Occasional Reinforced Extinction as a Method for Relapse Prevention: A Critical Systematic Review and Future Directions

Abstract

Introduction: Extinction is more vulnerable than the original acquisition memory, as relapse phenomena have systematically shown in the literature with different species and procedures. One strategy potentially useful to mitigate relapse is occasional reinforced extinction (ORE). In contrast to a standard extinction procedure, this strategy consists of the inclusion of a gradual and sparse number of conditioned stimulus–unconditioned stimulus pairings within the extinction phase. Here, we provide a comprehensive review of the available literature on ORE. Method: We conducted a literature search using three databases (Web of Science, Scopus, and PsycInfo) in July 2022, with an additional citation search. We collected data on different variables of interest, like the relapse phenomena being studied, the outcome measures, or the specific effects obtained. Results: A total of 350 studies were identified from the main database search, including 10 in the review. Five additional studies from the citation search were also included. The final sample consisted of 15 empirical reports. The observed procedural variability makes it difficult to evaluate the effectiveness of ORE to reduce different forms of relapse as the strategy has not consistently shown a general advantage over standard extinction. Conclusion: The current evidence assessing the effectiveness of ORE does not appear to be consistent, although there are plenty theoretical studies recommending and discussing the potential effectiveness of such technique. Moreover, the lack of conclusive laboratory evidence calls into question how general the potential benefits of its use in clinical settings would be.