Pavlovian fear reversal learning predicts outcome of exposure-based cognitive behavioral therapy for adult obsessive-compulsive disorder.

Extinction of conditioned fear responses is assumed to relate to beneficial effects of exposure-based treatment, but few studies investigated the role of fear conditioning for exposure techniques in clinical settings. Specifically, no study addressed the relationship between psychophysiological indicators of extinction and outcome of exposure and response prevention (ERP) in adult obsessive-compulsive disorder (OCD). This study investigated whether skin conductance responses (SCRs) to threat and safety signals in a pre-treatment Pavlovian reversal learning experiment predicted the outcome of individual, manualized and ERP-based cognitive behavioral therapy (CBT) for 32 patients with OCD. In the first part of the experiment (acquisition stage) a picture of a face (CS+) was paired with an electrical stimulation (US) in one third of the trials while a second face (CS-) was never presented with the US. During a subsequent reversal stage, the formerly safe face was now coupled with the US (new CS+) and the former CS+ was no longer paired with the US (new CS-). Regression analyses showed that a larger SCR difference between threat and safety stimuli (CS + vs. CS-) during late reversal predicted both symptom reduction and remission at post-treatment, suggesting that adaptive learning skills may be important for successful ERP in OCD.