Imagining threats beforehand can make you less afraid of them when (or if) they occur

Newly published research in the journal Neuron provides novel insights on fear management. According to researchers from the Icahn School of Medicine at Mount Sinai, imagining threats before they happen can weaken your response to them whenever — or if ever — they happen. The study has strong implications in the treatment of anxiety and other fear-related disorders.

The thesis of the argument is that fear is a learned reaction to certain stimuli. People quickly learn to fear a threatening or unpleasant experience. This fear will recur when certain cues, such as sights or sounds associated with the bad experience, are sensed. If the fear is severe, it can negatively impact life, often manifesting in emotional disorders like post-traumatic stress disorder, different forms of phobia, and anxiety.

It has been argued that the best way to remove fear is to experience the threatening cues without having a bad experience — a strategy which psychologists refer to as “threat extinction” or “extinction learning.” It is argued that by conditioning a person to repeatedly experience “bad” cues without the bad experience, the person will feel a reduction of fear, consequently eliminating the anxiety associated with it.

However, this type of therapy is impractical in some cases, especially when the cues associated with a traumatic event are difficult or unethical to reconstruct, such as a war zone. These cues may be too overwhelming for the patient to re-experience.

For such cases, researchers suggest relying on imagination. The concept of using internal simulation of real-life events is nothing new. Most psychotherapy sessions depend on the patient using their imagination. Nevertheless, its use in terms of fear management and elimination has not been fully explored, until now.

To test the usefulness of imagination in extinction learning, the Mount Sinai researchers exposed 68 study participants to auditory threat conditioning, which involved exposing them to two different sounds, one of which was paired with an electric shock. Then, the participants were randomized into three groups.

  • Group 1 (imagined extinction): Participants were tasked to “play” the conditioned tones in their head.
  • Group 2 (real extinction): Actual exposure to the conditioned auditory stimuli.
  • Group 3 (no extinction): Participants were directed to imagine two neural sounds from nature (either birds singing or rain falling) as a control for the general effects of imagination.

The threat memory was then reinstated in all participants through four unsignaled shocks, after which all participants were re-exposed to the conditioned auditory stimuli. To better assess the neurocognitive changes of imagination and threat perception, functional MRI images were collected from all the participants for each phase. Skin conductance responses were likewise recorded continuously.

Daniela Schiller, professor of neuroscience and psychiatry at the Icahn School of Medicine at Mount Sinai and senior author of the paper said of their findings: “We found that imagined extinction and real extinction were equally effective in the reduction of threat-related neural and physiological responses elicited upon re-exposure to real-world threatening cues.

“More specifically, neuroimaging results indicated that imagined extinction, like standard extinction, activated a network of threat suppression involving the ventromedial prefrontal cortex as a central hub.” (Related: Guided imagery paired with physical relaxation techniques can significantly reduce stress.)

The ventromedial prefrontal cortex is the area of the brain involved in threat response and extinction. It has been studied to play a significant role in anxiety disorders.

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