Over the years, anxiety has been treated mostly by using exposure treatment. During exposure, the client faces their fears, usually in steps. The idea is that the client experiences that nothing bad happens after being exposed to the thing they fear. Over time, the fear reduces. The counterpart of exposure in the lab is extinction. During extinction, participants are also confronted with a fearful stimulus without consequences.
While learning experiences are considered major contributors to the onset of anxiety in childhood, there is less known about their role in reducing fear. Most of the research has been done on extinction, it might not be the best option since treatment doesn’t seem to work for everyone. It is possible that extinction only reduces your expectancy of what you fear and what follows after this. However, you also have a certain dislike for what you are afraid of and this seems to be robust against extinction. In their study, Newall, Watson, Grant and Richardson, tried to reduce fear in a group of 7- to 12-year-olds by using counter-conditioning.
The experiment consisted of different phases. In the acquisition phase, all 66 participants saw 20 animal-face parings in total. For the CS+ (conditioned stimulus) a ratel or linsang was paired with a scared face. For the CS- (not conditioned), a ratel or linsang was paired with nothing. In the fear reduction phase, the extinction group saw both animals 10 times, followed by nothing. In the counter-conditioning group, a happy face followed the CS+ while nothing followed the CS-. The control group saw 20 nonsense scrambled words.
To measure if counter-conditioning indeed reduces fear and avoidance behaviour, the authors used the Fear Belief Questionnaire (FBQ) and the Nature Reserve Task (NRT). The FBQ listed seven hypothetical situations on which the children had to answer on a 5 point Likert scale. A higher score meant a higher fear belief for the animal picture that the situation was about. The NRT was a green rectangular board and children were told it simulated a nature reserve where the two animals live. On the board were two pictures of these animals, while children placed themselves in the bushland and moved their Lego figure to where they would most like to be in the reserve. The distance between the Lego figure and the animal picture was an index of avoidance/approach behaviour, with a greater distance indicating greater avoidance of the animal.
So is counter-conditioning better than extinction in reducing children’s fear learning? The short answer: yes! They did find evidence to support this. Yet, the story is never that simple. For their first set of analyses, the authors only included children that actually showed fear learning. That is, only children who showed a higher fear belief for the CS+ after acquisition as compared to baseline were included. The counter-conditioning group showed less fear for the CS+ after the fear reduction as compared to the control group. However, the extinction group reported the same amount of fear as compared to the control group. Nonetheless, there were no significant effects on the NRT.
What the authors then did was also run analyses only on the children that showed acquisition of avoidance. Meaning only children that avoided the CS+ more after acquisition as compared to baseline were included. In this group, they found that fear beliefs decreased after fear reduction at the same rate for all groups. On the NRT, The counter-conditioning group showed less avoidance than control, but the extinction group showed the same avoidance level as the control group.
It is interesting that for the FBQ and NRT learners, the results were not the same. But, discrepancy between measures is a more common problem, for instance between self-reports and physiological measures. So it might be that one measure is less valid than the other, or that children had difficulties in understanding the NRT.
Whatever the limitations may be, the results do suggest that counter-conditioning may be more effective in reducing fear learning in children than exposure. This has important implications for treating childhood anxiety disorders because counter-conditioning can be a possible addition to the standard treatment. Hopefully, this can lead to better treatment outcomes.