title: Effects of Approach-Avoidance Training on the Extinction and Return of Fear Responses.
abstract: OBJECTIVE
  Exposure therapy for anxiety involves confronting a patient with fear-evoking stimuli, a procedure based partially on Pavlovian extinction. Exposure and other extinction-based therapies usually lead to (partial) reduction of fear symptoms, but a substantial number of patients experience a return of fear after treatment. Here we tested whether the combination of fear extinction with modification of approach-avoidance tendencies using an Approach-Avoidance Task (AAT) would result in the further reduction of conditioned fear and/or help prevent return of fear after extinction.
  
  
  METHODS
  Two groups of participants underwent a fear acquisition procedure during which pictures of one neutral object were sometimes paired with shock (CS+), whereas pictures of another neutral object were not (CS-). The next day, in a fear extinction procedure, both objects were presented without shock. During the subsequent joystick AAT, one group primarily pulled CS+ pictures towards themselves and pushed CS- pictures away from themselves; reversed contingencies applied for the other group.
  
  
  RESULTS
  Approach training was effective in modifying conditioned action tendencies, with some evidence for transfer to a different approach/avoidance task. No group differences in subjective fear or physiological arousal were found during subsequent post- training and return-of-fear testing.
  
  
  CONCLUSIONS
  No reliable return-of-fear was observed in either group for either subjective or physiological fear measures.
  
  
  CONCLUSIONS
  Our results suggest that approach training may be of limited value for enhancing the short- and long-term effects of extinction-based interventions.
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition Center, Amsterdam, the Netherlands.
authors.forename: Angelos-Miltiadis
authors.initials: AM
authors.lastname: Krypotos
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition Center, Amsterdam, the Netherlands.
authors.forename: Inna
authors.initials: I
authors.lastname: Arnaudova
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition Center, Amsterdam, the Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Effting
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition Center, Amsterdam, the Netherlands.
authors.forename: Merel
authors.initials: M
authors.lastname: Kindt
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition Center, Amsterdam, the Netherlands; Department of Psychology, KU Leuven, Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Beckers
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D001362:Avoidance Learning; D005239:Fear; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology / Q000628:therapy