Abstract
Improving extinction learning has the potential to optimize psychotherapy for persistent anxiety-related disorders. Recent findings show that extinction learning can be improved with a cognitively demanding eye-movement intervention. It is, however, unclear whether [1] any cognitively-demanding task can enhance extinction, or whether it is limited to eye movements, and [2] the effectiveness of such an intervention can be enhanced by increasing cognitive load. Participants (n = 102, n = 75 included in the final sample) completed a Pavlovian threat conditioning paradigm across two days. One group underwent standard extinction (Control), a second group underwent extinction paired with a 1-back working memory task (Low-Load), and a third group underwent extinction paired with a 2-back working memory task (High-Load). We found that the conditioned response during extinction was reduced for both the Low-Load and the High-Load groups compared to the Control group. This reduction persisted during recovery the following day when no working memory task was executed. Finally, we found that within the High-Load group, participants with lower accuracy scores on the 2-back task (i.e., for who the task was more difficult) had a stronger reduction in the conditioned response. We did not observe this relationship within the Low-Load group. Our findings suggest that cognitive load induced by a working memory intervention embedded during extinction reduces persistent threat responses.
Highlights
Improving extinction learning has the potential to optimize psychotherapy for persistent anxietyrelated disorders
We first verified performance on the working memory intervention during extinction learning would be better in the Low-Load group compared to the High-Load group
We found that the reduction in the conditioned response remained 24 h later during spontaneous recovery, when no working memory task was performed, as well as for recovery after a reinstatement procedure
Summary
Improving extinction learning has the potential to optimize psychotherapy for persistent anxietyrelated disorders. We found that the conditioned response during extinction was reduced for both the Low-Load and the High-Load groups compared to the Control group This reduction persisted during recovery the following day when no working memory task was executed. A potential neurobiological model in support of the hypothesized role of cognitive load in diminishing threat responses proposes that treatment of fear and anxiety related disorders could be understood as a reorganization of resources between the central-executive control network and the salience network[15]. Demanding tasks potentially induce such a reorganization by activating the central-executive control network and reducing activation in the amygdala, a key structure of the salience network[15] Via this reorganization, cognitive demand can reduce threat-related responses[16,17] that do not tax working memory, as well as conscious subjective feelings of fear[9,10]
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