Secure attachment priming protects against relapse of fear in Young adults

Metaxia Toumbelekis,Richard A Bryant,Belinda J Liddell

doi:10.1038/s41398-021-01715-x

Abstract

Previous studies have shown that activating the attachment system attenuates fear learning. This study aimed to explore whether attachment priming can also impact on fear extinction processes, which underpin the management of anxiety disorders. In this study, 81 participants underwent a standard fear conditioning and extinction protocol on day 1 and returned 24 h later for an extinction recall and reinstatement test. Half the participants were primed to imagine their closest attachment figure prior to undergoing extinction training, while the other half were instructed to imagine a positive situation. Fear-potentiated startle and subjective expectancies of shock were measured as the primary indicators of fear. Attachment priming led to less relapse during the reinstatement test at the physiological but not subjective levels. These findings have translational potential to imply that activating awareness of attachment figures might augment long-term safety memories acquired in existing treatments to reduce relapse of fear.

Highlights

Anxiety disorders are among the most common mental health disorders worldwide, and incur enormous burdens to individuals, families, communities, and health systems [1]
The learned fear can be subsequently extinguished by repeated presentations of the ‘conditioned stimulus’ (CS) in the absence of the aversive outcome
Previous studies have shown that presenting positive stimuli [13, 14] or positive mood induction paradigms [15] prior to undergoing fear extinction reduces negative evaluations of the conditioned stimulus, inhibits the fear response and can enhance extinction learning and reduce relapse

Summary

Introduction

Anxiety disorders are among the most common mental health disorders worldwide, and incur enormous burdens to individuals, families, communities, and health systems [1]. The learned fear can be subsequently extinguished by repeated presentations of the ‘conditioned stimulus’ (CS) in the absence of the aversive outcome (i.e. extinction learning) This paradigm has been essential in modeling relapse of anxiety following the passage of time (spontaneous recovery), a change in environmental context (renewal) or a new stressful event (reinstatement) [6]. We utilized a visual imagery task as a method to activate brief awareness of one’s attachment figure immediately prior to extinction learning. This procedure could be readily applied to real-world settings in which people approach feared stimuli to overcome anxiety.

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