A review of boundary conditions and variables involved in the prevention of return of fear after post-retrieval extinction

Conflict Dynamics of Post-Retrieval Extinction: A Comparative Analysis of Unconditional and Conditional Reminders Using Skin Conductance Responses and EEG

The post-retrieval extinction paradigm, rooted in reconsolidation theory, holds promise for enhancing extinction learning and addressing anxiety and trauma-related disorders. This study investigates the impact of two reminder types, mild US-reminder (US-R) and CS-reminder (CS-R), along with a no-reminder extinction, on fear recovery prevention in a categorical fear conditioning paradigm. Scalp EEG recordings during reminder and extinction processes were conducted in a three-day design. Results show that the US-R group exhibits a distinctive extinction learning pattern, characterized by a slowed-down yet successful process and pronounced theta-alpha desynchronization (source-located in the prefrontal cortex) during CS processing, followed by enhanced synchronization (source-located in the anterior cingulate) after shock cancellation in extinction trials. These neural dynamics correlate with the subtle advantage of US-R in the Day 3 recovery test, presenting faster spontaneous recovery fading and generally lower fear reinstatement responses. Conversely, the CS reminder elicits CS-specific effects in later episodic tests. The unique neural features of the US-R group suggest a larger prediction error and subsequent effortful conflict learning processes, warranting further exploration.

Face your fears: attenuating remote fear memories by reconsolidation-updating

Traumatic events generate some of the most enduring memories, yet little is known about how long-lasting fear memories can be attenuated. In this review, we collect the surprisingly sparse evidence on remote fear memory attenuation from both animal and human research. What is becoming apparent is twofold: although remote fear memories are more resistant to change compared with recent ones, they can nevertheless be attenuated when interventions are targeted toward the period of memory malleability instigated by memory recall, the reconsolidation window. We describe the physiological mechanisms underlying remote reconsolidation-updating approaches and highlight how they can be enhanced through interventions promoting synaptic plasticity. By capitalizing on an intrinsically relevant phase of memory, reconsolidation-updating harbors the potential to permanently alter remote fear memories.

Making Leaps and Hitting Boundaries in Reconsolidation: Overcoming Boundary Conditions to Increase Clinical Translatability of Reconsolidation-based Therapies

Reconsolidation results in the restabilisation, and thus persistence, of a memory made labile by retrieval, and interfering with this process is thought to enable modification or weakening of the original trace. As such, reconsolidation-blockade has been a focus of research aiming to target the maladaptive memories underlying mental health disorders, including post-traumatic stress disorder and drug addiction. Current first-line therapies are not effective for all patients, and a substantial proportion of those for whom therapies are effective later relapse. A reconsolidation-based intervention would be invaluable as an alternative treatment for these conditions. However, the translation of reconsolidation-based therapies to the clinic presents a number of challenges, with arguably the greatest being the overcoming of the boundary conditions governing the opening of the reconsolidation window. These include factors such as the age and strength of memory, and can broadly be divided into two categories: intrinsic features of the targeted memory itself, and parameters of the reactivation procedure used. With maladaptive memory characteristics inevitably varying amongst individuals, manipulation of the other limitations imposed by procedural variables have been explored to circumvent the boundary conditions on reconsolidation. Although several apparently discrepant results remain to be reconciled and these limitations yet to be truly defined, many studies have produced successful results which encouragingly demonstrate that boundary conditions may be overcome using various proposed strategies to enable translation of a reconsolidation-based intervention to clinical use.

Guided reactivation of personal phobic memories prior to exposure exercises prevents the renewal of fear responses in subjects with claustrophobic fears

BACKGROUND AND OBJECTIVES

Basic research suggest behavioral strategies for interferencing the reconsolidation of fear memories to be a promising approach in reducing clinical fears. However, first clinical studies revealed mixed results highlighting the need to identify boundary conditions. We experimentally tested the specific hypothesis that post-retrieval threat exposure prevents context renewal usually observed in protocols without fear memory reactivation.

METHODS

In a preliminary investigation forty-three individuals with claustrophobic fears reactivated the individual phobic memory or not during a guided emotional imagery task and then performed standardized threat exposure to provide new information for updating the original memory. During retests seven and 28 days later, the context was different from that during treatment in half of the subjects.

RESULTS

In those who were guided, the fear memory was successfully reactivated as indexed by increased skin conductance level (SCL) during the imagery of personal scenes relative to neutral scenes. During retests the subjects of the memory non-activation group showed a return of reported fear after context change that, however, was not observed after post-retrieval exposure. In line, autonomic arousal (SCL) decreased over time in the memory reactivation group only if the context changed during retest.

LIMITATIONS

Limited sample size and the inclusion of an analog sample reduce the generalizability of the results.

CONCLUSIONS

The reactivation of fear memory prior to treatment through guided imagery of past personal phobic situations prevented contextual renewal of phobic fears which was observed in those subjects without reactivation of memory.

No evidence for disruption of reconsolidation of conditioned threat memories with a cognitively demanding intervention

Simultaneous execution of memory retrieval and cognitively demanding interventions alter the subjective experience of aversive memories. This principle can be used in treatment to target traumatic memories. An often-used interpretation is that cognitive demand interferes with memory reconsolidation. Laboratory models applying this technique often do not meet some important procedural steps thought necessary to trigger reconsolidation. It remains therefore unclear whether cognitively demanding interventions can alter the reconsolidation process of aversive memories. Here, 78 (41 included) healthy participants completed an established 3-day threat conditioning paradigm. Two conditioned stimuli were paired with a shock (CS+ s) and one was not (CS-). The next day, one CS+ (CS+ R), but not the other (CS+), was presented as a reminder. After 10 min, participants performed a 2-back working memory task. On day three, we assessed retention. We found successful acquisition of conditioned threat and retention (CS+ s > CS-). However, SCRs to the CS+ R and the CS+ during retention did not significantly differ. Although threat conditioning was successful, the well-established cognitively demanding intervention did not alter the reconsolidation process of conditioned threat memories. These findings challenge current views on how cognitively demand may enhance psychotherapy-outcome.

Can contingency rehearsal during the interval between a retrieval cue and extinction training change the effects of post-retrieval extinction?

Return of fear may be prevented by post-retrieval extinction (PRE), a procedure consisting of presenting a stimulus that was present during conditioning (retrieval cue) prior to extinction training. However, recent evidence suggests that there might be circumstances under which PRE is not effective to prevent the return of fear (boundary conditions), but some of these conditions remain unknown. We explored if rehearsing the CS, US or CS-US contingency during the interval between the retrieval cue and extinction training might change the effects of PRE. One day after differential fear conditioning, healthy human participants (n = 83) underwent either standard extinction (control condition, n = 31) or two different PRE procedures, one in which participants rehearsed the CS-US contingency during the interval between the retrieval cue and extinction (rehearsal condition, n = 25), or another in which they underwent a verbal fluency task directing their attention away from the experimental contingencies during this interval (nonrehearsal condition, n = 27). Return of fear in a reinstatement test was observed in both control and rehearsal conditions, whereas in the nonrehearsal condition there was a generalized increase in response to the CS+ and CS-. Differential response in the rehearsal condition had values slightly smaller than the control group with no significant differences from both control and nonrehearsal conditions. These results suggest that the overt behavior of participants during the interval between a retrieval cue and extinction training might change the effects of PRE in healthy human participants, but further manipulations of these variables are needed to confirm these findings.

Prevention of the return of extinguished fear by disrupting the interaction of neuronal nitric oxide synthase with its carboxy-terminal PDZ ligand

Exposure therapy based on the extinction of fear memory is first-line treatment for post-traumatic stress disorder (PTSD). However, fear extinction is relatively easy to learn but difficult to remember, extinguished fear often relapses under a number of circumstances. Here, we report that extinction learning-induced association of neuronal nitric oxide synthase (nNOS) with its carboxy-terminal PDZ ligand (CAPON) in the infralimbic (IL) subregion of medial prefrontal cortex negatively regulates extinction memory and dissociating nNOS-CAPON can prevent the return of extinguished fear in mice. Extinction training significantly increases nNOS-CAPON association in the IL. Disruptors of nNOS-CAPON increase extracellular signal-regulated kinase (ERK) phosphorylation and facilitate the retention of extinction memory in an ERK2-dependent manner. More importantly, dissociating nNOS-CAPON after extinction training enhances long-term potentiation and excitatory synaptic transmission, increases spine density in the IL, and prevents spontaneous recovery, renewal and reinstatement of remote fear of mice. Moreover, nNOS-CAPON disruptors do not affect other types of learning. Thus, nNOS-CAPON can serve as a new target for treating PTSD.

Neural substrates of propranolol-induced impairments in the reconsolidation of nicotine-associated memories in smokers

The majority of smokers relapse even after successfully quitting because of the craving to smoking after unexpectedly re-exposed to smoking-related cues. This conditioned craving is mediated by reward memories that are frequently experienced and stubbornly resistant to treatment. Reconsolidation theory posits that well-consolidated memories are destabilized after retrieval, and this process renders memories labile and vulnerable to amnestic intervention. This study tests the retrieval reconsolidation procedure to decrease nicotine craving among people who smoke. In this study, 52 male smokers received a single dose of propranolol (n = 27) or placebo (n = 25) before the reactivation of nicotine-associated memories to impair the reconsolidation process. Craving for smoking and neural activity in response to smoking-related cues served as primary outcomes. Functional magnetic resonance imaging was performed during the memory reconsolidation process. The disruption of reconsolidation by propranolol decreased craving for smoking. Reactivity of the postcentral gyrus in response to smoking-related cues also decreased in the propranolol group after the reconsolidation manipulation. Functional connectivity between the hippocampus and striatum was higher during memory reconsolidation in the propranolol group. Furthermore, the increase in coupling between the hippocampus and striatum positively correlated with the decrease in craving after the reconsolidation manipulation in the propranolol group. Propranolol administration before memory reactivation disrupted the reconsolidation of smoking-related memories in smokers by mediating brain regions that are involved in memory and reward processing. These findings demonstrate the noradrenergic regulation of memory reconsolidation in humans and suggest that adjunct propranolol administration can facilitate the treatment of nicotine dependence. The present study was pre-registered at ClinicalTrials.gov (registration no. ChiCTR1900024412).

Retrieval-extinction as a reconsolidation-based treatment for emotional disorders:Evidence from an extinction retention test shortly after intervention

The retrieval-extinction paradigm, a non-invasive memory intervention that is methodologically similar to exposure therapy, has significant clinical application prospects for targeting memory reconsolidation. However, it is difficult to distinguish whether the effect of preventing the return of fear by retrieval-extinction depends upon the reconsolidation-based mechanism or extinction-based mechanism. This study tested extinction retention shortly after intervention to determine whether retrieval-extinction is a reconsolidation-based approach or extinction-based approach as well as exploring the effect of sleep. In our experiment, the effects on fear conditional memory of standard extinction, retrieval-extinction, and extinction-retrieval were compared using the fear test at 3 h, 12 h without a night's sleep, and 12 h with a night's sleep after the intervention. The results showed that standard extinction and extinction-retrieval procedures reduce fear 3 h after intervention, while retrieval-extinction procedure reduces fear 12 h with a night's sleep after the intervention. The results suggest that standard extinction and extinction-retrieval create an extinction memory trace that competes with original memory trace, only retrieval-extinction update the original memory trace through memory reconsolidation. These findings provide solid evidence for the reconsolidation mechanism of the retrieval-extinction paradigm and highlight the effect of sleep on memory reconsolidation.

Destabilizing Different Strengths of Fear Memories Requires Different Degrees of Prediction Error During Retrieval

Reactivation of consolidated memories can induce a labile period, in which these reactivated memories might be susceptible to change and need reconsolidation. Prediction error (PE) has been recognized as a necessary boundary condition for memory destabilization. Moreover, memory strength is also widely accepted as an essential boundary condition to destabilize fear memory. This study investigated whether different strengths of conditioned fear memories require different degrees of PE during memory reactivation in order for the memories to become destabilized. Here, we assessed the fear-potentiated startle and skin conductance response, using the post-retrieval extinction procedure. A violation of expectancy (PE) was induced during retrieval to reactivate enhanced (unpredictable-shock) or ordinary (predictable-shock) fear memories that were established the day before. Results showed that a PE retrieval before extinction can prevent the return of predictable-shock fear memory but cannot prevent the return of unpredictable-shock fear memory, indicating that a single PE is insufficient to destabilize enhanced fear memory. Therefore, we further investigated whether increasing the degree of PE could destabilize enhanced fear memory using different retrieval strategies (multiple PE retrieval and unreinforced CS retrieval). We found that spontaneous recovery of enhanced fear memory was prevented in both retrieval strategies, but reinstatement was only prevented in the multiple PE retrieval group, suggesting that a larger amount of PE is needed to destabilize enhanced fear memory. The findings suggest that behavioral updating during destabilization requires PE, and the degree of PE needed to induce memory destabilization during memory retrieval depends on the strength of fear memory. The study indicates that memory reconsolidation inference can be used to destabilize stronger memories, and the findings shed lights on the treatment of posttraumatic stress disorders and anxiety disorders.

Targeting the reconsolidation of traumatic memories with a brief 2-session imaginal exposure intervention in post-traumatic stress disorder

BACKGROUND

Evidence suggests that extinction during memory reconsolidation diminishes the return of defensive responses. In order to translate these effects to the clinical setting, we tested whether retrieving a traumatic memory and delivering a brief two-sessions imaginal exposure intervention during its reconsolidation would produce stronger decreases in reactivity to these memories than standard imaginal exposure method.

METHODS

Participants with Post-Traumatic Stress Disorder (PTSD) had either their traumatic (n = 21) or a neutral (n = 21) memory retrieved 1 h before an imaginal exposure session for two consecutive days. One day before and one day after, participants were exposed to script-driven imagery of their traumatic event, during which skin conductance responses were measured and, immediately after, subjective responses were assessed by means of Visual Analogue Scales.

RESULTS

Traumatic retrieval improved the physiological, but not the subjective effects of imaginal exposure intervention on over-reactivity to traumatic memories.

CONCLUSIONS

Our results suggest that delivering extinction-based treatments over the reconsolidation of traumatic memories may enhance its effects. These results suggest that this is a promising path toward the development of new therapeutic techniques.

Evaluation of an angiotensin Type 1 receptor blocker on the reconsolidation of fear memory

Inhibition of the angiotensin type 1 receptor (AT₁R) has been shown to decrease fear responses in both humans and rodents. These effects are attributed to modulation of extinction learning, however the contribution of AT₁R to alternative memory processes remains unclear. Using classic Pavlovian conditioning combined with radiotelemetry and whole-genome RNA sequencing, we evaluated the effects of the AT₁R antagonist losartan on fear memory reconsolidation. Following the retrieval of conditioned auditory fear memory, animals were given a single intraperitoneal injection of losartan or saline. In response to the conditioned stimulus (CS), losartan-treated animals exhibited significantly less freezing at 24 h and 1 week; an effect that was dependent upon memory reactivation and independent of conditioned cardiovascular reactivity. Using an unbiased whole-genome RNA sequencing approach, transcriptomic analysis of the basolateral amygdala (BLA) identified losartan-dependent differences in gene expression during the reconsolidation phase. These findings demonstrate that post-retrieval losartan modifies behavioral and transcriptomic markers of conditioned fear memory, supporting an important regulatory role for this receptor in reconsolidation and as a potential pharmacotherapeutic target for maladaptive fear disorders such as PTSD.

Investigating the efficacy of the reminder-extinction procedure to disrupt contextual threat memories in humans using immersive Virtual Reality

Upon reactivation, consolidated memories can enter a temporary labile state and require restabilisation, known as reconsolidation. Interventions during this reconsolidation period can disrupt the reactivated memory. However, it is unclear whether different kinds of memory that depend on distinct brain regions all undergo reconsolidation. Evidence for reconsolidation originates from studies assessing amygdala-dependent memories using cue-conditioning paradigms in rodents, which were subsequently replicated in humans. Whilst studies providing evidence for reconsolidation of hippocampus-dependent memories in rodents have predominantly used context conditioning paradigms, studies in humans have used completely different paradigms such as tests for wordlists or stories. Here our objective was to bridge this paradigm gap between rodent and human studies probing reconsolidation of hippocampus-dependent memories. We modified a recently developed immersive Virtual Reality paradigm to test in humans whether contextual threat-conditioned memories can be disrupted by a reminder-extinction procedure that putatively targets reconsolidation. In contrast to our hypothesis, we found comparable recovery of contextual conditioned threat responses, and comparable retention of subjective measures of threat memory, episodic memory and exploration behaviour between the reminder-extinction and standard extinction groups. Our result provide no evidence that a reminder before extinction can prevent the return of context conditioned threat memories in humans.

Boundary conditions of post-retrieval extinction: A direct comparison of low and high partial reinforcement

Research has shown that a single presentation of the conditioned stimulus prior to extinction training can diminish conditioned responses. However, replication has proven difficult and appears to be limited by boundary conditions. Here we tested the boundary condition of memory strength by comparing the effect of reinforcement rate to assess its role in post-retrieval extinction. Eighty university students had undergone a three-day fear conditioning experiment in which two partial reinforcement schedules (40%, 80%) were applied. The findings indicated that both low and high partial reinforcement groups did not demonstrate recovery of conditioned responses after post-retrieval extinction. In contrast, both groups demonstrated significant recovery to standard extinction with significantly greater recovery in the 80% group relative to the 40% group. Additionally, we found that greater physiological arousal during memory retrieval significantly predicted recovery of fear at test phase. We conclude that when compared to a lower partial reinforcement schedule, a higher partial reinforcement resulted in the formation of a stronger memory as indicated by greater physiological arousal during memory reactivation and recovery of conditioned responses after standard extinction, but that it does not function as a boundary condition of post-retrieval extinction. These data are significant because it is the first study to investigate the effect of varying partial reinforcement schedules on fear recovery and add to the body of literature that continue to identify sources of failure in the application of post-retrieval extinction.

Preventing the return of fear in humans using reconsolidation update mechanisms: A verification report of Schiller et al. (2010)

In a highly influential report, Schiller et al. (2010) demonstrated long-lasting fear reduction in humans when conducting extinction training shortly following fear memory reactivation. While trying to experimentally replicate the critical conditions of Schiller et al. (2010, Experiment 1), we discovered several irregularities in their paper. Criteria for participant exclusion and the number of excluded participants were misreported; qualitative experimenter decisions actually determined their participant inclusions. Moreover, their statistical analyses were internally inconsistent. After corresponding with the original authors, we received their original data files, allowing us to replicate the reported analyses to verify their results. Here, we report the results of seven separate sets of analyses, three replicating the analyses reported by Schiller et al. (2010) and four applying more principled approaches to participant exclusion, thus including different subsets of the total datasets available, to deduce the influence of specific exclusions and experimenter decisions on the results. For Experiment 1, we were mostly able to replicate the analyses contained in the original report when applying the same qualitative exclusions. However, we found that all of the differences in fear recovery between reactivation-extinction and regular extinction reported by Schiller et al. (2010) were dependent on the qualitative exclusions that they made. With any of the principled approaches to participant exclusion, the degree of fear recovery was highly similar between groups. For Experiment 2, a similar analysis was not possible due to a lack of available data for the excluded participants. Hence, we conducted a verification analysis on the original sample only, which failed to confirm the differences in fear recovery reported by Schiller et al. (2010). Together with the re-analyses, we report a number of additional issues with the way Schiller et al. (2010) processed, analyzed, and reported their data that indicate that their results are unreliable and flawed.

No persistent attenuation of fear memories in humans: A registered replication of the reactivation-extinction effect

It has been proposed that memory retrieval can destabilize consolidated memories, after which they need to be reconsolidated in order to be retained. The presentation of relevant information during memory reconsolidation could then result in the modification of a destabilized memory trace, by allowing the memory trace to be updated before being reconsolidated. In line with this idea, Schiller et al. (2010) have demonstrated that memory retrieval shortly before extinction training can prevent the later recovery of conditioned fear responding that is observed after regular extinction training. Those findings have been the subject of considerable controversy, due in part to theoretical reasons but also due to a number of failures to obtain similar results in conceptual replication attempts. Here, we report the results of a highly powered, direct, independent replication of the critical conditions of Schiller et al. (2010, Experiment 1). Due to misrepresentation of the exclusion criteria in the original Schiller et al. (2010) report, data collection was considerably delayed. When we eventually managed to attain our pre-registered sample size, we found that we could not observe any benefit of reactivation-extinction over regular extinction training in preventing recovery of conditioned fear. The results of the present study, along with the mixed findings in the literature and the misreporting in Schiller et al. (2010), give cause to question whether there is robust evidence that reactivation-extinction prevents the return of fear in humans.