The influence of cost on avoidance recovery after fear extinction with response prevention

Eliminating avoidance responses is crucial for the treatment of anxiety disorders. However, previous experimental research indicates that conventional therapies, such as exposure with response prevention, may fail to fully eradicate avoidance when it does not entail a cost. This is evident in studies where individuals, after completing an extinction with response prevention (ERP) phase, are given the opportunity to avoid again. This study investigated the impact of introducing a cost for avoidance on the persistence of avoidance responses after an ERP phase. After fear conditioning, participants underwent an avoidance training phase. Introducing a cost midway through the phase reduced avoidance, suggesting the efficacy of incorporating costs into therapies. Following an ERP phase, the presence or absence of a cost for avoiding was manipulated at test. Extinction with response prevention successfully eliminated costly avoidance responses but was less effective for costless responses. Additionally, intolerance of uncertainty influenced the effect of introducing a cost. These findings suggest that addressing avoidance costs in therapy may help promote more adaptive coping strategies and improve treatment outcomes for anxiety disorders.