Reappraisal facilitates extinction in healthy and socially anxious individuals

Background and objectives Cognitive behavioral therapy (CBT) combines cognitive restructuring with exposure to feared stimuli in the treatment of anxiety disorders. Due to the complexities of cognition-emotion interactions during ongoing CBT, the underlying mechanisms remain unclear, which hinders treatment optimization. Methods We created a laboratory analogue by combining reappraisal, a key ingredient of cognitive restructuring, with Pavlovian conditioning, a key ingredient in behavioral treatments. The novel differential Pavlovian acquisition and extinction task featured social stimuli as conditioned and unconditioned stimuli under unregulated and reappraisal instructions. Results Findings indicated that reappraising the conditioned stimuli attenuated acquisition (Study 1) and facilitated extinction (Study 2) of conditioned negative valence. In Study 3, highly socially anxious individuals showed deficient extinction learning relative to low socially anxious individuals but compensated for this by using reappraisal. Limitations Diagnostic status of participants was not assessed in structured clinical interviews. Conclusions Reappraisal of feared stimuli could be useful in prevention and treatment of social anxiety