Lecture 8
Where is the science?
- Psychotherapy: not based on empirical science until 1960s
- Extreme examples: centrifuge therapy, insulin shock therapy, hydrotherapy and
lobotomy
The importance of historical awareness
- Scientists should not overestimate the significance of their discoveries
- The process of thinking and arguing, and of critically testing ideas is at least as
important as knowing the facts; science is an ongoing process, facts are temporary
Irrational fears are common
- Anxiety disorders are a leading form of mental illness worldwide
- 60 million in Europe
- Anxiety disorders are conceptualized as irrational and learned fears
- Irrespective of learning history, associative fear memory lies at the core of anxiety
disorders
Slide 7
- Certainly not in all paradigms, such as biological psychiatry, emotional memory does
not play a role
Animal model: fear learning and memory → fear conditioning
- So our brains operate in a way as predictive machines
- After trauma, people often blame themselves, in terms of conditioning this happens
because people feel like they are the predictor; although not realistic, you have a
feeling of being able to control the environment
Fear conditioning paradigm
- Fear memory is strong - generalizes over time, context and stimuli from the same
semantic category
- Strong fear memory is functional and taps into one of the most important survival
circuits
- But what if fear is irrational such as in anxiety disorders?
- Similar neurobiological processes for irrational fears
People are aware that their fears are irrational; however, when the actual situation they fear
has arrived they forget this and are unable to rationalize the fear/anxiety.
Slide 13
- Return of fear: spontaneous recovery
- The same holds when there is no new associative learning, but you present someone
with an unexpected shock; this returns the fear
- Changing the context will revive the fear (slide 16)
You always need a control stimulus; you need to have reference points to know what a fear
responds is; you do not need this in animals, the freezing is the fear response
, Slide 16
- Green: change the context
- Blue: test in new context again
- ABC is analogue of clinical practice
Slide 18
- If you go back to acquisition context there is a fear; but also in a new context
Relapse is explained by intact fear memory that resurfaces:
a) Leaving the therapeutic context : renewal
b) passage of time : Spontaneous recovery
c) Re-exposure to aversive events
d) New learning experience
Slide 21
- You learn context dependent
- You learn exception to a learn; in this context it is safe
- Generalization of extinction is a challenge
- Asymmetry between acquisition and extinction
Inhibitory memory is formed - Hippocampus, vmPFC
Fear memory remains intact and may resurface - Amygdala (animal models) (explanation for
relapse after treatment)
- The fear memory will not be removed, another memory will be created and there is a
battle between these memories
Traditional learning theory: habituation (CS → no CR)
Contemporary learning theory: learning (CS → no US) (fear of the fear)
- Feel, think and act as if the feared stimulus is followed by a catastrophe
Optimizing exposure treatment
To enhance learning, design exposures that violate expectancies
- Probability of expected negative outcome (US)
- Intensity of the anticipated catastrophe
- The extent to which the catastrophe is manageable
Focus on learning (mismatch (more contextualized → more vulnerable to relapse), prediction
error), consolidation and retrieval
- Anxiolytic drugs during exposure? other drugs?
Exposure is evidence based, effective, but…
- Many patients with anxiety disorders profit from exposure treatment
- But long-term effects are weak - only 38% profit at long-term
When you reactive memory (re-exposed), the memory may become active again (memory
reconsolidation)
Protein synthesis necessary for Long term memory (tested by blocking synthesis)
Where is the science?
- Psychotherapy: not based on empirical science until 1960s
- Extreme examples: centrifuge therapy, insulin shock therapy, hydrotherapy and
lobotomy
The importance of historical awareness
- Scientists should not overestimate the significance of their discoveries
- The process of thinking and arguing, and of critically testing ideas is at least as
important as knowing the facts; science is an ongoing process, facts are temporary
Irrational fears are common
- Anxiety disorders are a leading form of mental illness worldwide
- 60 million in Europe
- Anxiety disorders are conceptualized as irrational and learned fears
- Irrespective of learning history, associative fear memory lies at the core of anxiety
disorders
Slide 7
- Certainly not in all paradigms, such as biological psychiatry, emotional memory does
not play a role
Animal model: fear learning and memory → fear conditioning
- So our brains operate in a way as predictive machines
- After trauma, people often blame themselves, in terms of conditioning this happens
because people feel like they are the predictor; although not realistic, you have a
feeling of being able to control the environment
Fear conditioning paradigm
- Fear memory is strong - generalizes over time, context and stimuli from the same
semantic category
- Strong fear memory is functional and taps into one of the most important survival
circuits
- But what if fear is irrational such as in anxiety disorders?
- Similar neurobiological processes for irrational fears
People are aware that their fears are irrational; however, when the actual situation they fear
has arrived they forget this and are unable to rationalize the fear/anxiety.
Slide 13
- Return of fear: spontaneous recovery
- The same holds when there is no new associative learning, but you present someone
with an unexpected shock; this returns the fear
- Changing the context will revive the fear (slide 16)
You always need a control stimulus; you need to have reference points to know what a fear
responds is; you do not need this in animals, the freezing is the fear response
, Slide 16
- Green: change the context
- Blue: test in new context again
- ABC is analogue of clinical practice
Slide 18
- If you go back to acquisition context there is a fear; but also in a new context
Relapse is explained by intact fear memory that resurfaces:
a) Leaving the therapeutic context : renewal
b) passage of time : Spontaneous recovery
c) Re-exposure to aversive events
d) New learning experience
Slide 21
- You learn context dependent
- You learn exception to a learn; in this context it is safe
- Generalization of extinction is a challenge
- Asymmetry between acquisition and extinction
Inhibitory memory is formed - Hippocampus, vmPFC
Fear memory remains intact and may resurface - Amygdala (animal models) (explanation for
relapse after treatment)
- The fear memory will not be removed, another memory will be created and there is a
battle between these memories
Traditional learning theory: habituation (CS → no CR)
Contemporary learning theory: learning (CS → no US) (fear of the fear)
- Feel, think and act as if the feared stimulus is followed by a catastrophe
Optimizing exposure treatment
To enhance learning, design exposures that violate expectancies
- Probability of expected negative outcome (US)
- Intensity of the anticipated catastrophe
- The extent to which the catastrophe is manageable
Focus on learning (mismatch (more contextualized → more vulnerable to relapse), prediction
error), consolidation and retrieval
- Anxiolytic drugs during exposure? other drugs?
Exposure is evidence based, effective, but…
- Many patients with anxiety disorders profit from exposure treatment
- But long-term effects are weak - only 38% profit at long-term
When you reactive memory (re-exposed), the memory may become active again (memory
reconsolidation)
Protein synthesis necessary for Long term memory (tested by blocking synthesis)
