What is the most effective strategy to reduce fears in exposure therapy? An experimental study of devaluation and extinction learning in anxiety disorder patients and the neurobiological basis

Anxiety disorders are very common mental health disorders. They are characterised by excessive anxiety that interfere with daily life functioning. These disorders can be treated with psychological therapy: exposure therapy is the gold standard. Many patients however show an insufficient response to exposure therapy or relapse afterwards (up to 50%). There is a pressing need to improve the efficacy of the therapy. It is therefore necessary to increase insight into the underlying working mechanisms of exposure therapy. The proposed research focuses on two underlying mechanisms of exposure therapy: extinction learning and devaluation learning. These processes reduce fear via different approaches. Extinction is however highly fragile and dysfunctional in anxiety patients. Devaluation, on the other hand, is a highly understudied process but has potential to more robustly reduce fears. The novel aim of the project is to examine for the first time (1) whether devaluation is intact and less fragile than extinction learning in anxiety patients, and (2) which brain centres are involved in devaluation compared to extinction learning. The project uses a state-of-the-art laboratory approach with brain imaging. The project will provide critical information for therapy optimisation: (1) If devaluation is intact in patients, this could be a focus for adapting therapy protocols, (2) the brain mechanisms can be a focus of neurobiological interventions to boost therapy outcome