Reducing the return of avoidance and fear by directly targeting avoidance: Comparing incentive-based and instructed extinction of avoidance to passive fear extinction

Abstract

Enhancing the reduction of avoidance may optimize treatment for anxiety disorders. Past research focused on boosting fear extinction to reduce avoidance, however, with limited success. Directly extinguishing avoidance may be more promising. This preregistered study tested the impact of incentives and instruction for non-avoidance compared to passive fear extinction on long-term avoidance and fear reduction. On Day 1, participants acquired conditioned fear and avoidance to a conditioned stimulus (CS) paired with an aversive outcome. Next, incentives or instructions encouraged non-avoidance to the CS, which was no longer reinforced by a US regardless of avoidance (Incentives and Instruction group). In a third group, avoidance was unavailable and the CS was passively presented in absence of the US (Passive Fear Extinction group). On Day 2, avoidance retention and reinstatement and return of fear were tested. In the short term, incentives and instruction strongly reduced avoidance with similar fear reduction compared to passive fear extinction. Importantly, incentives and instruction were linked to lower long-term avoidance retention. Avoidance reinstatement was evident in all groups, but avoidance remained higher after passive fear extinction. Finally, incentives yielded a lower return of threat expectancies. Thus, targeting avoidance instead of fear better reduced long-term avoidance and, for incentives, the return of fear. Especially, incentives could be a promising add-on to exposure.