Unravelling the Neurocognitive Mechanisms Underlying Counter-conditioning

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Stress- and anxiety-related disorders are devastating for patients and a major burden on society. Although effective, a robust number of patients does not improve or relapse following extinction-based treatments. This highlights the need to find alternatives, like counterconditioning. In counter-conditioning the aversive outcome is replaced by a rewarding outcome, instead of merely omitting the aversive outcome. Here we aim to unravel the effectiveness and neurocognitive mechanisms underlying counterconditioning. We hypothesize that counter-conditioning either 1) enhances extinction learning, 2) integrates a fear and reward memory, or 3) overwrites the fear memory by a reward memory. We tested this in a two day between-subjects study. On day 1, participants were fear conditioned to one of two categories (animals vs. objects). Next, half of the participants underwent counter-conditioning (N = 10) during which novel trial-unique exemplars from the fear conditioned category were paired with a reward using monetary incentive delay. The other participants (N = 10) received standard extinction training. On day 2, return of fear responses and episodic memory for items from conditioning and counter-conditioning/extinction were tested. Results (pupil dilation, skin conductance (SCR), heart rate, reaction times, episodic memory, fMRI) indicate feasibility of the design to address our hypothesis. Moreover, category specific conditioned SCRs seem to reduce faster during counter-conditioning than extinction, supporting the idea of counterconditioning as a promising alternative to extinction. In the counter-conditioning group, episodic memory is enhanced for emotional salient items from both the conditioning and counter-conditioning phase, which is in line with our second hypothesis.
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