Context re-exposure during counterconditioning strengthens episodic memory for aversive and related positive events

Several clinical interventions rely on narrative reframing, whereby the outcome of an overly emotional memory is replaced with a more favourable one. Recently, concern has arisen that such interventions may not only alter elicited emotions, but also reduce the memory’s accuracy or even promote false memories. However, the relative simplicity of memories induced in traditional fear-conditioning paradigms (e.g., a tone-shock association) makes it challenging to experimentally model narrative reframing or test episodic distortions. We therefore developed a paradigm using trial-unique, multimodal, and personally meaningful events to investigate whether episodic counterconditioning can modify the episodic and affective (i.e., psychophysiological and subjective) components of aversive memories through new associations with semantically related positive events. Specifically, we hypothesised that spatial overlap between the aversive and related positive events would strengthen memory for both episodes and alleviate affective responses. Healthy participants (N = 100) encoded 20 memories, each comprising a cue (neutral object image) followed by an aversive or neutral outcome (image-sound combination) presented in a context (background image). The following day, 10 aversive memories were counterconditioned by pairing their cues with a semantically related positive outcome, with half presented in the original context and the other half in a novel context. While counterconditioning successfully induced positive affect, it did not alleviate affective responses the next day. Nonetheless, spatial overlap strengthened episodic memory for both the aversive and positive events. Future research should test whether context re-exposure during psychotherapy can likewise improve the accuracy of autobiographical aversive memories.