Low-Cost Avoidance Behaviors are Resistant to Fear Extinction in Humans
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Elevated levels of fear and avoidance are core symptoms across the anxiety disorders. It has long been known that fear serves to motivate avoidance. Consequently, fear extinction has been the primary focus in pre-clinical anxiety research for decades, under the implicit assumption that removing the motivator of avoidance (fear) would automatically mitigate the avoidance behaviors as well. Although this assumption has intuitive appeal, it has received little scientific scrutiny. The scarce evidence from animal studies is mixed, while the assumption remains untested in humans. The current study applied an avoidance conditioning protocol in humans to investigate the effects of fear extinction on the persistence of low-cost avoidance. Online danger-safety ratings and skin conductance responses documented the dynamics of conditioned fear across avoidance and extinction phases. Anxiety- and avoidance-related questionnaires explored individual differences in rates of avoidance. Participants first learned to click a button during a predictive danger signal, in order to cancel an upcoming aversive electrical shock (avoidance conditioning). Next, fear extinction was induced by presenting the signal in the absence of shocks while button-clicks were prevented (by removing the button in Experiment 1, or by instructing not to click the button in Experiment 2). Most importantly, post-extinction availability of the button caused a significant return of avoidant button-clicks. In addition, trait-anxiety levels correlated positively with rates of avoidance during a predictive safety signal, and with the rate of pre- to post-extinction decrease during this signal. Fear measures gradually decreased during avoidance conditioning, as participants learned that button-clicks effectively canceled the shock. Preventing button-clicks elicited a sharp increase in fear, which subsequently extinguished. Fear remained low during avoidance testing, but danger-safety ratings increased again when button-clicks were subsequently prevented. Together, these results show that low-cost avoidance behaviors can persist following fear extinction and induce increased threat appraisal. On the other hand, fear extinction did reduce augmented rates of unnecessary avoidance during safety in trait-anxious individuals, and instruction-based response prevention was more effective than removal of response cues. More research is needed to characterize the conditions under which fear extinction might mitigate avoidance.
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The availability of an avoidance response following fear extinction has been shown to increase levels of fear.
“the availability of an avoidance response following fear extinction has been shown to increase levels of fear”
From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Vervliet & Indekeu, 2015
The General discussion (page unavailable) says that fear measures remained low when avoidance was available after extinction. Avoidance responding returned, but danger-safety ratings increased only when avoidance availability was subsequently removed—not when it was restored. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe implicit assumption that decreasing Pavlovian fear responses will naturally lead to decreased avoidance and enhanced life functioning, and that relapse of fear will invariably lead to clinical relapse, is not supported by the literature.
“This reveals the implicit assumption that decreasing Pavlovian fear responses will naturally lead to decreased avoidance and enhanced life functioning, and relapse of fear will invariably lead to clinical relapse. However, this assumption is not supported by the literature.”
From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Vervliet & Indekeu, 2015
The General discussion reports that avoidance returned following fear extinction, supporting the challenge to the assumption that reducing fear automatically reduces avoidance. The paper does not assess life functioning or establish whether a return of fear invariably leads to clinical relapse. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAvoidance may persist even after fear has been extinguished.
“Avoidance may persist even after fear has been extinguished”
From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Vervliet & Indekeu, 2015
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- Authors
- Vervliet, B., & Indekeu, E.
- Affiliations
- Harvard University (US)
- KU Leuven (BE)
- Corresponding author
- Vervliet, Bram
- ORCID
- Vervliet, Bram
- Venue
- Frontiers in Behavioral Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2015-12-24
- Volume
- 9
- Pages
- 351-351
- ISSN
- 1662-5153 (ISSN-L)
- PMC
- PMC4689807
- OpenAlex
- W2213957725
- Cited by
- 157
- References
- 27
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 13 · 2023: 16 · 2022: 21 · 2021: 24 · 2020: 21 · 2019: 17 · 2018: 16 · 2017: 10 · 2016: 3
- FWCI
- 5.81
- Type
- journal article
- Language
- en
- Update notices
- corrigendum (2021-02-25)
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Behavioral Neuroscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Seventh Framework Programme (PIOF-GA-2013-627743)
- Onderzoeksraad, KU Leuven (PF/10/005)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- fear extinction, avoidance behavior, anxiety disorders, trait anxiety, response prevention, avoidance conditioning, threat appraisal, skin conductance
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