Exposure therapy with no exposure

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Science Translational Medicine  28 Mar 2018:
Vol. 10, Issue 434, eaat3883
DOI: 10.1126/scitranslmed.aat3883


fMRI and patient feedback methods reduce fear responses by changing brain patterns without conscious awareness.

Exposure therapy is one of the most effective tools in psychiatry to reduce specific phobias; however, due to unpleasant feelings during therapeutic exposure to the fearful stimuli, many people drop out from therapy. Taschereau-Dumouchel et al. tested the possibility to use magnetic resonance imaging (MRI) and machine learning to treat fear without the need to expose the subjects to fearful stimuli. MRI data were first collected from a cohort of 29 participants that viewed images of aversive stimuli as well as neutral objects, which enabled the researchers to generate brain patterns typically associated with fearful images. A separate cohort of 17 participants, with high phobia to at least two of these images, completed a 5-day protocol that included baseline MRI and physiological assessments, reward feedback training sessions (the therapy), and post-intervention assessments. The reward feedback training sessions did not include the fearful images, but rather participants looked at neutral shapes and were given real-time monetary reward when their neural MRI patterns were closely aligned to the average neural response to fearful stimuli. Importantly, after five days of such training, participants experienced reduced physiological arousal to fearful stimuli and showed reduced activity in the amygdala, suggesting an overall decrease in their fear response. None of the participants had any awareness of the study intent. Leveraging MRI and computational analysis, the authors developed a brain psychotherapy that might have implications for the treatment of anxiety disorders. Now researchers are able to shape brain patterns to specific constructs without the participants’ awareness, which might also be important for other psychiatric disorders that rely on exposures for treatment, such as post-traumatic stress disorder. However, future work in a clinical population is needed to test the possibility of using this method to treat anxiety-related disorders. More broadly, the research has intriguing implications for how the brain can be reorganized without conscious awareness.

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