Spacing extinction trials alleviates renewal and spontaneous recovery

Treatment Approaches for Posttraumatic Stress Disorder Derived From Basic Research on Fear Extinction

This brief review article will describe treatment approaches for posttraumatic stress disorder (PTSD) based on findings from basic research. The focus of this review will be fear conditioning and extinction models, which provide a translational model of PTSD that can help translate basic research in nonhuman animals through well-controlled trials confirming the efficacy of treatment approaches in humans with PTSD such as prolonged exposure therapy. Specific cognitive aspects of fear extinction processes, including consolidation and reconsolidation, are reviewed along with behavioral and pharmacological treatment strategies based on basic research in these areas including attempts to prevent the development of PTSD as well as the treatment of chronic PTSD. Pharmacological, behavioral, and device-based augmentation strategies of PTSD treatment based in basic science findings are reviewed, including those that disrupt noradrenergic receptor processes, medications that act on NMDA receptors, physical exercise, cannabinoids, estradiol, dexamethasone, yohimbine, losartan, dopamine, and MDMA, along with the evidence for their efficacy in human clinical samples. While fear extinction provides an exciting translational opportunity to improve PTSD based on basic science findings, we review limitations and challenges of the extant literature as well as future directions.

Enhancing Associative Learning in Rats With a Computationally Designed Training Protocol

Background

Learning requires the activation of protein kinases with distinct temporal dynamics. In Aplysia, nonassociative learning can be enhanced by a computationally designed learning protocol with intertrial intervals (ITIs) that maximize the interaction between fast-activated PKA (protein kinase A) and slow-activated ERK (extracellular signal-regulated kinase). Whether a similar strategy can enhance associative learning in mammals is unknown.

Methods

We simulated 1000 training protocols with varying ITIs to predict an optimal protocol based on empirical data for PKA and ERK dynamics in rat hippocampus. Adult male rats received the optimal protocol or control protocols in auditory fear conditioning and fear extinction experiments. Immunohistochemistry was performed to evaluate pCREB (phosphorylated cAMP response element binding)\protein levels in brain regions that have been implicated in fear acquisition.

Results

Rats exposed to the optimal conditioning protocol with irregular ITIs exhibited impaired extinction memory acquisition within the session using a standard footshock intensity, and stronger fear memory retrieval and spontaneous recovery with a weaker footshock intensity, compared with rats that received massed or spaced conditioning protocols with fixed ITIs. Rats exposed to the optimal extinction protocol displayed improved extinction of contextual fear memory and reduced spontaneous recovery compared with rats that received standard extinction protocols. Moreover, the optimal conditioning protocol increased pCREB levels in the dentate gyrus of the dorsal hippocampus, suggesting enhanced induction of long-term potentiation.

Conclusions

These findings demonstrate that a computational model-driven behavioral intervention can enhance associative learning in mammals and may provide insight into strategies to improve cognition in humans.

The Basolateral Amygdala: The Core of a Network for Threat Conditioning, Extinction, and Second-Order Threat Conditioning

Threat conditioning, extinction, and second-order threat conditioning studied in animal models provide insight into the brain-based mechanisms of fear- and anxiety-related disorders and their treatment. Much attention has been paid to the role of the basolateral amygdala (BLA) in such processes, an overview of which is presented in this review. More recent evidence suggests that the BLA serves as the core of a greater network of structures in these forms of learning, including associative and sensory cortices. The BLA is importantly regulated by hippocampal and prefrontal inputs, as well as by the catecholaminergic neuromodulators, norepinephrine and dopamine, that may provide important prediction-error or learning signals for these forms of learning. The sensory cortices may be required for the long-term storage of threat memories. As such, future research may further investigate the potential of the sensory cortices for the long-term storage of extinction and second-order conditioning memories.

A model for recovery-from-extinction effects in Pavlovian conditioning and exposure therapy

Exposure therapy is an effective intervention for anxiety-related problems. The mechanism of this intervention has been the extinction procedure in Pavlovian conditioning, and this application has provided many successful instances for the prevention of relapse. However, traditional associative theories cannot comprehensively explain many findings. In particular, it is difficult to explain the recovery-from-extinction effects, which is the reappearance of the conditioned response following extinction. In this paper, we propose an associative model that is a mathematical extension of Bouton's (1993, Psychological Bulletin, 114, 80-99) model for the extinction procedure. The core of our model is that the asymptotic strength of the inhibitory association depends on the degree of excitatory association retrieved in a context in which a conditioned stimulus (CS) is presented and that the retrieval is determined by the similarity between contexts during both reinforcement and non-reinforcement and the retrieval context. Our model provides an explanation of the recovery-from-extinction effects, and implications for exposure therapy.

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.

EXPRESS: Determinants of Extinction in a Streamed Trial Procedure

The strength of an association between a cue and its outcome is influenced by both the probability of the outcome given the cue and the probability of the outcome in the absence of the cue. Once an association has been formed, extinction is the procedure for reducing responding indicative of the association by repeated presentation of the cue without the outcome. The present experiments tested whether cumulative frequency and/or cumulative duration of these events affects associative extinction in a streamed trial extinction procedure with human participants. Experiment 1 assessed the effects of parametric manipulations of the frequency and duration of either the cue by itself or cue-outcome coabsence. In Experiment 1, participants proved relatively insensitive to manipulation of the event's duration. In contrast, judgments of the association by participants decreased when the frequency of cue-alone events was increased, even when the durations of those events were decreased so that cumulative exposure to the cue was equated. No effect of either the duration or the frequency of cue-outcome coabsence was observed. Experiment 2 demonstrated that the effect of cue-alone (i.e., extinction trial) frequency generalizes across a wide range of parameters for initial acquisition achieved by cue-outcome pairings. Experiment 3 tested for an interaction between event duration during initial learning and event duration during extinction. Collectively, these results indicate that the cumulative frequency, and not the cumulative duration, of extinction trials as well as the duration of the cue-outcome coabsences between extinction trials controls the effectiveness of an extinction procedure.

Extinction trial spacing across days differentially impacts fear regulation in adult and adolescent male mice

Fear regulation changes as a function of age and adolescence is a key developmental period for the continued maturation of fear neural circuitry. A consistent finding in the literature is diminished extinction retention in adolescents. However, these studies often directly compare adolescents to adults using a single protocol and therefore provide little insight into learning parameters that improve adolescent fear regulation. Studies in adults highlight the benefits of spaced learning over massed learning. These findings have been extended to fear regulation, with adult rodents exhibiting improved extinction learning and retention when cues are distributed over days versus a single session. However, similar studies have not been performed in adolescents. Here, we systematically examine the impact of trial spacing across days on fear regulation. Adolescent or adult male mice were exposed to one of three extinction paradigms that presented the same number of trials but differed in the temporal distribution of trials across days (one day, two days, or four days). We found that introducing consolidation events into the protocol improves adult extinction learning and short-term extinction retention but these effects disappear after two weeks. For adolescents, all three protocols were comparably effective in reducing freezing across extinction training and improved retention at both short-term and long-term fear recall time points relative to extinction-naive mice. These findings suggest that extinction protocols that incorporate consolidation events are optimal for adults but additional booster training may be required for enduring efficacy. In contrast, protocols incorporating either massed or spaced presentations show immediate and enduring benefits for adolescents.

The Role of Context Conditioning in the Reinstatement of Responding to an Alcohol-Predictive Conditioned Stimulus

Re-exposure to an unconditioned stimulus (US) can reinstate extinguished conditioned responding elicited by a conditioned stimulus (CS). We tested the hypothesis that the reinstatement of responding to an appetitive CS is driven by an excitatory association formed between the US and the context that the US was ingested in during US re-exposure. Male, Long-Evans rats were acclimated to drinking alcohol (15%, v/v) in the home-cage, then trained to associate an auditory CS with an alcohol-US that was delivered into a fluid port for oral intake. During subsequent extinction sessions, the CS was presented as before, but without alcohol. After extinction, rats were re-exposed to alcohol as in training, but without the CS (alcohol re-exposure). 24h later at test, the CS was presented as in training, but without alcohol. First, we tested the effect of extinguishing the context-alcohol association, formed during alcohol re-exposure, on reinstatement. Conducting four context extinction sessions across four days (spaced extinction) after the alcohol re-exposure session did not impact reinstatement. However, four context extinction sessions conducted across two days (massed extinction) prevented reinstatement. Next, we conducted alcohol re-exposure in a context that either differed from, or was the same as, the test context. One alcohol re-exposure session in a different context did not affect reinstatement, however, three alcohol re-exposure sessions in a different context significantly reduced reinstatement during the first CS trial. These results partially support the view that a context-US association formed during US re-exposure drives the reinstatement of responding to an appetitive, alcohol-predictive CS.

Recovery-from-extinction effects in an anuran amphibian: renewal effect, but no reinstatement

Recovery-from-extinction effects in which a conditioned response returns after extinction have been shown in mammals, birds and fish. Thus, these effects appear to be conserved among vertebrates; however, they have yet to be investigated in amphibians. Using prey catching conditioning in the fire-bellied toad (Bombina orientalis), we tested if renewal and reinstatement occurred after extinction when subjects were respectively re-exposed to the context or reinforcer used during conditioning. For renewal, a different context was used during extinction and thus renewal tests assessed if external contextual cues associated during conditioning stimulated prey catching performance. For reinstatement, the reinforcer withheld during extinction was simply delivered again prior to a test assessing if internal cues associated with recent prey consumption stimulated prey catching performance. Conditioning followed a fixed ratio 5 schedule of reinforcement, where five attempts to capture a cricket stimulus displayed on a computer screen were reinforced by delivery of a single live cricket. Performance was measured as the time to reach five prey catching attempts. A significant improvement in prey catching performance during conditioning followed by deterioration with extinction was seen in the experiments. Upon return to the context used for conditioning after extinction, toads showed a renewal effect whereby they displayed faster performance during testing compared to the end of extinction. Conversely, toads showed no reinstatement effect because pre-feeding of a cricket did not influence performance during the test that followed extinction. Reinstatement could have been lost in amphibian phylogeny due to secondary simplification of the nervous system.

Using Extinction-Renewal to Circumvent the Memory Strength Boundary Condition in Fear Memory Reconsolidation

Reconsolidation is a process by which memories are destabilized, updated, and then restabilized. Strong memories are resistant to undergoing reconsolidation. Here, we addressed whether an overtrained fear memory could be made susceptible to reconsolidation by first extinguishing, and then renewing, the memory. Rats were trained with ten tone-footshock pairings, followed by eight days of tone extinction in the training context. The next day, rats were placed into a second context and memory for the tone was renewed/reactivated with a single tone presentation. Immediately following reactivation, rats received an injection of midazolam or vehicle. Rats were then tested for freezing to the tone in a third context. Midazolam had no effect in rats that did not undergo tone extinction, but significantly attenuated freezing to the tone in extinguished rats. Thus, rats that received tone extinction underwent tone memory reconsolidation following its renewal. In a second experiment, we administered the reactivation session and midazolam injections prior to extinction. Midazolam had no effect and rats extinguished at a rate similar to controls. These data suggest that strong emotional memories are capable of updating following weakening of memory expression through extinction.

The lesser evil: Pavlovian-instrumental transfer & aversive motivation

While our understanding of appetitive motivation includes accounts of rich cognitive phenomena, such as choice, sensory-specificity and outcome valuation, the same is not true in aversive processes. A highly sophisticated picture has emerged of Pavlovian fear conditioning and extinction, but progress in aversive motivation has been somewhat limited to these fundamental behaviors. Many differences between appetitive and aversive stimuli permit different kinds of analyses; a widely used procedure in appetitive studies that can expand the scope of aversive motivation is Pavlovian-instrumental transfer (PIT). Recently, this motivational transfer effect has been used to examine issues pertaining to sensory-specificity and the nature of defensive control in avoidance learning. Given enduring controversies and unresolved criticisms surrounding avoidance research, PIT offers a valuable, well-controlled procedure with which to similarly probe this form of motivation. Furthermore, while avoidance itself can be criticized as artificial, PIT can be an effective model for how skills learned through avoidance can be practically applied to encounters with threatening or fearful stimuli and stress. Despite sensory-related challenges presented by the limited aversive unconditioned stimuli typically used in research, transfer testing can nevertheless provide valuable information on the psychological nature of this historically controversial phenomenon.

Failures of memory and the fate of forgotten memories

This review is intended primarily to provide cognitive benchmarks and perhaps a new mindset for behavioral neuroscientists who study memory. Forgetting, defined here broadly as all types of decreases in acquired responding to stimulus-specific eliciting cues, is commonly attributed to one or more of the following families of mechanisms: (1) (4) associative interference by information similar to, but different from the target information, (2) spontaneous decay of memory with increasing retention intervals, (3) displacement from short-term memory by irrelevant information, and (4) inadequate retrieval cues at test. I briefly review each of these families and discuss data suggesting that many apparent instances of spontaneous forgetting and displacement from short-term memory can be viewed as variants of inadequate retrieval cues and associative interference. The potential for recovery of target information from each of these families of forgetting without further relevant training is then reviewed, with a conclusion that most forgetting is due to retrieval failure as opposed to irreversible erasure of memory. The more general point is made that there are logical problems with ever talking about attenuating or erasing a memory as a consequence of conventional forgetting or disrupted consolidation/reconsolidation. Consideration is then given to the frequently overlooked but highly beneficial consequences of most forgetting. Lastly, the major variables that moderate forgetting are summarized, including (a) the similarities of the target information including training context to the explicit retrieval cues and context present at test, (b) the similarities of potentially interfering acquired information to the retrieval cues and context present at test, and (c) the retention interval for the target information relative to that for the potentially interfering information. Appropriate manipulation of these variables can reduce forgetting, and increase forgetting when desired.

The clinical potential of augmented reality

Augmented reality (AR) is a rapidly emerging technology that superimposes digital objects onto real-world scenes as viewed in real time through a smartphone, tablet, or headset. Whereas AR has been adopted for retail, entertainment, and professional training, it also has potential as a novel, mobile, and efficacious treatment modality for psychological disorders. In particular, extinction-based therapies (e.g., anxiety, substance use disorders) could utilize AR to present stimuli in natural environments, enhancing generalizability beyond the clinic. The limited psychological literature on AR has focused on the treatment of simple phobias. Here, with the goal of bringing this technology to the attention of clinicians and researchers, we describe AR, contrast it with virtual reality, review the theoretical foundation for extinction-based therapies, provide examples for the treatment of substance use disorders, and identify theoretical, practical, and implementation-based research questions.

Randomized controlled trial of d-cycloserine in cocaine dependence: Effects on contingency management and cue-induced cocaine craving in a naturalistic setting

Cocaine dependence constitutes a significant public health concern. This randomized, double-blind, placebo-controlled trial tested a novel approach to reducing cocaine use among cocaine-dependent individuals with d-cycloserine, a drug known to enhance learning and some learning-based therapies. Urine samples and cocaine craving were assessed across three phases: induction (Weeks 1-2), treatment (Weeks 3-5; urinalysis-based contingency management plus exposure therapy), and posttreatment (Weeks 6-7). During the treatment phase, either 50 mg of d-cycloserine or placebo was administered after delivery of urinalysis feedback with potential monetary reward and before exposure therapy sessions in naturalistic contexts individually associated with cocaine use. d-cycloserine significantly improved learning on an operant laboratory task. Contingency management significantly reduced cocaine use and craving. d-cycloserine did not significantly affect cocaine use or craving in the treatment phase. Craving significantly increased for the d-cycloserine group during the post treatment phase. Therefore, although the study showed that d-cycloserine was capable of improving learning, enhancement of learning-based therapy was not observed. Moreover, no differences in behavioral measures of cocaine demand (cocaine purchasing task) or monetary or sexual delay discounting were observed across phases or between groups in any phase. These results are somewhat consistent with previous findings suggesting that d-cycloserine administration increases cocaine craving, although they differ from other findings showing that d-cycloserine administration reduces alcohol or nicotine cravings. Methodological variables (e.g., guided vs. unguided exposure therapy sessions, length of extinction exposure) likely play a role in dissimilar findings observed across studies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel

BACKGROUND

Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).

METHODS

Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.

RESULTS

Five classes, namely rapid responder (7-17%), steep linear responder (14-22%), gradual responder (30-34%), non-responder (27-33%), and symptom exacerbation (7-13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.

CONCLUSIONS

Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.

Spacing of cue-approach training leads to better maintenance of behavioral change

The maintenance of behavioral change over the long term is essential to achieve public health goals such as combatting obesity and drug use. Previous work by our group has demonstrated a reliable shift in preferences for appetitive foods following a novel non-reinforced training paradigm. In the current studies, we tested whether distributing training trials over two consecutive days would affect preferences immediately after training as well as over time at a one-month follow-up. In four studies, three different designs and an additional pre-registered replication of one sample, we found that spacing of cue-approach training induced a shift in food choice preferences over one month. The spacing and massing schedule employed governed the long-term changes in choice behavior. Applying spacing strategies to training paradigms that target automatic processes could prove a useful tool for the long-term maintenance of health improvement goals with the development of real-world behavioral change paradigms that incorporate distributed practice principles.

A preregistered, direct replication attempt of the retrieval-extinction effect in cued fear conditioning in rats

In 2009, Monfils and colleagues proposed a behavioral procedure that was said to result in a permanent attenuation of a previously established fear memory, thereby precluding a possible return of fear after extinction (Monfils, Cowansage, Klann, & LeDoux, 2009). By presenting a single retrieval trial one hour before standard extinction training, they found an enduring reduction of fear. The retrieval-extinction procedure holds great clinical potential, particularly for anxiety patients, but the findings are not undisputed, and several conceptual replications have failed to reproduce the effect. These failures have largely been attributed to small procedural differences. This preregistered study is the first endeavor to exactly replicate three key experiments of the original report by Monfils et al. (2009), thereby gauging the robustness of their seminal findings. Despite adhering to the original procedures as closely as possible, we did not find any evidence for reduced return of fear with the retrieval-extinction procedure relative to regular extinction training, as assessed through spontaneous recovery, reinstatement and renewal. Behavior of animals in the control condition (extinction only) was comparable to that in the original studies and provided an adequate baseline to reveal differences with the retrieval-extinction condition. Our null findings indicate that the effect sizes in the original paper may have been inflated and question the legitimacy of previously proposed moderators of the retrieval-extinction effect. We argue that direct experimental evaluation of purported moderators of the retrieval-extinction effect will be key to shed more light on its nature and prerequisites.

A comparison of behavioral and pharmacological interventions to attenuate reactivated fear memories

Two experiments using rats in a contextual fear memory preparation compared two approaches to reduce conditioned fear: (1) pharmacological reconsolidation blockade and (2) reactivation-plus-extinction training. In Experiment 1, we explored different combinations of reactivation-plus-extinction parameters to reduce conditioned fear and attenuate reacquisition. In Experiment 2, memory reactivation was followed by extinction training or administration of midazolam (MDZ) (vs. vehicle) to reduce conditioned fear and attenuate spontaneous recovery. We found both treatments to be equally effective in both experiments. This study suggests that parameters leading to memory destabilization during reactivation are critical to observe long-lasting effects of MDZ or reactivation plus extinction.

The Spacing Effect for Structural Synaptic Plasticity Provides Specificity and Precision in Plastic Changes

In contrast to trials of training without intervals (massed training), training trials spaced over time (spaced training) induce a more persistent memory identified as long-term memory (LTM). This phenomenon, known as the spacing effect for memory, is poorly understood. LTM is supported by structural synaptic plasticity; however, how synapses integrate spaced stimuli remains elusive. Here, we analyzed events of structural synaptic plasticity at the single-synapse level after distinct patterns of stimulation in motoneurons of Drosophila We found that the spacing effect is a phenomenon detected at synaptic level, which determines the specificity and the precision in structural synaptic plasticity. Whereas a single pulse of stimulation (massed) induced structural synaptic plasticity, the same amount of stimulation divided in three spaced stimuli completely prevented it. This inhibitory effect was determined by the length of the interstimulus intervals. The inhibitory effect of the spacing was lost by suppressing the activity of Ras or mitogen-activated protein kinase, whereas the overexpression of Ras-WT enhanced it. Moreover, dividing the same total time of stimulation into five or more stimuli produced a higher precision in the number of events of plasticity. Ras mutations associated with intellectual disability abolished the spacing effect and led neurons to decode distinct stimulation patterns as massed stimulation. This evidence suggests that the spacing effect for memory may result from the effect of the spacing in synaptic plasticity, which appears to be a property not limited to neurons involved in learning and memory. We propose a model of spacing-dependent structural synaptic plasticity.SIGNIFICANCE STATEMENT Long-term memory (LTM) induced by repeated trials spaced over time is known as the spacing effect, a common property in the animal kingdom. Altered mechanisms in the spacing effect have been found in animal models of disorders with intellectual disability, such as Noonan syndrome. Although LTM is sustained by structural synaptic plasticity, how synapses integrate spaced stimuli and decode them into specific plastic changes remains elusive. Here, we show that the spacing effect is a phenomenon detected at the synaptic level, which determines the properties of the response in structural plasticity, including precision of such response. Whereas suppressing or enhancing Ras/mitogen-activated protein kinase signaling changed how synapses decode a pattern of stimuli, a disease-related Ras allele abolished the spacing effect for plastic changes.

Stepping back from 'persistence and relapse' to see the forest: Associative interference

Historically, there has been considerable interest in a large variety of forms of associative interference. However, various factors including interest in clinical application and perhaps recent funding priorities have resulted in a narrowed focus on one particular instance of interference, extinction, with relative neglect of other types of interference. We have been using the existing literature and conducting new experiments to determine whether there is a consistent set of rules governing the occurrence and persistence of two-phase associative interference across (a) proactive and retroactive interference, (b) cue and outcome interference, (c) the type of training in phase 1 (excitatory, inhibitory, or simple nonreinforcement), and (d) the type of training in phase 2 (excitatory, inhibitory, or simple nonreinforcement). Our hope is that a return to more general questions concerning associative interference might reveal broad truths concerning the nature of forgetting. Identifying global principles of associative interference may also help us better appreciate the nature of extinction, including how it can be enhanced and made more enduring, as well as how it can be minimized and made more fleeting.

Disgust and imaginal exposure to memories of sexual trauma: Implications for the treatment of posttraumatic stress

OBJECTIVE

Emerging evidence identifies disgust as a common and persistent reaction following sexual victimization that is linked to posttraumatic stress disorder (PTSD). Importantly, evidence suggests that compared with fear, disgust may be less responsive to repeated exposure, which may have implications for the treatment of PTSD. The current study sought to fill a gap in the existing literature by examining reductions in sexual trauma cue-elicited disgust and anxiety upon repeated imaginal exposure.

METHOD

Seventy-two women with a history of sexual victimization completed a single laboratory-based session that involved repeated imaginal exposure to idiographic disgust- and fear-focused sexual trauma scripts.

RESULTS

Results demonstrated that although anxiety and disgust declined at similar rates across exposure trials (t = -.24, p = .81), ratings of disgust (B0 = 61.93) were elevated compared with ratings of anxiety at initiation (B0 = 51.03; t = 4.49, p < .001) of exposure even when accounting for severity of PTSD symptoms. Moreover, change in disgust significantly predicted improvement in script-elicited PTSD symptoms across the course of exposure for individuals exhibiting significant decline in anxiety (B = .006, t = 2.00, p = .048). Change in script-elicited PTSD symptoms was minimal (and was not predicted by the decline in disgust) for individuals exhibiting less change in anxiety (B = -.002, t = -0.46, p = .65).

CONCLUSION

These results add to an increasing literature documenting the importance of disgust in the development, maintenance, and treatment of sexual-trauma-related PTSD. (PsycINFO Database Record

The right time to learn: mechanisms and optimization of spaced learning

For many types of learning, spaced training, which involves repeated long inter-trial intervals, leads to more robust memory formation than does massed training, which involves short or no intervals. Several cognitive theories have been proposed to explain this superiority, but only recently have data begun to delineate the underlying cellular and molecular mechanisms of spaced training, and we review these theories and data here. Computational models of the implicated signalling cascades have predicted that spaced training with irregular inter-trial intervals can enhance learning. This strategy of using models to predict optimal spaced training protocols, combined with pharmacotherapy, suggests novel ways to rescue impaired synaptic plasticity and learning.

Implications of learning theory for developing programs to decrease overeating

Childhood obesity is associated with medical and psychological comorbidities, and interventions targeting overeating could be pragmatic and have a significant impact on weight. Calorically dense foods are easily available, variable, and tasty which allows for effective opportunities to learn to associate behaviors and cues in the environment with food through fundamental conditioning processes, resulting in measurable psychological and physiological food cue reactivity in vulnerable children. Basic research suggests that initial learning is difficult to erase, and that it is vulnerable to a number of phenomena that will allow the original learning to re-emerge after it is suppressed or replaced. These processes may help explain why it may be difficult to change food cue reactivity and overeating over the long term. Extinction theory may be used to develop effective cue-exposure treatments to decrease food cue reactivity through inhibitory learning, although these processes are complex and require an integral understanding of the theory and individual differences. Additionally, learning theory can be used to develop other interventions that may prove to be useful. Through an integration of learning theory, basic and translational research, it may be possible to develop interventions that can decrease the urges to overeat, and improve the weight status of children.

Histone deacetylase inhibition facilitates massed pattern-induced synaptic plasticity and memory

Massed training is less effective for long-term memory formation than the spaced training. The role of acetylation in synaptic plasticity and memory is now well established. However, the role of this important protein modification in synaptic plasticity induced by massed pattern of stimulation or memory induced by massed training is not well understood. Here we show that increasing the level of acetylation enhances long-term potentiation induced by massed pattern of high frequency stimulation. Furthermore, enhancing acetylation level facilitates long-term memory by massed training. Thus, increasing acetylation level facilitates synaptic plasticity and memory by massed patterns.

A dissociation between recognition and reactivation: The renewal effect at 3 months of age

Extinction allows organisms to adapt to an ever-changing environment. Despite its theoretical and applied significance, extinction has never been systematically studied with human infants. Using the operant mobile task, we examined whether 3-month-olds would exhibit evidence of original learning following extinction. In a recognition paradigm, infants exhibited renewal when tested in the acquisition context (ABA renewal) or a neutral context (ABC and AAB renewal) 1 day following extinction (Experiment 1a) and spontaneous recovery 3 days following extinction (Experiment 1b). In Experiments 2a-2b, we used a reminder paradigm to examine whether the extinguished response could be reinstated after the operant response had been forgotten. We failed, however, to find reinstatement of extinguished responding after spontaneous forgetting, regardless of the reminder and test contexts. We attributed this retention failure to competing responses at test. Although extinguished responding is recovered during infancy, this effect is elusive after the response has been forgotten.

Configurations of the interoceptive discriminative stimulus effects of ethanol and nicotine with two different exteroceptive contexts in rats: Extinction & recovery

Interoceptive states interact with exteroceptive contexts in modulating operant behavior, which is maintained by its consequences. Evaluating discriminative stimulus control by overlapping interoceptive and exteroceptive configurations (gestalts) and the contribution of each modality may be clinically important for understanding aspects of relapsing behavior (e.g., drug abuse). With rats, the current investigation used a completely counterbalanced one-manipulandum operant drug discrimination procedure that established discriminative stimulus control between nicotine (0.3mg/kg) in one exteroceptive context and EtOH (1.0g/kg) in a differing exteroceptive context. One combined interoceptive-exteroceptive condition occasioned sessions of food reinforcement (S(D)) and the other counterbalanced condition occasioned sessions of non-reinforcement (S(Δ)). Each stimulus modality contributed to discriminative control, but to lesser extents than the combined intero-exteroceptive compound configurations (Experiments 1 & 2). In Experiment 1, responding was extinguished in the interoceptive stimulus conditions alone in a neutral exteroceptive context, but then renewed by reconfiguring the drugs with the exteroceptive contexts, and reversed in the opposing exteroceptive contexts. In Experiment 2, responding was extinguished in the interoceptive and exteroceptive contexts separately. Reconfiguration of the full intero-exteroceptive compound configurations did not promote recovery. These results suggest that interoceptive and exteroceptive discriminative control can be methodologically configured in modulating operant behavior during acquisition, extinction, and recovery of behavior; however, configuring interoceptive and exteroceptive discriminative stimuli do not appear to function as unique cues that differ from each stimulus modality alone. Clinical implications are discussed.

Effects of systematic cue exposure through virtual reality on cigarette craving

INTRODUCTION

Cigarette cravings have been associated with less successful attempts to quit smoking and a greater likelihood of relapse after smoking cessation. Background craving refers to a relatively steady and continuous experience of craving, while cue-induced craving refers to phases of intense craving triggered by cues associated with smoking. Cue exposure treatment (CET) involves repeated exposure to stimuli associated with substance use in order to reduce craving responses. However, mixed results have been found regarding the effect of CET on both types of craving. The aim of this study was to assess the effect of systematic virtual reality cue exposure treatment (VR-CET) on background and cue-induced cravings.

METHODS

Participants were 48 treatment-seeking smokers. The VR-CET consisted of prolonged exposure sessions to several interactive virtual environments. The VR-CET was applied once a week over 5 weeks. An individualized hierarchy of exposure was drawn up for each patient starting from the easiest virtual environment. Background and cue-induced cravings were recorded in each session.

RESULTS

Cue-induced craving decreased over each session as a result of prolonged exposure. VR-CET also reduced cue-induced and background cravings across the 5 sessions, showing a cumulative effect across the exposure sessions.

CONCLUSIONS

Our results evidenced the utility of VR-CET in reducing both types of cigarette craving. A combination of CET through VR with psychological treatments may improve current treatments for smoking cessation.

Behavioral techniques for attenuating the expression of fear associations in an animal model of anxiety

BACKGROUND AND OBJECTIVES

Recent data indicate that extinguished fear often returns when the testing conditions differ from those of treatment. Several manipulations including extensive extinction training, extinction in multiple contexts, and spacing the extinction trials and sessions reduce the return of fear. Moreover, extensive extinction and extinction in multiple contexts summate in reducing return of fear, and the spacing of the extinction trials and the spacing of extinction sessions summate in reducing return of fear. Here we evaluated whether these techniques also attenuate the context specificity of latent inhibition, and whether they summate to further decrease fear responding at test.

METHODS

In two experiments, with rats as subjects in a lick suppression preparation, we assessed the effects of massive CS preexposure, CS preexposure in multiple contexts, and of spacing the CS-preexposure trials and sessions, in reducing the context specificity of latent inhibition.

RESULTS

Fear responding was attenuated by all four manipulations. Moreover, extensive CS preexposure in multiple contexts, and conjoint spacing of the CS-preexposure trials and sessions, were more effective in reducing the context specificity of latent inhibition than each manipulation alone.

LIMITATIONS

Our experimental designs evaluated degrees of context specificity of latent inhibition but omitted groups in which latent inhibition was assessed without a context shift away from the context of latent inhibition treatment. This precluded us from drawing conclusions concerning absolute (as opposed to relative) levels of recovery from latent inhibition.

CONCLUSIONS

Techniques effective in decreasing the return of conditioned fear following extinction are also effective in decreasing the context specificity of latent inhibition in an animal model of anxiety. Fear and anxiety disorders might be prevented in anxious human participants with the same techniques used here, but that is still an empirical question.

Can fear extinction be enhanced? A review of pharmacological and behavioral findings

There is considerable interest, from both a basic and clinical standpoint, in gaining a greater understanding of how pharmaceutical or behavioral manipulations alter fear extinction in animals. Not only does fear extinction in rodents model exposure therapy in humans, where the latter is a cornerstone of behavioral intervention for anxiety disorders such as post-traumatic stress disorder and specific phobias, but also understanding more about extinction provides basic information into learning and memory processes and their underlying circuitry. In this paper, we briefly review three principal approaches that have been used to modulate extinction processes in animals and humans: a purely pharmacological approach, the more widespread approach of combining pharmacology with behavior, and a purely behavioral approach. The pharmacological studies comprise modulation by: brain derived neurotrophic factor (BDNF), d-cycloserine, serotonergic and noradrenergic drugs, neuropeptides, endocannabinoids, glucocorticoids, histone deacetylase (HDAC) inhibitors, and others. These studies strongly suggest that extinction can be modulated by drugs, behavioral interventions, or their combination, although not always in a lasting manner. We suggest that pharmacotherapeutic manipulations provide considerable promise for promoting effective and lasting fear reduction in individuals with anxiety disorders. This article is part of a Special Issue entitled 'Memory enhancement'.

Associative Accounts of Recovery-from-Extinction Effects

Recovery-from-extinction effects (e.g., spontaneous recovery, renewal, reinstatement, and facilitated reacquisition) have become the focus of much research in recent years. However, despite a great deal of empirical data, there are few theoretical explanations for these effects. This paucity poses a severe limitation on our understanding of these behavioral effects, impedes advances in uncovering neural mechanisms of response recovery, and reduces our potential to prevent relapse after exposure therapy. Towards correcting this oversight, this review takes prominent models of associative learning that have been used in the past and continue to be used today to explain Pavlovian conditioning and extinction, and assesses how each model can be applied to account for recovery-from-extinction effects. The models include the Rescorla-Wagner (1972) model, Mackintosh's (1975) attentional model, Pearce and Hall's (1980) attentional model, Wagner's (1981) SOP model, Pearce's (1987) configural model, McLaren and Mackintosh's (2002) elemental model, and Stout and Miller's (2007) SOCR (comparator hypothesis) model. Each model is assessed for how well it explains or does not explain the various recovery-from-extinction phenomena. We offer some suggestions for how the models might be modified to account for these effects in those instances in which they initially fail.

Epigenetic priming of memory updating during reconsolidation to attenuate remote fear memories

Traumatic events generate some of the most enduring forms of memories. Despite the elevated lifetime prevalence of anxiety disorders, effective strategies to attenuate long-term traumatic memories are scarce. The most efficacious treatments to diminish recent (i.e., day-old) traumata capitalize on memory updating mechanisms during reconsolidation that are initiated upon memory recall. Here, we show that, in mice, successful reconsolidation-updating paradigms for recent memories fail to attenuate remote (i.e., month-old) ones. We find that, whereas recent memory recall induces a limited period of hippocampal neuroplasticity mediated, in part, by S-nitrosylation of HDAC2 and histone acetylation, such plasticity is absent for remote memories. However, by using an HDAC2-targeting inhibitor (HDACi) during reconsolidation, even remote memories can be persistently attenuated. This intervention epigenetically primes the expression of neuroplasticity-related genes, which is accompanied by higher metabolic, synaptic, and structural plasticity. Thus, applying HDACis during memory reconsolidation might constitute a treatment option for remote traumata.

Animal models of fear relapse

Whereas fear memories are rapidly acquired and enduring over time, extinction memories are slow to form and are susceptible to disruption. Consequently, behavioral therapies that involve extinction learning (e.g., exposure therapy) often produce only temporary suppression of fear and anxiety. This review focuses on the factors that are known to influence the relapse of extinguished fear. Several phenomena associated with the return of fear after extinction are discussed, including renewal, spontaneous recovery, reacquisition, and reinstatement. Additionally, this review describes recent work, which has focused on the role of psychological stress in the relapse of extinguished fear. Recent developments in behavioral and pharmacological research are examined in light of treatment of pathological fear in humans.

Classical conditioning and pain: conditioned analgesia and hyperalgesia

This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity.

Memory retrieval before or after extinction reduces recovery of fear in adolescent rats

Adolescent rats exhibit impaired extinction retention compared to pre-adolescent and adult rats. A single nonreinforced exposure to the conditioned stimulus (CS; a retrieval trial) given shortly before extinction has been shown in some circumstances to reduce the recovery of fear after extinction in adult animals. This study investigated whether a retrieval-extinction procedure would reduce the recovery of extinguished fear in adolescent rats. Furthermore, the effect of the retrieval-extinction sequence on fear recovery was examined by presenting the retrieval trial following extinction to some animals. In Experiment 1 adolescent rats received one nonreinforced CS presentation (a retrieval trial) or equivalent context exposure (no retrieval) 10 min before fear extinction. A retrieval trial shortly before extinction reduced overall levels of fear in both test contexts (i.e., it improved extinction retention and reduced renewal). In Experiment 2 a weakening of renewal was observed with a retrieval-extinction manipulation, regardless of whether the retrieval trial occurred in the training or extinction context. A key result was that a retrieval trial 10 min, but not 6 h, after extinction led to reduced overall levels of fear similar to that observed if the retrieval trial was given before extinction (Experiments 3 and 4), inconsistent with the current interpretation of the reduction in relapse being due to a disruption of reconsolidation. Together, these findings show that the impaired extinction retention observed in adolescents can be ameliorated by a very simple behavioral manipulation, but also raise some questions about the mechanisms underlying the retrieval-extinction effect.

Preventing return of fear in an animal model of anxiety: additive effects of massive extinction and extinction in multiple contexts

Fear conditioning and experimental extinction have been presented as models of anxiety disorders and exposure therapy, respectively. Moreover, the return of fear serves as a model of relapse after exposure therapy. Here we present two experiments, with rats as subjects in a lick suppression preparation, in which we assessed the additive effects of two different treatments to attenuate the return of fear. First, we evaluated whether two phenomena known to generate return of fear (i.e., spontaneous recovery and renewal) summate to produce a stronger reappearance of extinguished fear. At test, rats evaluated outside the extinction context following a long delay after extinction (i.e., a delayed context shift) exhibited greater return of extinguished fear than rats evaluated outside the extinction context alone, but return of extinguished fear following a delayed context shift did not significantly differ from the return of fear elicited in rats tested following a long delay after extinction alone. Additionally, extinction in multiple contexts and a massive extinction treatment each attenuated the strong return of fear produced by a delayed context shift. Moreover, the conjoint action of these treatments was significantly more successful in preventing the reappearance of extinguished fear, suggesting that extensive cue exposure administered in several different therapeutic settings has the potential to reduce relapse after therapy for anxiety disorders, more than either manipulation alone.

Rapid remission of conditioned fear expression with extinction training paired with vagus nerve stimulation

BACKGROUND

Fearful experiences can produce long-lasting and debilitating memories. Extinction of conditioned fear requires consolidation of new memories that compete with fearful associations. In human subjects, as well as rats, posttraining stimulation of the vagus nerve enhances memory consolidation. Subjects with posttraumatic stress disorder show impaired extinction of conditioned fear. The objective of this study was to determine whether vagus nerve stimulation (VNS) can enhance the consolidation of extinction of conditioned fear.

METHODS

Male Sprague-Dawley rats were trained on an auditory fear conditioning task followed by 1 to 10 days of extinction training. Treatment with vagus nerve or sham stimulation was administered concurrently with exposure to the fear conditioned stimulus. Another group was given VNS and extinction training but the VNS was not paired with exposure to conditioned cues. Retention of fear conditioning was tested 24 hours after each treatment.

RESULTS

Vagus nerve stimulation paired with exposure to conditioned cues enhanced the extinction of conditioned fear. After a single extinction trial, rats given VNS stimulation demonstrated a significantly lower level of freezing, compared with that of sham control rats. When extinction trials were extended to 10 days, paired VNS accelerated extinction of the conditioned response.

CONCLUSIONS

Extinction paired with VNS is more rapid than extinction paired with sham stimulation. As it is currently approved by the Federal Food and Drug Administration for depression and seizure prevention, VNS is a readily available and promising adjunct to exposure therapy for the treatment of severe anxiety disorders.

Reversal Without Remapping

The “cognitive revolution” in psychology is often framed as a departure from associationist principles rooted in animal learning research, yet it is clear that these principles have immediate relevance for contemporary questions in cognitive and social psychology. Intuitions about the consequences of learning procedures can easily be misleading, making these principles particularly important. To illustrate this point, we identified recent examples of studies applying a particular learning paradigm—response-reversal training—to the study of three different psychological problems (e.g., why objects in the right side of space are preferred to those in the left in right-handed people). The strategy of each study was to alter a typically encountered contingency once in the laboratory, in order to reverse a hypothesized learned response. Yet, contrary to intuitions, we demonstrate that behavior changes can be observed without the reversal of a prior association. Further, many different associative changes can underlie response reversals. We focus on these examples of response-reversal training, but our broader aim is to help connect the animal learning literature to problems in cognitive and social psychology in an effort to strengthen the inferences that might be drawn about learned associations in these contexts.

Reactivated memories compete for expression after Pavlovian extinction

We view the response decrement resulting from extinction treatment as an interference effect, in which the reactivated memory from acquisition competes with the reactivated memory from extinction for behavioral expression. For each of these memories, reactivation is proportional to both the strength of the stimulus-outcome association and the quality of the facilitatory cues for that association which are present at test. Here we review basic extinction and recovery-from-extinction phenomena, showing how these effects are explicable in this associative interference framework. Moreover, this orientation has and continues to dictate efficient manipulations for minimizing recovery from extinction. This in turn suggests procedures that might reduce relapse from exposure therapy for a number of psychological disorders. Some of these manipulations enhance the facilitatory cues from extinction that are present at test, others strengthen the extinction association (i.e., CS-no outcome), and yet others seem to work by a combination of these two processes.