دانلود رایگان مقاله نظریه خاموش سازی و بی اشتهایی عصبی

Abstract

By virtue of adopting the core symptomatic fear (i.e., a fear of weight gain) as a primary treatment target, the treatment of AN centrally involves exposure-driven processes. However, exposure trials targeting the fear of weight gain in AN have been sparse, yielding mixed results to date. In translating extinction theory to the treatment of AN, it is likely that the absence of a clear distinction between what constitutes the core feared cue and the core feared outcome has stymied the application of exposure treatments in AN. This review considers several configurations of the core fear association in AN, noting distinct therapeutic strategies which may allow for more precise efforts in violating fear-based expectancies. Specific guidance is offered in the clinical decision making process as to which strategies might best promote inhibitory learning, and a clinical case is discussed, in which treatment was adjusted to specifically violate the core underlying fear association.

10. Summary

Given the unique nature of AN, in which the core symptomatic fear (i.e., weight gain) is adopted as a primary treatment target, exposure-based processes are intertwined with treatment pathways. However, the application of exposure-based treatments in the context of AN has been sparse, and has been met with mixed results (Koskina et al., 2013; Steinglass et al., 2014). Perhaps the most salient barrier to exposure-based treatment in the context of AN is that little consensus exists in determining what constitutes the core feared cue/stimulus, and what constitutes the core feared outcome in AN (Murray et al., in press). The absence of this necessary distinction stymies the application of exposure-based treatments and the targeted violation of feared expectancies, as effective exposure-based interventions ought to be tailored to specifically target the core fear associations that underpin illness psychopathology. Thus, the application of exposure-based treatments in AN warrants careful consideration, and conceptualizing AN treatment through the lens of extinction theory offers several distinct pathways for treatment delivery. Clearly, a greater distillation of the core fear association in AN is required in determining optimal pathways for translating extinction learning theory to the exposure-based treatment of AN (Murray et al., in press).