Extinction Learning

Extinction learning is the gradual weakening and eventual disappearance of a learned or “conditioned” response. This occurs when the previously reinforced stimulus or behavior is repeatedly presented without the anticipated fear/anxiety consequences. It’s a form of new learning that creates an inhibitory memory, which competes with the original memory, rather than erasing. In agoraphobia, extinction learning occurs when a person repeatedly confronts feared situations (conditioned stimuli) without the feared catastrophe (unconditioned stimulus, having a panic attack, being trapped, losing control) actually happening. When the expected negative outcome doesn’t happen, there’s new learning the situation is safe, thus reducing fear-avoidance behavior. An example from exposure therapy involves therapist and patient with agoraphobia afraid of shopping in a crowded mall: 

• Initial fear learning: Patient previously associated crowded mall (conditioned stimulus/CS) with a severe panic attack or loss of control (unconditioned stimulus/US), which led to strong anxiety and avoidance behavior.
• Extinction procedure (exposure therapy): Guided by therapist, patient engages in a planned, gradual, and repeated exposure to the feared situation in a safe environment. Patient might  start by picturing themselves in the mall or looking at pictures of one. It progresses to briefly standing outside a mall, entering for a few minutes, going to one store, and eventually shopping during busy hours.
• Expectancy violation: During extinction learning, patient’s anxiety initially rises, but they remain in the situation and don’t experience the anticipated catastrophe (they don’t pass out, lose control, or have a heart attack).
• New learning: Over many repetitions, patient’s brain forms a new, inhibitory memory: “I can be in a crowded mall, and nothing terrible happens.” Link between mall and panic attack is weakened.
• Outcome: Fear response gradually diminishes, and patient can eventually go to mall without significant distress, effectively reducing agoraphobic avoidance and increasing their mobility