Presenting unpaired unconditional stimuli (US) during extinction training reduces the renewal of conditional fear due to context change. The present study investigated whether this reduced return of fear is specific to the aversive US presented during acquisition or can also be observed after extinction with unpaired presentations of another aversive or of a non-aversive US. Using an ABA renewal paradigm that trained extinction in a context different from that of the acquisition, renewal and re-acquisition test phases, participants received five unpaired presentations of either the aversive US used during acquisition (Group Aversive-Same), an aversive US not presented during acquisition (Group Aversive-Different) or a non-aversive US (Group Non-aversive) during extinction training. Renewal of electrodermal conditional responses was observed in group Non-aversive, but not in groups Aversive-Same or Aversive-Different. Re-acquisition did not differ across the groups. These results are consistent with a valenced arousal account to explain the effects of unpaired presentations of the US during extinction training which would suggest that extinction learning is enhanced under conditions of increased aversive arousal.

Although exposure-based therapy is widely recognized as effective for treating various anxiety disorders, a significant proportion of patients fail to benefit or experience a return of fear following successful treatment. One promising strategy involves occasional presentation of fear-evoking stimuli during extinction (occasional reinforced extinction, ORE). This study investigates a novel approach to translate ORE into clinical practice by incorporating occasional vivid imagery of individuals' worst-case fear scenarios during in-vivo exposure. Forty-seven spider-fearful individuals were randomly assigned to receive either a one-session in-vivo standard exposure treatment (Exp-Only) or an one-session in-vivo exposure treatment supplemented with occasional mental imagery of their worst-case spider scenario (Exp+ORE). Fear of spider questionnaires and a generalization behavioral approach test were administered prior to and one week after treatment. Both groups showed improvement from baseline to post-assessment, but the Exp+ORE group demonstrated significantly greater reductions in self-reported fear and avoidance of spiders compared to standard exposure training. During the generalization behavioral approach test, subjective distress and approach behavior toward the spider significantly improved from baseline to post-assessment in all participants, with no discernible group differences. Findings moreover indicate that occasional imagery during exposure lead to greater expectancy violation compared to standard exposure, providing insights into potential underlying mechanisms of the ORE approach. Incorporating mental imagery into the occasional reinforced extinction approach could hold promise for enhancing the efficacy of exposure-based treatments for anxiety disorders in clinical settings.

Augmented Depression Therapy (ADepT) is an individual psychotherapy for depression, which has been shown to be effective in the general adult population. A randomised multiple baseline case series evaluated the feasibility, acceptability, and effectiveness of ADepT in young adults (aged 20–24). Eleven depressed young adults were recruited from a UK university wellbeing service to receive ADepT during the COVID-19 pandemic, with outcomes evaluated relative to pre-specified continuation targets. All participants received a minimum adequate treatment dose (>60% target); 89% judged ADepT as acceptable and satisfactory and would recommend it to others (>60% target); only 9% showed reliable deterioration for depression or wellbeing (meeting <30% target); and there were no trial- or treatment-related serious adverse events. Qualitative interviews revealed most participants were satisfied with and experienced benefits from ADepT. At post-treatment, reliable improvement was shown by 33% of participants for depression and 67% of participants for wellbeing (not meeting target of both >60%), with medium effect size improvements for depression (g = 0.78) and large effect size improvement for wellbeing (g = 0.93; not meeting target of both >0.80). ADepT is feasible, acceptable, and safe in young adults but may require modification to maximise effectiveness. Further research outside of the COVID-19 pandemic is warranted.

BackgroundPaediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples. Methods641 children and adolescents aged 6–17 years (Mage = 9.45 yr; 47.6% girls) engaged in a brief, impromptu speech and a social discussion with a confederate. Participants included 307 with SoAD, 285 with other mental disorders, and 49 non-clinical controls. Participants who completed each task self-reported their anticipated probability and cost of negative evaluation, self-focused attention, personal evaluation of social performance, and engagement in post-event rumination (assessed 1 h later). Independent raters also scored their social performance. Relationships between the variables were tested through path analysis. ResultsParticipants with SoAD were more likely to avoid and reported significantly greater state anxiety than both comparison groups. They also reported higher levels of each of the putative maintaining processes than either comparison group. In contrast, independent observers did not discriminate between groups on their overt social performance. Path analyses demonstrated good fit of a priori models to the data for both social tasks. ConclusionsPaediatric SoAD is associated with strong expectation of the probability and cost of negative evaluation, excess self-focused attention, and more negative evaluation of one's own social performance. In turn, these putative processes are strong predictors of state anxiety and post-event processing in response to both a speech and social interaction.