Effectiveness of extinction with response prevention on costly and costless avoidance behaviour

Abstract

Eliminating avoidance responses is central to treating anxiety disorders, yet prior experimental research suggests that conventional therapies like exposure with response prevention may not fully eradicate avoidance when the avoidance response incurs no cost. This study aimed to determine the impact of introducing a cost on the avoidance response and whether costly and costless responses are differentially affected by extinction with response prevention (ERP). Participants (134 undergraduate psychology students from the University of Málaga) underwent fear conditioning where an aversive sound was paired with two stimuli. A neutral stimulus (CS-) was never paired with the sound. Participants were then allowed to avoid the sound by clicking a button. Midway through this phase, a cost for avoiding was introduced. Introducing a cost reduced, but did not eradicate, avoidance. Participants subsequently underwent an ERP phase during which clicking on the button was made ineffective. Finally, at test, they were allowed to use the button again. The presence or absence of a cost for avoiding was manipulated between-stimuli. In line with prior research, ERP did not eliminate costless avoidance. However, it was effective in reducing costly avoidance to the level of the CS-. Prospective Intolerance of Uncertainty was positively associated with the size of the effect of introducing a cost. These findings underscore the importance of addressing avoidance costs in therapy, either by introducing them or by increasing patients’ awareness of the adverse consequences of avoidance, to promote more adaptive coping strategies and enhance exposure-based treatment outcomes for anxiety disorders.