Research on unconscious fear responses has recently been translated into experimental paradigms for reducing fear that bypass conscious awareness of the phobic stimulus and thus do not induce distress. These paradigms stand in contrast to exposure therapies for anxiety disorders, which require direct confrontation of feared situations and thus are distressing. We systematically review these unconscious exposure paradigms. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-based search yielded 39 controlled experiments based on 10 paradigms that tested whether exposure without awareness can reduce fear-related responses. In randomized controlled trials of phobic participants, unconscious exposure interventions: (a) reduced behavioral avoidance (weighted mean d = 0.77, N = 469) and self-reported fear (d = 0.78, N = 329) during in vivo exposure to feared situations; (b) reduced neurobiological indicators of fear and enhanced such indicators of fear regulation (d = 0.81, N = 205); (c) had significantly stronger effects on reducing symptomatic behaviors and enhancing neurobiological indicators of fear regulation than did conscious exposure (d = 0.78, N = 342); and (d) produced these effects without inducing subjective fear. In fear-conditioned participants, unconscious exposureinduced extinction learning (d = 0.80, N = 420), even during sleep, and yielded somewhat stronger extinction learning than conscious exposure did (d = 0.44, N = 438). We organize these findings within a neuroscientific framework and evaluate alternative mechanisms for unconscious exposure. The use of incommensurate outcome measures across exposure paradigms and nonreporting of relevant statistics limited meta-analyses. Despite steps taken to address publication bias, 25.6% of included studies came from a single laboratory. We propose potential clinical applications of these findings. Future research should clarify underlying mechanisms, use common outcome measures, and explore effects on other anxiety disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

中文翻译：

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“我们所要害怕的只是恐惧本身”：通过阻止对恐惧的认识来减少恐惧的范式。


对无意识恐惧反应的研究最近已被转化为减少恐惧的实验范式，这些范式绕过了对恐惧刺激的有意识意识，因此不会引起痛苦。这些范式与焦虑症的暴露疗法形成鲜明对比，后者需要直接面对恐惧的情况，因此令人痛苦。我们系统地回顾了这些无意识暴露范式。A 基于系统评价和荟萃分析的搜索的首选报告项目产生了 39 个基于 10 个范式的对照实验，这些实验测试了没有意识的暴露是否可以减少与恐惧相关的反应。在针对恐惧参与者的随机对照试验中，无意识暴露干预：（a） 减少体内暴露于恐惧情况时的行为回避（加权平均值 d = 0.77，N = 469）和自我报告的恐惧（d = 0.78，N = 329）;（b） 减少恐惧的神经生物学指标并增强恐惧调节的此类指标 （d = 0.81，N = 205）;（c） 与有意识暴露相比，在减少症状行为和增强恐惧调节的神经生物学指标方面的作用明显更强 （d = 0.78，N = 342）;（d） 在不引起主观恐惧的情况下产生这些效果。在恐惧条件反射的参与者中，无意识暴露诱导了消退学习 （d = 0.80， N = 420），即使在睡眠期间也是如此，并且产生的消退学习比有意识暴露 （d = 0.44， N = 438） 更强。我们在神经科学框架内组织这些发现，并评估无意识暴露的替代机制。在暴露范式中使用不相称的结局测量和不报告相关统计数据限制了荟萃分析。尽管采取了措施来解决出版偏倚，但 25.6% 的纳入研究来自单个实验室。我们提出了这些发现的潜在临床应用。未来的研究应阐明潜在机制，使用常见的结局指标，并探索对其他焦虑障碍的影响。（PsycInfo 数据库记录 （c） 2024 APA，保留所有权利）。