Changing negative autobiographical memories in the lab: a comparison of three eye-movement tasks.

There is strong evidence that executing eye-movement (EM) tasks that load working memory (WM) while thinking of an emotional memory reduces the emotionality and vividness of this memory. According to WM theory, EM tasks that load WM more should be more effective to devalue emotional memories. In this study, we compared three EM tasks: dot tracking, letter identification, and a combination of dot tracking and letter identification. First, participants completed a reaction time (RT) task to assess the WM load of the three EM tasks relative to a control task (viewing a black screen). Then, participants were asked to think of a negative autobiographical memory while executing one of these EM tasks and asked to recall another negative memory while executing the control task. Before and after each task, participants rated emotionality and vividness of the memory. All EM tasks slowed down RTs relative to the control task, and the letter identification task induced the largest RTs. Reductions of vividness relative to the control task, however, were comparable across the EM tasks, and there were no reliable reductions of emotionality. We discuss these findings in light of the WM theory and alternative theories for the effects of dual-task interventions.

Future-oriented imagery rescripting facilitates conducting behavioral experiments in social anxiety.

Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test negative beliefs about a social situation they feared. They were assigned to one of two groups: imagery rescripting focused on the feared outcome of the behavioral experiment or no imagery rescripting (i.e., a break). All participants were then asked to complete ratings scales and to conduct the behavioral experiment. Before the behavioral experiment, the imagery rescripting condition, compared to the control condition, showed reduced anticipated probability and severity of the feared outcome, lower anxiety and helplessness levels, and increased willingness to conduct the behavioral experiment. Imagery-based interventions focused on feared outcomes seem promising to prepare anxious individuals to engage in treatment.

The effect of imagery rescripting on prospective mental imagery of a feared social situation.

BACKGROUND AND OBJECTIVES: Negative mental imagery appears to play a role in anxiety disorders and can involve aversive memories or anticipated future threats. Modulating aversive memories through imagery rescripting generally reduces negative memory appraisals and associated anxiety. This pre-registered two-day analog study investigated whether imagery rescripting of aversive memories also reduces negative imagery of future threats. METHODS: On Day 1, socially anxious individuals (N = 52) were randomly assigned to imagery rescripting of an aversive memory or progressive relaxation (control condition). Before each intervention, they were asked to imagine a feared social situation that may happen in their future and evaluate this situation. They also rated the aversive memory before and after the intervention phase. The feared future situation was again evaluated at follow-up on Day 2. RESULTS: Unexpectedly, no group differences were found on the main outcome measures. That is, negative memory appraisals reduced after both interventions. Likewise, in both groups, negative details decreased, and positive details increased in prospective mental imagery, and anxiety and avoidance towards the imagined event decreased. On the exploratory measures, the imagery rescripting group showed increased positive appraisals of memory and future threat, and decreased negative future-threat appraisals, compared to the progressive relaxation group. LIMITATIONS: No passive control group was included, so potential time or placebo effects cannot be precluded. CONCLUSIONS: The interventions had similar effects on the main outcomes and influenced mental imagery of future threats. Some differences were found on the exploratory measures that warrant further investigation with a passive control condition.

Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking.

Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticipatory anxiety and distress during exposure, and increases exposure willingness and duration. Forty-three individuals with moderate public speaking anxiety were randomized to a standardized positive mental imagery exercise about future public speaking or no-task. All participants were then asked to present in a virtual reality environment. Anticipatory anxiety reduced in the positive mental imagery group, but not in the control group. Additionally, the positive mental imagery group reported lower distress during exposure than the control group, but groups did not differ in exposure willingness. Due to limited variance, effects on exposure duration could not be tested. Future-oriented positive mental imagery is promising to prepare individuals for exposure to previously avoided situations.

Threat memory devaluation by a dual-task intervention: Testing return of fear and intrusive memory over 48 hours.

BACKGROUND AND OBJECTIVES: In dual-tasking, individuals recall a threat-related memory while performing a demanding dual-task. This is a fruitful approach to reduce the unpleasantness and vividness of aversive memories and to reduce conditioned fear responses. Crucially, it remains unclear whether dual-tasking can also reduce conditioned fear responses and intrusive memories over time. In this pre-registered two-day fear conditioning paradigm, we examined whether a dual-task intervention reduces return of fear and the frequency of intrusive memories of an aversive film over time. METHODS: On Day 1, 76 healthy participants underwent fear acquisition with aversive film clips. They were then randomly allocated to one of three conditions: dual-tasking, memory recall without a dual-task ('recall only'), or no task. Afterwards, they underwent an extinction phase and were asked to record intrusive film memories over 48 h. On Day 3, return of fear was assessed. RESULTS: On Day 1, fear acquisition and extinction were successful. On Day 3, spontaneous recovery and renewal were evident, but, overall, participants reported few intrusions. The dual-task and recall only groups reported reduced unpleasantness of threat memory compared to the no task group, but they did not show reduced (return of) fear responses or fewer intrusions. LIMITATIONS: Intrusion frequency was low in all three groups, which limits the detection of intervention effects. CONCLUSIONS: Even though dual-tasking and recall only devalued threat memory temporarily compared to no task, these interventions did not reduce (return of) fear responses and intrusions. Future studies could focus on improving the potency of imagery-based interventions.

Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure.

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.

Devaluation of threat memory using a dual-task intervention does not reduce context renewal of fear.

Many patients who benefit from exposure-based therapy for anxiety disorders fail to maintain their gains. Learned fear may return when they encounter phobic stimuli in a different context than the one in which extinction occurred. In the current pre-registered experiment, we tested whether threat memory devaluation reduces context renewal of fear. A dual-task intervention was used to devalue threat memory. During this intervention, individuals recall the threat memory while simultaneously performing a demanding secondary task (e.g., making eye movements). On day 1, participants (N = 75) underwent fear acquisition with an aversive film clip in context A. On day 2, 25 participants were assigned to each group, namely a dual-task group, or one of two control groups: recall only task (without the dual-task) or no intervention. Afterwards, all participants underwent extinction training in context B and were then exposed to context A again in a test phase. The dual-task intervention effectively degraded threat memory compared to no intervention, but the recall only intervention was also partly effective. However, all three groups showed comparable fear renewal on subjective and physiological measures. This indicates that threat memory devaluation was not effective to prevent context renewal.

Renewal of conditioned fear responses using a film clip as the aversive unconditioned stimulus.

BACKGROUND AND OBJECTIVES: Pavlovian fear conditioning paradigms are valuable to investigate fear learning and the return of extinguished fear in the lab. However, their validity is limited, because the aversive stimuli (e.g., electric shocks) typically lack the modalities and complexity of real-world aversive experiences. To overcome this limitation, we examined fear acquisition, extinction and contextual renewal using an audiovisual unconditioned stimulus (US). METHOD: On day 1, 50 healthy participants completed an acquisition phase in a specific context (i.e., desk or bookcase, 'context A'). Pictures of colored lamps served as conditioned stimuli and an aversive film clip was used as US. On day 2, extinction took place in the same context ('context A') or in a different context ('context B'). Afterwards, renewal was tested in the acquisition context (AAA vs. ABA design). RESULTS: As hypothesized, fear acquisition and extinction, as measured by US expectancy ratings, fear potentiated startle (FPS), and skin conductance responses (SCRs), were successful. Most importantly, conditioned responding was renewed on all measures in the ABA condition, but not in the AAA condition. Differential renewal (i.e., larger renewal for CS + than for CS-) was only observed for US expectancy ratings. LIMITATIONS: The return of conditioned responses was non-differential for FPS and SCR. CONCLUSIONS: The current set-up enables investigation of fear renewal using an audiovisual US. Future studies can utilize this paradigm to investigate interventions that aim to reduce fear renewal by modifying the US memory, such as Eye Movement Desensitization and Reprocessing and imagery rescripting.