Is it possible to rewrite old traumatic fear memories and thus significantly reduce the suffering of many patients? The discovery of memory reconsolidation suggests that this could be much easier than many researchers have long assumed.  This is because new research has shown that our memory hovers in a changeable, protein synthesis-dependent state after each recall. During this time window, it is possible to “update” the memory through interventions (e.g. preventing protein synthesis with anisomycin). (Nader & Hardt, 2009; Nader, Schafe, & Le Doux, 2000). Our memory is therefore much more modifiable than we realize. This opens up many new possibilities for the psychotherapy of anxiety disorders (panic disorder, post-traumatic stress disorder, social anxiety, phobias, agoraphobia, etc.).

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Studies (just a small selection):  Elsey, J. W., & Kindt, M. (2017). Tackling maladaptive memories through reconsolidation: From neural to clinical science. Neurobiology of Learning and Memory, 142, 108-117.

Mallet, C., Chick, C. F., Maatoug, R., Fossati, P., Brunet, A., & Millet, B. (2022). Memory reconsolidation impairment using the β-adrenergic receptor blocker propranolol reduces nightmare severity in patients with posttraumatic stress disorder: a preliminary study. Journal of Clinical Sleep Medicine, 18(7), 1847-1855.

Pigeon, S., Lonergan, M., Rotondo, O., Pitman, R. K., & Brunet, A. (2022). Impairing memory reconsolidation with propranolol in healthy and clinical samples: a meta-analysis. Journal of Psychiatry and Neuroscience, 47(2), E109-E122.

Soeter, M., & Kindt, M. (2011). Disrupting reconsolidation: pharmacological and behavioral manipulations. Learning & Memory, 18(6), 357-366.

The research is clear: the more we embrace fear (exposure, confrontation), the more it will release us from its grip. But how can therapeutic anxiety confrontation be made even more effective? Studies have been able to show that in the treatment of anxiety disorders, it is more effective in the long run not to confront the same situation over and over again, but to master different anxiety-provoking situations. By confronting different challenges, one learns that anxiety is not always justified in every situation and that one can gain control over anxiety. However, one-sided confrontation with a particular situation can lead to stagnation and contribute to the likelihood of a return of fear. The video highlights the exciting research on this topic….

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Studies (small sample only):

Bandarian-Balooch, S., Neumann, D. L., & Boschen, M. J. (2015). Exposure treatment in multiple contexts attenuates return of fear via renewal in high spider fearful individuals. Journal of behavior therapy and experimental psychiatry, 47, 138-144.

Burck, E. (2019). Angst-Was hilft wirklich gegen Angst und Panikattacken?: Die effektivsten Strategien gegen Angst und Panik aus Sicht der Forschung. BoD–Books on Demand.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour research and therapy, 58, 10-23.

de Jong, R., Lommen, M. J., de Jong, P. J., & Nauta, M. H. (2019). Using multiple contexts and retrieval cues in exposure-based therapy to prevent relapse in anxiety disorders. Cognitive and Behavioral Practice, 26(1), 154-165.

Gunther, L. M., Denniston, J. C., & Miller, R. R. (1998). Conducting exposure treatment in multiple contexts can prevent relapse. Behaviour research and therapy, 36(1), 75-91.

Mineka, S., Mystkowski, J. L., Hladek, D., & Rodriguez, B. I. (1999). The effects of changing contexts on return of fear following exposure therapy for spider fear. Journal of consulting and clinical psychology, 67(4), 599.

Shiban, Y., Schelhorn, I., Pauli, P., & Mühlberger, A. (2015). Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality. Behaviour research and therapy, 71, 45-53.

The “Pokémon Go” hype that drove people to the streets in large numbers in the late summer of 2016 was the first proof of the mass appeal of “augmented reality” (AR). Although the new technology (especially Zuckerberg’s Metaverse) is often rightly criticized, it does hold some opportunities for psychotherapy. For example, behavioral experiments and exposure exercises with feared stimuli (e.g., spiders, cockroaches, snakes, etc) can be conducted until habituation occurs and fear is unlearned. But how good is therapy in augmented reality compared to normal therapy in “real” reality.

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Studies (small sample only):

Albakri, G., Bouaziz, R., Alharthi, W., Kammoun, S., Al-Sarem, M., Saeed, F., & Hadwan, M. (2022). Phobia Exposure Therapy Using Virtual and Augmented Reality: A Systematic Review. Applied Sciences, 12(3), 1672.

Abate, A. F., Nappi, M., & Ricciardi, S. (2011, July). AR based environment for exposure therapy to mottephobia. In International Conference on Virtual and Mixed Reality (pp. 3-11). Springer, Berlin, Heidelberg.

Baus, O., & Bouchard, S. (2014). Moving from virtual reality exposure-based therapy to augmented reality exposure-based therapy: a review. Frontiers in human neuroscience, 8, 112.

Botella, C., Pérez-Ara, M. Á., Bretón-López, J., Quero, S., García-Palacios, A., & Baños, R. M. (2016). In vivo versus augmented reality exposure in the treatment of small animal phobia: a randomized controlled trial. PloS one, 11(2), e0148237.

De Witte, N. A., Scheveneels, S., Sels, R., Debard, G., Hermans, D., & Van Daele, T. (2020). Augmenting exposure therapy: mobile augmented reality for specific phobia. Frontiers in Virtual Reality, 8.

Tsai, C. F., Yeh, S. C., Huang, Y., Wu, Z., Cui, J., & Zheng, L. (2018). The effect of augmented reality and virtual reality on inducing anxiety for exposure therapy: a comparison using heart rate variability. Journal of Healthcare Engineering, 2018

Whether it is social anxiety, animal phobia, agoraphobia or generalized anxiety disorder, some strategies from emotion regulation research can be successfully applied to almost all fears. The video presents helpful perspective shifts and thought patterns that have helped subjects reduce or completely overcome anxiety in a number of studies:

1. shifting to the “you” perspective

2. cognitive reappraisal

3. acceptance (instead of suppression of emotions)

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Studies (only small selection): Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of consulting and clinical psychology, 80(5), 750.

Burck, E. (2019). Angst-Was hilft wirklich gegen Angst und Panikattacken?: Die effektivsten Strategien gegen Angst und Panik aus Sicht der Forschung. BoD–Books on Demand.

Kross, E., Vickers, B. D., Orvell, A., Gainsburg, I., Moran, T. P., Boyer, M., … & Ayduk, O. (2017). Third‐person self‐talk reduces Ebola worry and risk perception by enhancing rational thinking. Applied Psychology: Health and Well‐Being, 9(3), 387-409.

Moser, J. S., Dougherty, A., Mattson, W. I., Katz, B., Moran, T. P., Guevarra, D., … & Kross, E. (2017). Third-person self-talk facilitates emotion regulation without engaging cognitive control: Converging evidence from ERP and fMRI. Scientific reports, 7(1), 1-9.

Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. Journal of consulting and clinical psychology, 76(6), 1083.

Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological bulletin, 138(4), 775.

Wittchen, H. U., & Hoyer, J. (2011). Klinische Psychologie & Psychotherapie (Vol. 1131). Heidelberg: Springer.