Category: Translational

Symposium

Augmenting Exposure Therapy With a Brief Fear Reactivation Trial

Sunday, November 19
8:30 AM - 10:00 AM
Location: Sapphire Ballroom I & J, Level 4, Sapphire Level

Keywords: Translational Research | Fear | Phobias
Presentation Type: Symposium

Background: Compelling evidence across species, and research paradigms suggests that reactivation of a previously consolidated memory returns the memory to a temporary labile state in which it must undergo a protein synthesis-dependent process of memory reconsolidation (Nader et al, 2000). During this temporary reconsolidation window, integration of new experiences creates an updated “version” of the original memory. Monfils et al (2009) first demonstrated that reactivation of a fear memory prior to extinction training in rodents lead to significantly less spontaneous recovery, fear renewal, and fear reinstatement relative to controls. These effects have been replicated for shock conditioned fear in both rodents and humans (Kredlow et al, 2015). Here we present two studies testing whether presenting a brief pre-treatment fear reactivation (RFM) would enhance standard in vivo exposure therapy for naturally acquired pathological fear.


Methods: In Study 1, participants with a fear of snakes or spiders (n = 42) were randomized to receive a 10-second RFM either 30 minutes before or directly after a brief (18-minute) exposure therapy procedure. Participants completed two BATs at baseline, 1-day post-treatment, and 1-month follow-up. In Study 2, snake and spider phobic participants (N = 130) were randomized to receive a 20-second RFM at baseline (at least 1 day prior to treatment) or 25 minutes prior to exposure therapy. Participants completed two BATs (treatment and generalization contexts) at baseline, post-treatment, and 1-week follow-up.


Results: In study 1, pre-exposure RFM resulted in lower fear at the 1-month follow-up (p = .04) and steeper fear decline during the early exposure trials, but showed equivalent levels of fear at post-treatment. In study 2, those receiving pre-exposure RFM achieved faster fear decline during treatment (p = .003), but no overall differences in reported fear at the 1-week follow-up.


Discussion: Across two studies with differing procedures and control groups, pre-exposure RFM resulted in more rapid fear attenuation during exposure therapy and equivocal evidence of superior fear reduction at follow-up. Overall, these findings provide preliminary evidence that a 10 or 20 second pre-exposure RFM may boost the efficiency and efficacy of exposure therapy.

Michael J. Telch

Professor
University of Texas at Austin

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