Uncovering Neurocognitive Mechanisms and Enhancement of Exposure-based Fear Learning With Cognitive Training

Anxiety disorders remain are among the most prevalent psychiatric conditions and areassociated with negative outcomes spanning poor health to increased suicide risk. Whileexposure therapy is recognized as a gold standard empirically supported treatment, manyindividuals fail to achieve adequate response. Exposure therapy is grounded in fearextinction learning models, which suggest that anxiety diminishes when individualsrepeatedly confront their fears. To improve exposure‐based interventions, it is criticalto enhance our understanding of underlying mechanisms of fear extinction and how tobetter target these mechanisms. Fear extinction requires basic neurocognitive abilitiesthat allow individuals to learn from and adapt to experiences confronting fearedsituations. Emerging cross sectional and experimental data suggest that working memory isa particularly important neurocognitive process that is associated with fear learningoutcomes. By enhancing working memory through experimental manipulations like cognitivetraining, we may improve the fear extinction learning processes essential for successfulexposure therapy. Unlike other neurocognitive enhancements (e.g., medications),computer‐based working memory training offers high mechanistic precision, ease ofadministration, and low cost. The long‐term goal of this research is to develop a novelmechanistic understanding of the neurocognitive processes involved in exposure‐based fearextinction learning, ultimately aiming to improve interventions for anxiety disorders.This study will test the effects of manipulating working memory prior to a massedexposure paradigm, comparing working memory training plus massed exposure (WMT+Ex) to asham training plus massed exposure (ST+Ex) condition. Using public speaking anxiety as aclinical exemplar, we will employ a rigorous experimental trial design combined with avalidated single‐visit speech exposure paradigm to assess fear extinction learningoutcomes through multiple measures, including behavioral, physiological, neural, andself‐report. The central hypothesis is that WMT+Ex will improve markers of fearextinction learning considered to underlie clinical response in exposure therapy.Specific aims are to 1) determine the extent to which working memory training deliveredprior to massed exposure improves behavioral and neural markers of fear extinctionlearning, and 2) evaluate the effects of working memory training delivered prior tomassed exposure on fear extinction learning occurring during exposure. This study isexpected to achieve two goals: first, to advance our understanding of the neurocognitivemechanisms of fear extinction through a rigorous experimental design, and second, tovalidate a combined working memory training and exposure paradigm. If successful inenhancing fear extinction, this approach could be further explored in therapeutic formatsto assess its clinical effects.