

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Friederike Raeder, Marcella L. Woud, Silvia Schneider, Christina Totzeck, Dirk Adolph, Jürgen Margraf, and Armin Zlomuzica declare that they have no conflict of interest.

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Raeder, F., Woud, M.L., Schneider, S. et al. Reactivation and Evaluation of Mastery Experiences Promotes Exposure Benefit in Height Phobia. Cogn Ther Res 43, 948–958 (2019). https://doi.org/10.1007/s10608-019-10018-x

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