Utilizing rewards to dampen fear and its recovery

Fearful memories can be extinguished by repeated exposure, without aversive outcomes. Fear extinction as the basis for exposure therapy, is a common treatment for anxiety and fear-related disorders, but it can be unpleasant and does not always work. Across two independent studies, we investigated whether a novel reward-fear deepened extinction procedure dampens fear while physiological, neural and subjective pleasantness changes were tracked. This presentation of reward cues enhanced fear extinction powerfully, resulting in effective protection against the return of fear a week later. Moreover, fear extinction accompanying a reward cue was perceived as more pleasant. On the neural level, we identified a network involving hippocampus and amygdala that underlies the benefit of this novel deepened extinction, where connectivity changes also predicted changes in subjective pleasantness. Our study identifies the effects of deepened extinction in regulating long-term fear recovery and its underlying neural mechanism. We shed light on an innovative method to enhance fear extinction, with high translational potential for therapy.