Augmenting exposure therapy with pre-extinction fear memory reactivation and deepened extinction: A randomized controlled trial.

BACKGROUND:Pre-extinction fear memory reactivation (PE-FMR) and deepened extinction (DE) enhance long-term extinction of shock-conditioned fear, and may also enhance long-term extinction of naturally acquired fear. Preliminary data suggest that PE-FMR may additionally boost the speed of fear reduction during exposure therapy. DESIGN:Randomized controlled trial, factorial design. METHODS:Participants with elevated fears of either spiders or snakes were randomized to (1) exposure therapy alone (n = 41), (2) exposure therapy + PE-FMR (n = 42), (3) exposure therapy + DE (n = 41), or (4) exposure therapy + PE-FMR + DE (n = 42). Participants were assessed at baseline, post-treatment, and one-week follow-up on subjective and behavioral indices of phobia. Because treatment length was tailored to speed of fear reduction, survival analyses were used to examine the speed of fear reduction during treatment. RESULTS:DE did not improve clinical outcomes at post-treatment or follow-up, whereas PE-FMR produced more rapid fear reduction and was able to achive equivalent outcomes even when the duration of exposure therapy (tailored to speed of fear reduction) was shortened by an average of 21%. CONCLUSIONS:Data suggest that PE-FMR is a promising strategy for reducing the overall duration of exposure-based therapies. CLINICAL TRIAL REGISTRATION:(clinicaltrials.gov)NCT02160470.