Differential Effects of Extinction with Response Prevention on Avoidance Behavior as a Function of Response Cost

Abstract

Avoidance behaviors are a hallmark of anxiety disorders and a key target in exposure-based treatments such as extinction with response prevention (ERP). However, prior research suggests that ERP may be limited in reducing avoidance responses when these are not associated with any cost. This study examined whether the presence of a cost modulates the persistence of avoidance after extinction. A total of 134 undergraduate psychology students underwent fear conditioning, during which an aversive sound was paired with two conditioned stimuli (CS+), while a third stimulus (CS−) was never paired with the sound. Participants were then allowed to avoid the sound by clicking a button, and midway through this phase, doing so incurred a cost (point loss). During ERP, the button became ineffective. Finally, at test, participants could again use the button, with cost manipulated between stimuli. Results showed that costless avoidance was not fully suppressed after ERP, mirroring prior findings. In contrast, costly avoidance was eliminated after ERP. These findings suggest that incorporating or emphasizing the costs of avoidance may enhance the effectiveness of exposure-based therapies for anxiety disorders.