Peters Jacqueline, Filmer Anna I, van Doorn Johnny B, Metselaar Vivian N, Visser Renée M, Kindt Merel
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
Mol Psychiatry. 2025 Jun;30(6):2729-2738. doi: 10.1038/s41380-024-02882-1. Epub 2025 Jan 9.
Memory reconsolidation interventions offer an exciting alternative to exposure treatment because they may target fear memories directly, thereby preventing relapse. A previous reconsolidation intervention for spider fear abruptly reduced avoidance behaviour, whereas changes in self-reported fear followed later. In this pre-registered placebo-controlled study, we first aimed to conceptually replicate these effects in spider phobia. Second, we investigated whether re-encountering the phobic cue after the reconsolidation intervention is necessary for changes in self-reported fear to occur. Third, we tested whether the window to trigger such changes is time limited. Individuals with spider phobia (N = 69) were randomized into three groups and underwent a memory reactivation procedure with a tarantula, followed immediately by propranolol (reconsolidation intervention) or placebo. One reconsolidation intervention group and the placebo group re-encountered spiders two days after treatment in behavioural approach tasks, whereas another reconsolidation intervention group re-encountered spiders after four weeks. Changes in spider avoidance behaviour and self-reported fear were followed for one year. In the short term, the reconsolidation intervention was not more effective than placebo: both conditions benefited from the intervention. In the long term, the reconsolidation intervention was more effective than placebo, but only when the phobic stimulus was re-encountered within days after treatment. Specifically, we found less tarantula avoidance behaviour and self-reported fear over the course of one year when spiders were re-encountered two days after the reconsolidation intervention, but not when the behavioural test was conducted four weeks after the intervention. These findings challenge the idea that a reconsolidation-inspired intervention alone is sufficient to treat clinical fears: Experiencing the behavioural change during the re-encounter within days after the reconsolidation window has closed seems crucial to observe a lasting fear reduction.
记忆再巩固干预为暴露疗法提供了一种令人兴奋的替代方法，因为它们可能直接针对恐惧记忆，从而预防复发。先前针对蜘蛛恐惧的再巩固干预突然减少了回避行为，而自我报告的恐惧变化则随后出现。在这项预先注册的安慰剂对照研究中，我们首先旨在从概念上在蜘蛛恐惧症中复制这些效果。其次，我们研究了在再巩固干预后再次接触恐惧线索是否是自我报告的恐惧发生变化的必要条件。第三，我们测试了触发此类变化的窗口期是否受时间限制。患有蜘蛛恐惧症的个体（N = 69）被随机分为三组，并接受了用狼蛛进行的记忆重新激活程序，随后立即服用普萘洛尔（再巩固干预）或安慰剂。一个再巩固干预组和安慰剂组在治疗两天后在行为接近任务中再次接触蜘蛛，而另一个再巩固干预组在四周后再次接触蜘蛛。对蜘蛛回避行为和自我报告的恐惧变化进行了一年的跟踪。短期内，再巩固干预并不比安慰剂更有效：两种情况都从干预中受益。从长期来看，再巩固干预比安慰剂更有效，但只有在治疗后几天内再次接触恐惧刺激时才有效。具体而言，我们发现，在再巩固干预两天后再次接触蜘蛛时，在一年的时间里狼蛛回避行为和自我报告的恐惧较少，但在干预四周后进行行为测试时则不然。这些发现挑战了仅靠再巩固启发的干预就足以治疗临床恐惧的观点：在再巩固窗口关闭后的几天内再次接触期间经历行为变化似乎对于观察到持久的恐惧减轻至关重要。
