Attenuating Neural Threat Expression with Imagination

Abstract

Imagination is an internal simulation of real-life events. In the clinic, imagination is a common treatment tool for anxiety disorders, but the neural processes through which imagination exerts behavioral control are unclear. This investigation tests if and how imagined exposures to a threatening stimulus, conditioned in the real world, influence neural and bodily manifestations of threat. We found that imagined extinction and real extinction are equally effective in the reduction of threat-related neural patterns and physiological responses elicited upon re-exposure to real-world threatening cues. Network connectivity analysis during the extinction phase showed that imagined extinction, like real extinction, engaged the ventromedial prefrontal cortex (vmPFC) as a central hub. Furthermore, vmPFC, primary auditory cortex and amygdala activation during imagined and real extinction predicted extinction success, measured by one’s neural threat pattern expression upon reexposure to the real-world cues. The nucleus accumbens, however, uniquely predicted extinction success in the imagined extinction group alone. We conclude that deliberate imagination can attenuate reactions to threat by utilizing perceptual and learning neural mechanisms.