Young and old Pavlovian fear memories can be modified with extinction training during reconsolidation in humans

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.

Reconsolidation and Fear Extinction: An Update

Fear memories can be updated behaviorally by delivering extinction trials during the reconsolidation window, which results in a persistent attenuation of fear memories (Monfils et al., Science 324:951-955, 2009). This safe and non-invasive paradigm, termed retrieval-extinction (or post-retrieval extinction), has also been found to be successful at preventing the return of fear in healthy fear conditioned humans (Schiller et al., Nature 463:49-53, 2010), and in the time since its discovery, there has been an explosion of research on the use of retrieval-extinction in fear memories in humans and other animals, some of which have found a long-term reduction in conditioned responding, and some who have not. These discrepant findings have raised concerns as to whether retrieval-extinction really results in updating of the original fear memory, or if it simply enhances extinction. We will first review the progress made on elucidating the cellular mechanisms underlying the fear attenuating effects of retrieval-extinction and how they differ from traditional extinction. Special attention will be paid to the molecular events necessary for retrieval-extinction to successfully occur and how these reconsolidated memories are represented in the brain. Next, we will examine the parameters that determine whether or not a memory will be updated via extinction during the reconsolidation window (also known as boundary conditions). These boundary conditions will also be discussed as possible explanations for discrepant findings of the retrieval-extinction effect. Then we will examine the factors that can determine whether an individual's fears will successfully be attenuated by retrieval-extinction. These individual differences include genetics, age, and psychopathology. Finally, we will discuss recent attempts to bring the retrieval-extinction paradigm from the bench to the bedside for the behavioral treatment of anxiety and trauma disorders.

Effect of lysergic acid diethylamide (LSD) on reinforcement learning in humans

BACKGROUND

The non-selective serotonin 2A (5-HT2A) receptor agonist lysergic acid diethylamide (LSD) holds promise as a treatment for some psychiatric disorders. Psychedelic drugs such as LSD have been suggested to have therapeutic actions through their effects on learning. The behavioural effects of LSD in humans, however, remain incompletely understood. Here we examined how LSD affects probabilistic reversal learning (PRL) in healthy humans.

METHODS

Healthy volunteers received intravenous LSD (75 μg in 10 mL saline) or placebo (10 mL saline) in a within-subjects design and completed a PRL task. Participants had to learn through trial and error which of three stimuli was rewarded most of the time, and these contingencies switched in a reversal phase. Computational models of reinforcement learning (RL) were fitted to the behavioural data to assess how LSD affected the updating ('learning rates') and deployment of value representations ('reinforcement sensitivity') during choice, as well as 'stimulus stickiness' (choice repetition irrespective of reinforcement history).

RESULTS

Raw data measures assessing sensitivity to immediate feedback ('win-stay' and 'lose-shift' probabilities) were unaffected, whereas LSD increased the impact of the strength of initial learning on perseveration. Computational modelling revealed that the most pronounced effect of LSD was the enhancement of the reward learning rate. The punishment learning rate was also elevated. Stimulus stickiness was decreased by LSD, reflecting heightened exploration. Reinforcement sensitivity differed by phase.

CONCLUSIONS

Increased RL rates suggest LSD induced a state of heightened plasticity. These results indicate a potential mechanism through which revision of maladaptive associations could occur in the clinical application of LSD.

Verbal manipulations of learning expectancy do not enhance reconsolidation

Objectives

Pharmacological studies using propranolol suggest that if reactivation signals that new information will be learned (i.e., there is an expectation for learning) reconsolidation can be enhanced. We examined if the verbal instructions to expect new learning will enhance reconsolidation of fear memories using the post-retrieval extinction paradigm.

Methods

On day one, participants (n = 48) underwent differential fear conditioning to two images (CS+ and CS-). On day two, participants were randomly assigned to one of three groups; groups one and two had their memory for the CS+ reactivated (i.e., a single presentation of the CS+) 10 minutes prior to extinction, whereas group three did not have their memory reactivated but went right to extinction (no reactivation group). One reactivation group was told that they would learn something new about the images (expectation for learning group), and the other group was told that they would not learn anything new (no expectation for learning group). On day three, return of fear was measured following reinstatement (i.e., four shocks). Fear potentiated startle (FPS) and skin conductance response (SCR) were measured throughout.

Results

There was evidence of fear acquisition for participants for SCR but not FPS. With regards to reconsolidation, SCR increased for the CS+ and CS-in all groups from the end of extinction to the beginning of re-extinction (i.e., return of fear). For FPS, post-hoc tests conducted on the sub-group of participants showing fear learning showed that FPS remained stable in the two reactivation groups, but increased to the CS+, but not the CS- in the no reactivation group.

Implications

These findings suggest that a verbal manipulation of the expectation for learning may not be salient enough to enhance reconsolidation. Results are discussed in relation to theories on differences in between SCR, as a measure of cognitive awareness, and FPS, as a measure of fear.

Skin conductance levels and responses in Asian and White participants during fear conditioning✰

Fear conditioning paradigms are frequently used in the translational study of anxiety and fear-related disorders. Accordingly, it is important to understand whether the measurement of fear conditioning responses is systematically influenced by an individual's race. Studies have found increased pain sensitivity and smaller physiological startle responses in Asian individuals, compared to White individuals; to our knowledge, no studies have evaluated whether skin conductance response (SCR) outcomes differ between Asian and White individuals. In a series of secondary data analyses, we investigated potential differences in skin conductance level (SCL), orienting SCR, unconditioned SCR, SCR to CS+ and CS-, differential SCR, and differential SCR non-responder status. In sample 1, Asian participants (n = 97) demonstrated a significantly smaller mean differential SCR compared to White participants (n = 86). No other between group differences were observed. In sample 2, there was no difference in mean differential SCR between Asian (n = 52) and White (n = 62) participants, although more Asian participants failed to show adequate skin conductance levels for study entry. To our knowledge, this is the first study to evaluate differences between Asian and White samples using skin conductance outcomes in a fear conditioning paradigm. We detected only subtle evidence for SCR differences between Asian and White samples, unlikely to reach significance outside large studies.

The evidence for and against reactivation-induced memory updating in humans and nonhuman animals

Systematic investigation of reactivation-induced memory updating began in the 1960s, and a wave of research in this area followed the seminal articulation of "reconsolidation" theory in the early 2000s. Myriad studies indicate that memory reactivation can cause previously consolidated memories to become labile and sensitive to weakening, strengthening, or other forms of modification. However, from its nascent period to the present, the field has been beset by inconsistencies in researchers' abilities to replicate seemingly established effects. Here we review these many studies, synthesizing the human and nonhuman animal literature, and suggest that these failures-to-replicate reflect a highly complex and delicately balanced memory modification system, the substrates of which must be finely tuned to enable adaptive memory updating while limiting maladaptive, inaccurate modifications. A systematic approach to the entire body of evidence, integrating positive and null findings, will yield a comprehensive understanding of the complex and dynamic nature of long-term memory storage and the potential for harnessing modification processes to treat mental disorders driven by pervasive maladaptive memories.

The influence of dispositional cognitive reappraisal and expressive suppression on post-retrieval and standard extinction

Individual differences in the ability to habitually regulate emotion may impact the efficacy of fear memory extinction. The aim of this study was to assess the relationship between dispositional cognitive reappraisal and expressive suppression with post-retrieval and standard extinction. Fear memory and extinction were measured with the recovery of skin conductance responses. We also examined the relationship between a temporal feature of electrodermal responding (half-recovery time) and each of the emotion regulation strategies. University students (N = 80) underwent a three-day fear conditioning procedure using a within-subject design consisting of acquisition on day one, post-retrieval extinction and standard extinction on day two, and recovery test on day three. Individual difference data on self-reported levels of cognitive reappraisal, expressive suppression, trait anxiety, and depression were collected. We did not detect a relationship between the two emotion regulation strategies measured in this study and acquisition or extinction. We found, however, that increased dispositional use of cognitive reappraisal was associated with lower spontaneous recovery to both the post-retrieval extinction and standard extinction stimulus after controlling for age, trait anxiety, and depression. There were no associations between expressive suppression and conditioned responses. We also observed patterns of faster dissipation of arousal for reappraisal and slower for suppression to the conditioned stimulus during extinction training, which may represent the unique influence of each emotion strategy on the regulation of fear. We conclude greater daily use of cognitive reappraisal, but not expressive suppression, associates with extinction retention after receiving both standard and post-retrieval extinction.

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.

Positive and Neutral Updating Reconsolidate Aversive Episodic Memories via Different Routes

Aversive memories are long-lasting and prone to burden our emotional wellbeing and mental health. Yet, how to remedy the maladaptive effects of aversive memories remains elusive. Using memory reactivation and emotional updating manipulations, we investigated how positive and neutral emotion may update aversive memories for reconsolidation in humans. We found that positive updating after reactivation was equivalent to neutral updating in impairing true memories of a previous aversive event after a 12-hour wakeful delay, but induced more false memory. Moreover, additional 12-hour delay with overnight sleep did not further enlarge true memory differences, but attenuated the effect of reactivation and updating on false memory. Interestingly, the neutral rather than the positive updating reduced the emotional arousal of the aversive memory 24 hours later. Our findings could serve as references for real-world therapeutic applications regarding how positive and neutral updating may reshape aversive memories, especially when taking wake- and sleep-filled reconsolidation into account.

Interfering with fear memories by eye movement desensitization and reprocessing

OBJECTIVE

Pharmacologic and behavioral interventions that block reconsolidation of reactivated fear memory have demonstrated only limited success in modifying stronger and long-standing fear memories. Given the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) in treating PTSD, pursuit eye movements are a promising and novel intervention for studies of human memory reconsolidation. Here, we examined the efficacy of pursuit eye movements in interfering with reconsolidation of conditioned fear memories.

METHODS

We conducted a 3-day differential Pavlovian fear conditioning procedure in healthy adults, using videos of biologically prepared stimuli (tarantulas), partly reinforced with electrical shocks while recording skin conductance response (SCR) as a measure of autonomic conditioned responses. Fear conditioning was performed on Day 1. On Day 2, 38 participants were randomized into groups performing pursuit eye movements either immediately after fear memory reactivation, when the fear memory was stable, or 10 min later, when the fear memory was assumed to be more labile. On Day 3, fear memory strength was assessed by SCR to both reactivated and nonreactivated fear memories.

RESULTS

Strong differential conditioning to the spider stimuli were observed during both fear acquisition and fear memory reactivation. Reactivated fear memory conditioned responses of participants performing pursuit eye movements after a 10-min delay were significantly smaller in the reinstatement phase (0.16 μS; 95% CI [0.02, 0.31]).

CONCLUSIONS

Pursuit eye movements were effective in reducing fear-conditioned SCR in reinstatement. This result supports the theoretical proposition that EMDR can interfere with reactivated fear memory reconsolidation.

Is Reconsolidation a General Property of Memory?

Memory reconsolidation holds great hope for memory modification approaches and clinical treatments of mental disorders associated with maladaptive memories. However, it remains controversial as to whether reconsolidation is a general property of all types of memory. Especially, discrepancies have been reported in research focusing on whether declarative memory undergoes reconsolidation, and whether old memories can be reorganized after retrieval. Here, we discuss how these inconsistent results can be reconciled and what information we need to uncover for the general use of reconsolidation.

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.

Method for the identification of pharmacological intervention for the disruption of fear memory in PTSD-rat model

A large portion of the human population is exposed to traumatic events once in their lifetime, 10% of which may undergo post-traumatic stress disorder (PTSD). It is a mental condition triggered by a traumatic event resulting in severe anxiety disorder which may severely affect the daily routine life of the individual. The patient expresses the aversive memory by recalling any fear event related to the traumatic experience. The disruption of fear memory related to fear event is one of the best approaches to treat PTSD. In this regard, pharmacological interventions provide a possible way to erase or lessen the fear memory of the traumatic event. The screening and identification of drugs is one of the crucial steps to introduce new potent drugs in preclinical setup. Pavlovian fear conditioning is the well known experimental protocol to study fear memory. In this article, we are presenting a detailed method of Pavlovian fear conditioning which we have optimized in our lab for the identification of drugs having the potential to disrupt fear memory in the PTSD-rat model. In this protocol, various stages of memory formation including consolidation, reconsolidation, and extinction have been targeted to study the effect of a particular drug.•The protocol provides step by step procedure to study the effects of known or putative drugs in an animal model of PTSD.•The method also explains the separate protocols to target specific stages of memory so that one can identify the effects of drugs on a particular phase of remote or recent memory formation.

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.

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.

Impact of a reminder/extinction procedure on threat-conditioned pupil size and skin conductance responses

A reminder can render consolidated memory labile and susceptible to amnesic agents during a reconsolidation window. For the case of threat memory (also termed fear memory), it has been suggested that extinction training during this reconsolidation window has the same disruptive impact. This procedure could provide a powerful therapeutic principle for treatment of unwanted aversive memories. However, human research yielded contradictory results. Notably, all published positive replications quantified threat memory by conditioned skin conductance responses (SCR). Yet, other studies measuring SCR and/or fear-potentiated startle failed to observe an effect of a reminder/extinction procedure on the return of fear. Here we sought to shed light on this discrepancy by using a different autonomic response, namely, conditioned pupil dilation, in addition to SCR, in a replication of the original human study. N = 71 humans underwent a 3-d threat conditioning, reminder/extinction, and reinstatement, procedure with 2 CS+, of which one was reminded. Participants successfully learned the threat association on day 1, extinguished conditioned responding on day 2, and showed reinstatement on day 3. However, there was no difference in conditioned responding between the reminded and the nonreminded CS, neither in pupil size nor SCR. Thus, we found no evidence that a reminder trial before extinction prevents the return of threat-conditioned responding.

Effect of d-cycloserine on fear extinction training in adults with social anxiety disorder

Preclinical and clinical data have shown that D-cycloserine (DCS), a partial agonist at the N-methyl-d-aspartate receptor complex, augments the retention of fear extinction in animals and the therapeutic learning from exposure therapy in humans. However, studies with non-clinical human samples in de novo fear conditioning paradigms have demonstrated minimal to no benefit of DCS. The aim of this study was to evaluate the effects of DCS on the retention of extinction learning following de novo fear conditioning in a clinical sample. Eighty-one patients with social anxiety disorder were recruited and underwent a previously validated de novo fear conditioning and extinction paradigm over the course of three days. Of those, only 43 (53%) provided analyzable data. During conditioning on Day 1, participants viewed images of differently colored lamps, two of which were followed by with electric shock (CS+) and a third which was not (CS-). On Day 2, participants were randomly assigned to receive either 50 mg DCS or placebo, administered in a double-blind manner 1 hour prior to extinction training with a single CS+ in a distinct context. Day 3 consisted of tests of extinction recall and renewal. The primary outcome was skin conductance response to conditioned stimuli, and shock expectancy ratings were examined as a secondary outcome. Results showed greater skin conductance and expectancy ratings in response to the CS+ compared to CS- at the end of conditioning. As expected, this difference was no longer present at the end of extinction training, but returned at early recall and renewal phases on Day 3, showing evidence of return of fear. In contrast to hypotheses, DCS had no moderating influence on skin conductance response or expectancy of shock during recall or renewal phases. We did not find evidence of an effect of DCS on the retention of extinction learning in humans in this fear conditioning and extinction paradigm.

Remote fear memory is sensitive to reconditioning

Exposure of some individuals to recurring traumatic events from the same perpetrator or situation, such as during child abuse or domestic violence, is quite prevalent. Studies have shown that the number of traumatic events experienced is positively related to the severity of post-traumatic stress disorder and other mental disorders. Using a contextual fear conditioning (Cond1) and reconditioning (Cond2) paradigm, which were separated by either 1 or 35 days, we examined fear responses to immediate extinction and retrieval-extinction procedures after repeated fear conditioning stress. Based on the time interval between Cond1 and Cond2, the animals were divided into recent and remote fear memory groups. We observed that when Cond2 was performed in the original conditioning context in which Cond1 was performed, the reconditioned remote fear memory was resistant to the disruptive effect of immediate extinction and retrieval-extinction paradigms. Furthermore, the resistance to disruptive effects could be induced by very low shock intensities, which cannot even induce any fear response in naive animals. When Cond2 was performed in a novel context, animals with remote fear memory acquired a significantly higher fear response to the novel context. Our findings suggest that remote fear memory may be more sensitive to reconditioning and resistant to post-reconditioning disruption.

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

Experimental evidence suggests that the return of fear may be prevented by post-retrieval extinction (PRE), a procedure consisting of extinction training after the presentation of a retrieval cue. However, attempts to replicate these findings have yielded mixed results, with some studies showing diminished fear responses after PRE, whereas others show no effect on the return of fear following this procedure. The discrepancies across studies have been interpreted as evidence that there might be conditions under which PRE is not effective (boundary conditions), but these variables have yet to be fully described. We aimed to provide an overview of PRE in humans. We briefly present the theory and research that originated post-retrieval procedures with a focus on the experimental setup used in human studies. We continue with a compilation of possible experimental boundary conditions along with some questions for future research.

Memory boundaries: opening a window inspired by reconsolidation to treat anxiety, trauma-related, and addiction disorders

Pioneering research over the past two decades has shown that memories are far more malleable than we once thought, thereby highlighting the potential for new clinical avenues for treatment of psychopathology. We first briefly review the historical foundation of memory reconsolidation-a concept that refers to hypothetical processes that occur when a memory is retrieved and restored. Then, we provide an overview of the basic research on memory reconsolidation that has been done with humans and other animals, focusing on models of fear, anxiety-related disorders, and addiction, from the perspective that they all involve disorders of memory. This basic research has fuelled early stage developments of novel treatment techniques. More specifically, we consider behavioural interventions inspired by reconsolidation updating, namely retrieval-extinction techniques. We discuss the set of principles that would be needed for memory modifications within a putative reconsolidation time window, and review research that employs reconsolidation-based strategies with clinical populations. We conclude by highlighting current pitfalls and controversies surrounding the use of reconsolidation-based approaches, but end on an optimistic note for clinical research going forward. Despite the challenges, we believe that drawing on ideas from psychological science can help open up treatment innovation.

Avoidance Behavior Prevents Modification of Fear Memory During Reconsolidation

Several studies have revealed that fear recovery is prevented when extinction training is conducted after retrieval of a fear memory. Postretrieval extinction training is related to modification of memory during reconsolidation. Providing new information during reconsolidation can modify the original memory. We propose that avoidance behavior is a relevant factor that prevents subjects from obtaining new safety information during reconsolidation. Postretrieval extinction training without avoidance behavior reduced the fear response to conditioned stimulus and prevented spontaneous recovery in the current study, which corresponded with previous studies. Under the condition of postretrieval extinction training with avoidance behavior, the fear response was not reduced as much as it was in the condition without avoidance. It is possible that avoidance behavior prevents receiving new safety information during postretrieval extinction training.

Exploring the boundaries of post-retrieval extinction in healthy and anxious individuals

Over a dozen studies have examined the efficacy of post-retrieval extinction (PRE) in healthy adults in the fear conditioning laboratory, with a recent meta-analysis reporting an overall small-moderate effect on attenuating the return of fear compared to standard extinction. The current study was designed to extend PRE effects to a mixed sample of healthy and anxious individuals, explore potential moderators, and examine the benefit of PRE for a memory conditioned over multiple days. Healthy (n = 49) and anxious (n = 43) adults received either one day of acquisition followed by PRE, one day of acquisition followed by extinction, or three days of acquisition followed by PRE. Comparing participants who received one day of acquisition followed by PRE or extinction, no significant effect of PRE was observed on differential skin conductance response reinstatement or reactivity to the conditioned stimulus alone. Anxiety symptoms did not moderate outcomes. There was no difference in return of fear for anxious participants who received three days of acquisition followed by PRE versus one day of acquisition followed by PRE. These results further highlight the variability of findings in the PRE literature and need for further examination of individual difference factors that may moderate PRE effects.

Who is studied in de novo fear conditioning paradigms? An examination of demographic and stimulus characteristics predicting fear learning

A common challenge in fear conditioning studies is that a relatively large proportion of individuals fail to acquire a differential conditioned skin conductance response (SCR). Researchers have identified demographic factors associated with poorer fear learning and explored the use of different fear conditioning paradigms across various populations. However, few studies have strategically aimed to enhance acquisition by manipulating the unconditioned stimulus (UCS). In the current manuscript, we examined whether demographic factors predicted failure to condition (n = 274) and explored whether modifications to the UCS enhanced fear learning (n = 143). Results indicated that race, but not age, education, or gender, predicted failure to condition. Stepwise logistic regression demonstrated that race was the most influential of these predictors; African Americans were less likely to acquire a conditioned SCR, compared to non-African Americans. Also, use of a compound UCS (i.e., electric shock combined with a scream noise) led to nearly double the rate of acquisition of a conditioned SCR. Hence, use of a compound UCS may provide a way to reduce the number of excluded individuals in studies of fear-conditioned SCR and thereby improve the representativeness of research samples.

Behavioral interventions to eliminate fear responses

Fear memory underlies anxiety-related disorders, including posttraumatic stress disorder (PTSD). PTSD is a fear-based disorder, characterized by difficulties in extinguishing the learned fear response and maintaining extinction. Currently, the first-line treatment for PTSD is exposure therapy, which forms an extinction memory to compete with the original fear memory. However, the extinguished fear often returns under numerous circumstances, suggesting that novel methods are needed to eliminate fear memory or facilitate extinction memory. This review discusses research that targeted extinction and reconsolidation to manipulate fear memory. Recent studies indicate that sleep is an active state that can regulate memory processes. We also discuss the influence of sleep on fear memory. For each manipulation, we briefly summarize the neural mechanisms that have been identified in human studies. Finally, we highlight potential limitations and future directions in the field to better translate existing interventions to clinical settings.

Mood Regulation Focused CBT Based on Memory Reconsolidation, Reduced Suicidal Ideation and Depression in Youth in a Randomised Controlled Study

Suicide attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused cognitive behavioural therapy (MR-CBT) (n = 15) was compared with treatment as usual (TAU) (n = 12) in a group of depressed adolescents in a clinical setting. MR-CBT focuses on mood regulation by means of counter conditioning with memory reconsolidation being the proposed mechanism of change. Subjects practice keeping emotionally positive memories to diminish the emotional impact of negative memories. Symptoms of depression were tested with a short version of the Mood and Feelings Questionnaire (SMFQ), and wellbeing with the World Health Organization 5 Wellbeing Index (WHO-5). Suicidal events were rated according to the clinical interview Columbia Suicide Severity Rating Scale (C-SSRS). Suicidal events at the end of treatment were significantly reduced in the MR-CBT group, but not in the TAU group. Depression and wellbeing improved significantly in both treatment groups. While far from conclusive, the results are encouraging enough to suggest that further studies should be undertaken to examine whether psychotherapy focusing on mood regulation for young individuals at risk might enhance secondary prevention of suicide.

Is it possible to modify fear memories in humans with extinction training within a single day?

Extinction procedures have been used widely in the study of fear memories, and different positions have been adopted regarding the efficacy of such procedures and the mechanisms involved. It has been argued that extinction may interfere with the consolidation of the fear memory if the procedure is applied with the appropriate timing after acquisition. However, the opposite position is also held, that is, that the extinction does not achieve an elimination of the fear response. The aim of the present study is to test the short-term effects of immediate extinction in fear reduction when this extinction is preceded by a retrieval trial. For this, a procedure similar to that employed by Schiller et al. (Nature 463(7277): 49-53, 2010) was used, but in a single day and with white noise as an aversive unconditioned stimulus. The results indicate that a CS+ single retrieval trial before the extinction procedure after acquisition was more effective in fear reduction than standard immediate extinction.

An Additional Prior Retrieval Alters the Effects of a Retrieval-Extinction Procedure on Recent and Remote Fear Memory

Several studies have shown that the isolated retrieval of a consolidated fear memory can induce a labile phase, during which extinction training can prevent the reinstatement, a form of relapse in which fear response to a fear-provoking context returns when a mild shock is presented. However, fear memory retrieval may also have another opposing result: the enhancement of fear memory. This implies that the fear memory trace can be modified by a brief retrieval. Unclear is whether the fear-impairing effect of retrieval-extinction (RE) is altered by a prior brief retrieval. The present study investigated the responses of recent and remote fear memories to the RE procedure after the presentation of an additional prior retrieval (priRet). We found that a single RE procedure effectively blocked the reinstatement of 2-day recent contextual fear memory. The memory-impairing effect of the RE procedure on recent fear was not observed when priRet was presented 6 or 24 h before the RE procedure. In contrast to the 2-day recent memory, the RE procedure failed to block the reinstatement of 36-day remote fear memory but successfully disrupted the return of remote fear memory after priRet. This memory-disruptive effect on remote memory did not occur when priRet was performed in a novel context. Nimodipine administration revealed that the blockade of priRet-induced processes recovered the effects of the RE procedure on both recent and remote fear memories. Our findings suggest that the susceptibility of recent and remote fear memories to RE procedures can be altered by an additional retrieval.

Can Memories of Traumatic Experiences or Addiction Be Erased or Modified? A Critical Review of Research on the Disruption of Memory Reconsolidation and Its Applications

Recent research suggests that the mere act of retrieving a memory can temporarily make that memory vulnerable to disruption. This process of "reconsolidation" will typically restabilize the neural representation of the memory and foster its long-term storage. However, the process of reconsolidating the memory takes time to complete, and during this limited time window, the original memory may be modified either by the presentation of new information or with pharmacological agents. Such findings have prompted rising interest in using disruption during reconsolidation as a clinical intervention for anxiety, posttraumatic stress, and substance use disorders. However, "boundary conditions" on memory reconsolidation may pose significant obstacles to clinical translation. The aim of this article is to critically examine the nature of these boundary conditions, their neurobiological substrates, and the potential effect they may have on disruption of reconsolidation as a clinical intervention. These boundary conditions also highlight potential constraints on the reconsolidation phenomenon and suggest a limited role for memory updating consistent with evolutionary accounts of associative learning for threat and reward. We conclude with suggestions for future research needed to elucidate the precise conditions under which reconsolidation disruption may be clinically useful.

A reminder before extinction strengthens episodic memory via reconsolidation but fails to disrupt generalized threat responses

A reminder can temporarily renew flexibility of consolidated memories, referred to as reconsolidation. Pavlovian threat-conditioning studies suggest that a reminder can renew flexibility of threat responses but that episodic memories remain stable. In contrast, outside the threat-conditioning domain, studies testing memory for word lists or stories find that a reminder can renew flexibility of episodic memory. This discrepancy in findings leaves it unclear if episodic memories reconsolidate, or only Pavlovian responses. Here we unite the different approaches in the field and show that a reminder can retroactively strengthen episodic memory for Pavlovian threat-conditioned events, but that, in contrast to threat-conditioning studies with simple sensory stimuli, extinction after a reminder fails to prevent recovery of generalized threat responses. Our results indicate the episodic memories also reconsolidate, allowing strengthening of relevant memories. These findings also suggest that generalized threat responses and episodic memories are less susceptible to be modified by reminder-interventions procedures.

An Update on Memory Reconsolidation Updating

The reactivation of a stored memory in the brain can make the memory transiently labile. During the time it takes for the memory to restabilize (reconsolidate) the memory can either be reduced by an amnesic agent or enhanced by memory enhancers. The change in memory expression is related to changes in the brain correlates of long-term memory. Many have suggested that such retrieval-induced plasticity is ideally placed to enable memories to be updated with new information. This hypothesis has been tested experimentally, with a translational perspective, by attempts to update maladaptive memories to reduce their problematic impact. We review here progress on reconsolidation updating studies, highlighting their translational exploitation and addressing recent challenges to the reconsolidation field.

Memory Reconsolidation Interference as an Emerging Treatment for Emotional Disorders: Strengths, Limitations, Challenges, and Opportunities

Experimental research on emotional memory reconsolidation interference, or the induction of amnesia for previously established emotional memory, has a long tradition, but the potential of that research for the development of novel interventions to treat psychological disorders has been recognized only recently. Here we provide an overview of basic research and clinical studies on emotional memory reconsolidation interference. We point out specific advantages of interventions based on memory reconsolidation interference over traditional treatment for emotional disorders. We also explain how findings from basic research suggest limitations and challenges to clinical translation that may help to understand why clinical trials have met with mixed success so far and how their success can be increased. In closing, we preview new intervention approaches beyond the induction of amnesia that the phenomenon of memory reconsolidation may afford for alleviating the burden imposed by emotional memories and comment on theoretical controversies regarding the nature of memory reconsolidation.

The computational nature of memory modification

Retrieving a memory can modify its influence on subsequent behavior. We develop a computational theory of memory modification, according to which modification of a memory trace occurs through classical associative learning, but which memory trace is eligible for modification depends on a structure learning mechanism that discovers the units of association by segmenting the stream of experience into statistically distinct clusters (latent causes). New memories are formed when the structure learning mechanism infers that a new latent cause underlies current sensory observations. By the same token, old memories are modified when old and new sensory observations are inferred to have been generated by the same latent cause. We derive this framework from probabilistic principles, and present a computational implementation. Simulations demonstrate that our model can reproduce the major experimental findings from studies of memory modification in the Pavlovian conditioning literature.

Extinction during reconsolidation eliminates recovery of fear conditioned to fear-irrelevant and fear-relevant stimuli

Extant literature suggests that extinction training delivered during the memory reconsolidation period is superior to traditional extinction training in the reduction of fear recovery, as it targets the original fear memory trace. At present it is debated whether different types of fear memories are differentially sensitive to behavioral manipulations of reconsolidation. Here, we examined post-reconsolidation recovery of fear as a function of conditioned stimulus (CS) fear-relevance, using the unconditioned stimulus (US) to reactivate and destabilize conditioned fear memories. Participants (N = 56; 25 male; M = 24.39 years, SD = 7.71) in the US-reactivation and control group underwent differential fear conditioning to fear-relevant (spiders/snakes) and fear-irrelevant (geometric shapes) CSs on Day 1. On Day 2, participants received either reminded (US-reactivation) or non-reminded extinction training. Tests of fear recovery, conducted 24 h later, revealed recovery of differential electrodermal responding to both classes of CSs in the control group, but not in the US-reactivation group. These findings indicate that the US reactivation-extinction procedure eliminated recovery of extinguished responding not only to fear-irrelevant, but also to fear-relevant CSs. Contrasting previous reports, our findings show that post-reconsolidation recovery of conditioned responding is not a function of CS fear-relevance and that persistent reduction of fear, conditioned to fear-relevant CSs, can be achieved through behavioral manipulations of reconsolidation.

Translational Approaches Targeting Reconsolidation

Maladaptive learned responses and memories contribute to psychiatric disorders that constitute a significant socio-economic burden. Primary treatment methods teach patients to inhibit maladaptive responses, but do not get rid of the memory itself, which explains why many patients experience a return of symptoms even after initially successful treatment. This highlights the need to discover more persistent and robust techniques to diminish maladaptive learned behaviours. One potentially promising approach is to alter the original memory, as opposed to inhibiting it, by targeting memory reconsolidation. Recent research shows that reactivating an old memory results in a period of memory flexibility and requires restorage, or reconsolidation, for the memory to persist. This reconsolidation period allows a window for modification of a specific old memory. Renewal of memory flexibility following reactivation holds great clinical potential as it enables targeting reconsolidation and changing of specific learned responses and memories that contribute to maladaptive mental states and behaviours. Here, we will review translational research on non-human animals, healthy human subjects, and clinical populations aimed at altering memories by targeting reconsolidation using biological treatments (electrical stimulation, noradrenergic antagonists) or behavioural interference (reactivation-extinction paradigm). Both approaches have been used successfully to modify aversive and appetitive memories, yet effectiveness in treating clinical populations has been limited. We will discuss that memory flexibility depends on the type of memory tested and the brain regions that underlie specific types of memory. Further, when and how we can most effectively reactivate a memory and induce flexibility is largely unclear. Finally, the development of drugs that can target reconsolidation and are safe for use in humans would optimize cross-species translations. Increasing the understanding of the mechanism and limitations of memory flexibility upon reactivation should help optimize efficacy of treatments for psychiatric patients.

Disruption of human fear reconsolidation using imaginal and in vivo extinction

Memories are not set forever, but can be altered following reactivation, which renders memories malleable, before they are again stabilized through reconsolidation. Fear memories can be attenuated by using extinction during the malleable period. The present study adopts a novel form of extinction, using verbal instructions, in order to examine whether fear memory reconsolidation can be affected by an imaginal exposure. The extinction using verbal instructions, called imaginal extinction, consists of a recorded voice encouraging participants to imagine the scene in which fear was acquired, and to envision the stimuli before their inner eye. The voice signals stimuli appearance, and identical to standard (in vivo) extinction, participants discover that the conditioned stimulus no longer is followed by unconditioned stimulus (UCS). In this way, imaginal extinction translates clinically used imaginal exposure into the standard experimental fear conditioning paradigm. Fear was acquired by pairing pictorial stimuli with an electric shock UCS. Then, both standard and imaginal extinction were given following fear memory reactivation, either after 10min, within the reconsolidation interval, or after 6h, outside of the reconsolidation interval. In vivo and imaginal extinction produced comparable reductions in conditioned responses during extinction and importantly, both disrupted reconsolidation of conditioned fear and abolished stimulus discrimination between reinforced and non-reinforced cues. Thus, disrupted reconsolidation of fear conditioning can be achieved without in vivo stimulus presentation, through purely cognitive means, suggesting possible therapeutic applications.

Post-retrieval extinction in adolescence prevents return of juvenile fear

Traumatic experiences early in life can contribute to the development of mood and anxiety disorders that manifest during adolescence and young adulthood. In young rats exposed to acute fear or stress, alterations in neural development can lead to enduring behavioral abnormalities. Here, we used a modified extinction intervention (retrieval+extinction) during late adolescence (post-natal day 45 [p45]), in rats, to target auditory Pavlovian fear associations acquired as juveniles (p17 and p25). The effects of adolescent intervention were examined by assessing freezing as adults during both fear reacquisition and social transmission of fear from a cagemate. Rats underwent testing or training at three time points across development: juvenile (p17 or p25), adolescent (p45), and adult (p100). Retrieval+extinction during late adolescence prevented social reinstatement and recovery over time of fears initially acquired as juveniles (p17 and p25, respectively). Adolescence was the only time point tested here where retrieval+extinction prevented fear recall of associations acquired 20+ days earlier.

Modification of Fear Memory by Pharmacological and Behavioural Interventions during Reconsolidation

Background

Dysfunctional fear responses play a central role in many mental disorders. New insights in learning and memory suggest that pharmacological and behavioural interventions during the reconsolidation of reactivated fear memories may increase the efficacy of therapeutic interventions. It has been proposed that interventions applied during reconsolidation may modify the original fear memory, and thus prevent the spontaneous recovery and reinstatement of the fear response.

Methods

We investigated whether pharmacological (propranolol) and behavioural (reappraisal, multisensory stimulation) interventions reduce fear memory, and prevent reinstatement of fear in comparison to a placebo control group. Eighty healthy female subjects underwent a differential fear conditioning procedure with three stimuli (CS). Two of these (CS+) were paired with an electric shock on day 1. On day 2, 20 subjects were pseudo-randomly assigned to either the propranolol or placebo condition, or underwent one of the two behavioural interventions after one of the two CS+ was reactivated. On day 3, all subjects underwent an extinction phase, followed by a reinstatement test. Dependent variables were US expectancy ratings, fear-potentiated startle, and skin conductance response.

Results

Differential fear responses to the reactivated and non-reactivated CS+ were observed only in the propranolol condition. Here, the non-reactivated CS+ evoked stronger fear-potentiated startle-responses compared to the placebo group. None of the interventions prevented the return of the extinguished fear response after re-exposure to the unconditioned stimulus.

Conclusions

Our data are in line with an increasing body of research stating that the occurrence of reconsolidation may be constrained by boundary conditions such as subtle differences in experimental manipulations and instructions. In conclusion, our findings do not support a beneficial effect in using reconsolidation processes to enhance effects of psychotherapeutic interventions. This implies that more research is required before therapeutic interventions may benefit from a combination with reconsolidation processes.

Trait Anxiety Modulates Brain Activity during Performance of Verbal Fluency Tasks

Trait anxiety is thought to be associated with pathological anxiety, and a risk factor for psychiatric disorders. The present study examines the brain mechanisms associated with trait anxiety during the performing of verbal fluency tasks. The aim is to show how trait anxiety modulates executive functions as measured by verbal fluency, and to explore the link between verbal fluency and anxiety due to the putative negative biases in high-anxious individuals. Seven tasks of verbal fluency were used: letter "k," "f," verbs, "animals," "vehicles," "joy," and "fear." The results of 35 subjects (whole sample), and 17 subjects (nine men, eight women) selected from the whole sample for the low/high-anxious groups on the basis of Trait Anxiety scores were analyzed. The subjects were healthy, Polish speaking, right-handed and aged from 20 to 35 years old. fMRI (whole-brain analysis with FWE corrections) was used to show the neural signals under active participation in verbal fluency tasks. The results confirm that trait anxiety slightly modulates neural activation during the performance of verbal fluency tasks, especially in the more difficult tasks. Significant differences were found in brain activation during the performance of more complex tasks between individuals with low anxiety and those with high anxiety. Greater activation in the right hemisphere, frontal gyri, and cerebellum was found in people with low anxiety. The results reflect better integration of cognitive and affective capacities in individuals with low anxiety.

An Initial Test of Reconsolidation in Disgust-Related Learning and Extinction

This study examines whether the spacing of a single unreinforced retrieval trial relative to extinction learning allows for "rewriting" the original disgust association, thereby preventing the return of disgust using a paradigm that employs disgust-relevant unconditioned stimuli (US). During conditioning, disgusting US were paired with a color square that served as the conditioned stimuli (CS). Participants (n = 54) then returned to the lab 24 hours later and received a "reactivation" intervention which consisted of one unpaired presentation of the CS+. Participants were then randomized to receive extinction trials either 10 min (Group A) or 6 hours (Group B) after reactivation. A third control group (Group C) did not receive the reactivation manipulation before extinction. Participants returned 24 hours later for additional extinction trials and at a 1-month follow-up for disgust reinstatement. Although the paradigm resulted in participants evaluating the CS+ as significantly more unpleasant after being associated with a disgust-relevant US, extinction learning within the reconsolidation window did not influence self-reported reduction or return of disgust. However, there was some evidence suggesting that those who received reactivation (Groups A and B), regardless of timing, evaluated the CS+ as less unpleasant after extinction relative to acquisition, whereas this pattern was not observed among those who did not receive reactivation (Group C). The implications of these findings for anxiety-related disorders in which disgust has been implicated will be discussed.

Compound stimulus extinction reduces spontaneous recovery in humans

Fear-related behaviors are prone to relapse following extinction. We tested in humans a compound extinction design ("deepened extinction") shown in animal studies to reduce post-extinction fear recovery. Adult subjects underwent fear conditioning to a visual and an auditory conditioned stimulus (CSA and CSB, respectively) separately paired with an electric shock. The target CS (CSA) was extinguished alone followed by compound presentations of the extinguished CSA and nonextinguished CSB. Recovery of conditioned skin conductance responses to CSA was reduced 24 h after compound extinction, as compared with a group who received an equal number of extinction trials to the CSA alone.

Why Forget? On the Adaptive Value of Memory Loss

Is forgetting mostly a positive force in human life? On the surface, this seems to not be the case, and people often associate memory loss with frustration in their everyday lives. Yet, forgetting does not have exclusively negative consequences; it also serves valuable, indeed vital, functions. In this article, I review and reflect on evidence from various areas of research, and I argue that forgetting serves at least three broad purposes. First, it is part of emotion regulation, and it promotes subjective well-being by limiting access to negative memories and by reducing unpleasant affect. Forgetting thereby allows for positivity and painlessness. Second, it is involved in knowledge acquisition, and it provides a basis for obtaining semantic and procedural knowledge by allowing for abstraction and automatization. Third, forgetting is part of context attunement, and it orients information processing for the present and the future by facilitating environmental sensitivity and by ensuring that knowledge is current, which enables timeliness and updating. Overall, I suggest that forgetting helps people to be happy, well-structured, and context sensitive, and thereby that it serves fundamentally adaptive functions.