Exposure and extinction — MRCPsych Paper A MCQ

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ModeratePsychologyExposure and extinctionMRCPsych Paper A

A 30-year-old woman with spider phobia undergoes repeated exposure to an uncovered spider. She remains in its presence without escaping or using safety behaviours, and her predicted outcome of being bitten does not occur. Which learning process best accounts for the therapeutic effect?

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Correct answer: B — Extinction learning

The answer is B, extinction learning. Exposure to the conditioned stimulus—the spider—without the expected aversive outcome permits new inhibitory learning that the spider does not reliably predict harm. Avoiding safety behaviours strengthens this learning because the absence of harm cannot be attributed to a protective action. Negative reinforcement would strengthen escape or avoidance because it removes anxiety; neither occurs here. Stimulus generalisation is the spread of a learned response to similar stimuli. State-dependent learning concerns retrieval being facilitated by a matching internal state. Positive punishment involves adding an aversive consequence to reduce a behaviour and does not explain fear reduction during exposure.

Reference: Craske MG, Treanor M, Zbozinek TD, Vervliet B. Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus. Behaviour Research and Therapy. 2022;152:104069. https://pubmed.ncbi.nlm.nih.gov/35325683/