Behavioral and neural processes in counterconditioning: Past and future directions

doi:10.1016/j.brat.2019.103532

Behaviour Research and Therapy

Volume 125, February 2020, 103532

https://doi.org/10.1016/j.brat.2019.103532 Get rights and content

Highlights

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Counterconditioning is a technique and process of behavior modification.
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Whether counterconditioning is more or less effective than extinction is unclear.
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We review behavioral and neural findings of counterconditioning across species.
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We hope this review motivates further research on this underexplored topic.

Abstract

Counterconditioning refers both to the technique and putative process by which behavior is modified through a new association with a stimulus of an opposite valence. Similar to extinction, counterconditioning is considered a form of inhibition that interferes with the expression of the originally learned response without erasing it. But whereas interest in extinction continues to rise, counterconditioning has received far less attention. Here, we provide an in-depth review of counterconditioning research and detail whether counterconditioning is any more effective than extinction at preventing relapse of the originally learned behavior. We consider the clinical implications of counterconditioning, describe recent neurobiological and neuroimaging research in this area, and consider future avenues in need of further investigation.

Section snippets

A short history of counterconditioning

As the term implies, counterconditioning is derived from research in Pavlovian and operant conditioning. In a typical Pavlovian counterconditioning design, a neutral conditioned stimulus (CS, e.g., a tone) is first paired with a biologically salient US of a particular valence (e.g., shock or food) and then paired with a US of the opposite valence (e.g., food or shock, respectively). In rodents, performance at test is oftentimes measured as the amount of time either freezing to the CS, the

Counterconditioning versus standard extinction

Extinction refers both to the technique of omitting a US or reinforcement following conditioning, as well as to the process by which omission leads to a reduction in learned behavior. It is considered a form of retroactive inhibition that interferes with expression of the originally learned response. It is also widely appreciated that extinction tends to be a fairly weak and impermanent form of inhibition, and that the originally learned response often reemerges under a variety of circumstances

Non-human animal research on counterconditioning

While the focus of counterconditioning has predominately been on modulating responses to the CS, early work showed that counterconditioning alters the value of a US (US1) when it is paired with another US of the opposite valence (US2). Pearce and Dickinson (1975) showed that pairing shock with food (US1-US2 pairing) reduced the effectiveness of the shock in subsequent conditioned suppression training. Another fairly robust finding in the counterconditioning literature is that of proactive

Neurobiology of counterconditioning

Whether the neural mechanism by which counterconditioning achieves its effects are distinct from the well-delineated neural circuitry of extinction is unclear. The switch from appetitive-to-aversive conditioning has been linked to reduced levels of activity in midbrain periaqueductal grey, as compared to aversive conditioning without prior appetitive conditioning (Nasser & McNally, 2012). Appetitive-to-aversive counterconditioning is also linked to increased activity in regions associated with

Human research on counterconditioning

Human research focused on counterconditioning has been sparse, but the topic has maintained some interest in the area of pain, fear, and changing learned preferences. The use of counterconditioning as a strategy to reduce fear of pain shows mixed results. Meulders, Karsdorp, Claes, and Vlaeyen (2015) first fear-conditioned a movement (CS) using a painful shock (US), and then paired the movement with either monetary reward (counterconditioning group) or simply omitted the US (extinction group).

Derivatives of counterconditioning

Another approach to augment extinction training involves replacing a valenced US (e.g., shock) with a neutral stimulus. Raes and De Raedt (2012) found that replacing the aversive US with a neutral outcome (a simple tone) was equivalent to replacing the aversive US with an appetitive outcome (the sound of baby laughter), in reducing evaluative responses of fear. In a cross-species behavioral experiment, Dunsmoor, Campese, et al. (2015) tested the effect of augmenting extinction by replacing

Negative valence system disorders

The principles of counterconditioning have been effectively utilized through systematic desensitization therapy to treat disorders characterized by negative valence, such as Specific Phobias and Obsessive Compulsive Disorder (Tryon, 2005). Paunovic (2011) developed an exposure counterconditioning method to treat PTSD by asking patients to undergo imaginal reliving of a pleasurable emotional experience incompatible to the trauma. Approaches that integrate exposure treatment with appetitive

Optimizing counterconditioning

The ultimate goal of seeking alternative approaches to standard extinction is to innovate clinical treatment to more effectively prevent the relapse of unwanted thoughts and behavior. Counterconditioning is procedurally distinct from standard extinction because it involves the presentation of a new outcome, rather than omission of the expected outcome. Mechanistically, counterconditioning might operate by increasing the prediction error, thereby enhancing the recruitment of dopaminergic

Counterconditioning via real-time fMRI neurofeedback

An inherit drawback of exposure-based treatments is the distress and anxiety caused by stimulus exposure during treatment. In the worst case, the anxiety produced during exposure leads to patient attrition (Loerinc et al., 2015). Real-time fMRI neurofeedback (rt-fMRI) combined with multivariate pattern analysis (MVPA) may offer one path of treatment without the need for patient exposure to the stimulus (Norman, Polyn, Detre, & Haxby, 2006; Sitaram et al., 2017). The general goal of combining

Conclusion

Historically, research on counterconditioning has been largely situated in learning theory accounts of animal behavior. But research on affective value coding in the brain has borrowed from the theoretical tradition of aversive-appetitive interactions in Pavlovian conditioning, and exciting avenues of neuroimaging research in humans is using counterconditioning in an attempt to change the neural representations of feared stimuli. As research on counterconditioning moves forward, an important

Acknowledgments

The authors acknowledge funding from National Institutes of Health R00MH106719 and a National Science Foundation CAREER award (#1844792) to JED and National Institutes of Health R00MH106719-04S to NEK.

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Behavioral and neural processes in counterconditioning: Past and future directions

Highlights

Abstract

Section snippets

A short history of counterconditioning

Counterconditioning versus standard extinction

Non-human animal research on counterconditioning

Neurobiology of counterconditioning

Human research on counterconditioning

Derivatives of counterconditioning

Negative valence system disorders

Optimizing counterconditioning

Counterconditioning via real-time fMRI neurofeedback

Conclusion

Acknowledgments

Behavior Therapy

Current Biology

Behavior Therapy

Advances in Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Biological Psychiatry

Preventive Medicine

Journal of Psychiatric Research

The Journal of Pain

Trends in Cognitive Sciences

Behaviour Research and Therapy

Neural Networks

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Biological Psychiatry

Current opinion in behavioral sciences

Biological Psychology

Neuron

Behaviour Research and Therapy

Behavior Therapy

Neurobiology of Learning and Memory

Biological Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Trends in Cognitive Sciences

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Trends in Neurosciences

Clinical Psychology Review

Behaviour Research and Therapy

Behaviour Research and Therapy

Clinical Psychology Review

Neurobiology of Learning and Memory

The Journal of Pain

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Trends in Cognitive Sciences

Learning and Motivation

Journal of Anxiety Disorders

Behavior Therapy

Exposure to novelty weakens conditioned fear in long-Evans rats

Psicológica: International Journal of Methodology and Experimental Psychology

Pavlovian associations are forever: On classical conditioning and extinction

Journal of Psychophysiology

Affective valence in the brain: Modules or modes?

Nature Reviews Neuroscience

Context, time, and memory retrieval in the interference paradigms of Pavlovian learning

Psychological Bulletin

Context and behavioral processes in extinction

Learning & Memory