Disrupting fear memory reconsolidation in individuals with fear of spiders with cTBS: A Proof-of-Concept Study

Anxiety disorders can be effectively treated with both cognitive behavioural therapy and psychopharmacological interventions. However, only 50 % of patients demonstrate significant benefits from these approaches. Therefore, investigating strategies to improve treatment effectiveness or develop novel therapeutic approaches remains an important research objective. Current therapeutic modalities may leave the original fear memory intact, potentially leading to symptom recurrence over time. In contrast, the disruption of reconsolidation processes can facilitate permanent modifications to fear memory, resulting in a reduced risk of relapse after psychotherapy. Recent laboratory studies have shown that the reconsolidation of experimentally induced fear can be effectively disrupted by repetitive transcranial magnetic stimulation (rTMS) and significantly prevents the return of fear. In this study, we translated these results to participants with elevated fear of spiders. 34 participants with spider fear were randomly assigned to a verum or a placebo intervention using continuous theta-burst stimulation (80 % of resting motor threshold) applied over the right dorsolateral prefrontal cortex ten minutes after the reactivation (3 min confrontation with a living tarantula) of the spider fear memory. The ANOVA for the primary outcome (Spider Phobia Questionnaire, SPQ) resulted in a significant effect of time, but no significant interaction of time and treatment group. Notably, exploratory analyses revealed a significant correlation between stimulation intensity in the verum group and the reduction in spider fear. This association suggest that rTMS-induced disruptions of reconsolidation may serve as a viable therapeutic option for anxiety disorders; however, further research is needed to delineate the optimal parameters for such interventions.