Behavioral and Magnetoencephalographic Correlates of Fear Generalization Are Associated With Responses to Later Virtual Reality Exposure Therapy in Spider Phobia

Neural correlates of fear conditioning are associated with treatment-outcomes to behavioral exposure in spider phobia – Evidence from magnetoencephalography

“…As described in detail elsewhere ( Roesmann et al, 2022 ), 89 out of 100 eligible patients completed all relevant assessments for this study: (1) a clinical pre-treatment assessment, (2) a behavioral and MEG pre-treatment assessment comprising the fear conditioning paradigm, (3) the VRET, and (4) a clinical post-treatment assessment.…”

“…Relevant assessments for this study took place on four separate days (for details, see Roesmann et al, 2022b ). After a (1) clinical pre-treatment assessment , in which primary and secondary outcome measures and clinical and demographic characteristics were obtained, patients completed (2) a behavioral and a MEG pre-treatment assessment including the fear conditioning paradigm.…”

“…In an attempt to link laboratory research on classical fear conditioning with treatment outcomes, studies yielded evidence for associations between behavioral and neural pre-treatment correlates of extinction ( Ball et al, 2017 , Forcadell et al, 2017 , Hahn et al, 2015 , Lange et al, 2020 , Lueken et al, 2013 , Raeder et al, 2020 , Waters and Pine, 2016 ) or fear generalization ( Roesmann et al, 2022 ) and treatment outcomes. Both approaches have linked this relationship with the ventromedial prefrontal cortex (vmPFC) ( Lange et al, 2020 , Roesmann et al, 2022b ), a core hub for fear inhibition ( Milad & Quirk, 2012 ) as well as fear and safety learning ( Battaglia et al, 2020 , Fullana et al, 2016 ; for a recent discussion on the contribution of subregions, see Battaglia et al, 2021 ). Additionally, lateral prefrontal regions were shown to underpin the link between fear generalization and treatment outcome ( Roesmann et al, 2022 ).…”

“…Both approaches have linked this relationship with the ventromedial prefrontal cortex (vmPFC) ( Lange et al, 2020 , Roesmann et al, 2022b ), a core hub for fear inhibition ( Milad & Quirk, 2012 ) as well as fear and safety learning ( Battaglia et al, 2020 , Fullana et al, 2016 ; for a recent discussion on the contribution of subregions, see Battaglia et al, 2021 ). Additionally, lateral prefrontal regions were shown to underpin the link between fear generalization and treatment outcome ( Roesmann et al, 2022 ).…”

“…First, we predicted that higher CS+/CS- differences in fear ratings – particularly due to lower fear ratings of the CS- – would be associated with better treatment outcomes. Second, we predicted that dorsolateral and ventromedial prefrontal structures involved in safety processing and/or the inhibition of fear during fear conditioning ( Battaglia et al, 2021 , Fullana et al, 2016 , Rehbein et al, 2015 , Roesmann et al, 2022b ) and during exposure therapy ( Landowska et al, 2018 ) would show higher activations to CS- in treatment responders.…”