Translating experimental neuroscience into clinical treatment: Preventing the return of fear in youth with anxiety disorders using memory reconsolidation mechanisms.

For more than 50 years, exposure therapy has been the most powerful treatment for reducing fears at any age. However, with up to half of youth either failing to respond or relapsing, there is a clear need to maximise the power of this treatment to avoid a negative life trajectory. Fears are underpinned by beliefs that particular situations or objects are dangerous. When we encounter these situations, we remember this fear association and experience anxiety. Exposure therapy involves repeatedly confronting the situation (e.g., dog) in the absence of negative outcomes (e.g., bite), in order to change the associations that we remember when we subsequently encounter the situation. When a memory is recalled, it becomes labile for a short period of time (i.e., several hours) before being restabilised in long-term memory during a process called memory reconsolidation. New information presented during this labile period can be incorporated into the memory during reconsolidation, altering the original memory. Experimental research with animals and humans suggests that fear memories can be manipulated using behavioural methods during this labile phase, reducing (or even eradicating) underlying fear associations. Despite promising effects in laboratory contexts, the potential for these methods to permanently eliminate real-world fears has received little attention.

This study will be the first to investigate whether behavioural manipulation of normal memory reconsolidation processes during exposure therapy can optimise outcomes for youth with anxiety disorders and prevent the return of fear. Youth with clinically significant fears of public speaking will be randomly allocated to one of three treatment groups. All will receive a single intensive exposure therapy session with experimental manipulation used to compare effects when exposure is delivered within the memory reconsolidation window, after the memory reconciliation window has closed, or without activation of the memory reconciliation window prior to exposure. Changes in severity of public speaking anxiety will be assessed before and after treatment and 1 month later.