An integrated review of fear and avoidance learning in anxiety disorders and application to eating disorders

Abstract

Clinical fear is at the core of anxiety disorders. Considerable research has examined processes through which clinical fears are learned and unlearned (i.e., acquisition, generalization, extinction, return of fear) in anxiety disorders. Empirically supported models of these processes implicate both associative and instrumental learning. Research has also delineated that avoidance (i.e., behaviors intended to prevent aversive experiences) and fear approach (i.e., behaviors that involve exposure to one's fear) modulate fear learning, yet these processes remain under-researched in anxiety-based disorders. The purpose of the current review is to a) review existing research on clinical fear learning, incorporating fear approach, avoidance, and inhibitory learning, and b) extend this model to advance the understanding of fear-based learning in eating disorders. Implications for research and treatment are discussed, including how the anxiety field can inform eating disorder research and the importance of empirically testing fear learning in eating disorders to improve treatment.