Reducing chronic anxiety by making the threatening event predictable: an experimental approach

Panic disorder is characterized by both specific, phased fear and generalized, chronic anxiety. Standard extinction procedures are efficient in reducing specific fear. However, methods based on human conditioning research - that are capable of reducing chronic anxiety have not yet been thoroughly investigated. This study evaluates a new way of reducing chronic anxiety by signaling aversive events (or by making them more predictable). Using an experimental approach with healthy participants, specific fear and chronic anxiety were operationalized in a within-subjects fear-potentiated startle paradigm by, respectively, conditioning to a cue by presenting predictable shocks and conditioning to a context induced by unpredictable shocks. The results clearly demonstrate that context conditioning is reduced when a discrete cue is added that predicts the onset of the aversive event. The data suggest that making unpredictable events, such as for example panic attacks, predictable, may reduce the generalized and sustained anxiety that often complicates exposure treatment.