Flipbook

1 INTRODUCTION 19 SAFETY BEHAVIOR AND THE RETURN OF FEAR If safety behavior exerts a causal influence on fear and anxiety, then it may play a role in relapse after therapy. A substantial number of patients relapse after initial recovery (Vervliet et al., 2013). Relapse can be explained by the inhibitory learning account of fear extinction. During extinction, the CS acquires a second, inhibitory association (i.e., CS – no US) that is available alongside the first, excitatory association (i.e., CS – US; Bouton, 2002). Hence, the meaning of the CS (i.e., danger or safety) becomes ambiguous, and depends on which association is activated. Inhibitory learning is context-specific (Bouton, 2004), which means that the inhibitory association is active in the context (e.g., external surrounding or the individual’s internal physical state) in which it was learned, see Figure 2. Figure 2. Inhibitory learning is context-dependent (graphical depiction by Vervliet et al., 2013). The circle with CX indicates the context in which the inhibitory association was learned. In the extinction context, the inhibitory CS – US association is active. The context-specificity of inhibitory learning also means that the inhibitory association is inactive, and the excitatory association is active in contexts that are different from the context in which inhibitory learning occurred. A change in the external context or person’s internal state after extinction reactivates the excitatory CS – US association, and returns fear for the CS (Vervliet et al., 2013). This is called renewal. Additionally, extinguished fears can return with the passage of time (spontaneous recovery), and following an unsignaled US (reinstatement; Bouton 2002, 2016; Vervliet et al., 2013). The return of fear after extinction, that is, the US The role of context after extinction CX CS