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Neural Mechanisms of Imaginal and in Vivo Exposure

U

Uppsala University

Status

Completed

Conditions

Fear of Spiders

Treatments

Behavioral: Exposure
Behavioral: In vivo exposure
Behavioral: Approach-avoidance conflict
Behavioral: Imaginal exposure

Study type

Interventional

Funder types

Other

Identifiers

NCT05193383
2020-06930a

Details and patient eligibility

About

Imaginal exposure is a widely used and effective psychological treatment technique. Recent research suggests that neural activations and emotional responses during imaginal exposure are similar to those elicited during in vivo exposure. However, to the investigators knowledge, no direct comparison between in vivo and imaginal exposure has been performed during neuroimaging. This study compares neural activations and emotional responses during imaginal and in vivo exposure. This study also explores the generalizability of fear reduction achieved through imaginal exposure to fear responses elicited by in vivo stimuli, and vice versa, in a follow-up session approximately one week later. A better understanding of the mechanisms behind both types of exposure could have significant clinical utility, as well as elucidate the differences between fear created from outward stimuli and fear created from inward stimuli, such as mental imagery.

Full description

The study includes participants fearful of spiders and entails two experimental sessions, roughly one week apart. The first session includes brain imaging using functional magnetic resonance imaging (fMRI). During the first session, participants will be randomized into one of two conditions - in vivo exposure or imaginal exposure. In the in vivo exposure condition, participants will be shown video clips of spiders (fearful stimuli) and leaves (neutral stimuli) in different situations. In the imaginal exposure condition, participants will be instructed to produce mental imagery of the corresponding stimuli used for in vivo exposure.

Previous research found that the brief exposure procedure used during session 1 produced a fear reduction when the procedure was repeated one week later. Thus, in order to conceptually replicate this finding, and to examine the generalizability of fear reduction, participants return roughly one week later for a follow-up session. In the follow-up session, participants undergo a similar exposure procedure as used in session 1, but with half of the stimuli in vivo and the other half of the stimuli as mental imagery. In this way, it can be studied whether fear reduction generalize from exposure modality to another. The effects of imaginal and in vivo exposure on avoidance behavior towards fear-provoking stimuli (spiders) will also be assessed using an approach-avoidance conflict paradigm, using pictures of spiders to probe spider fear.

The current study will also explore the impact of mental imagery vividness during imaginal exposure on fear reduction. Additionally, the study will assess if vividness level can predict the generalizability of the effects of imaginal exposure to fear-provoking stimuli (mental imagery of a spider) on subsequent fear responses to to in vivo stimuli (film clip of a spider) one week later.

Functional magnetic resonance imaging (7T) is used to measure neural activations (session 1). Skin conductance is used to measure arousal response (session 1 & 2). Subjective fear and mental imagery vividness ratings will also be collected.

Enrollment

87 patients

Sex

All

Ages

18 to 60 years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

  • Willing and able to provide informed consent and complete study procedures
  • Fear of spiders

Exclusion criteria

  • Current psychiatric disorder other than spider phobia
  • Current use of psychotropic medication
  • Current neurological conditions
  • MRI-contraindications (i.e metal implants in skull)

Trial design

Primary purpose

Basic Science

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

87 participants in 2 patient groups

Imaginal exposure
Experimental group
Description:
Exposure to mental imagery including a fearful stimulus (spider) and corresponding scenes including a neutral stimulus (leaf)
Treatment:
Behavioral: Imaginal exposure
Behavioral: Approach-avoidance conflict
Behavioral: Exposure
In vivo exposure
Experimental group
Description:
Exposure to video clips including a fearful stimulus (spider) and corresponding clips including a neutral stimulus (leaf)
Treatment:
Behavioral: Approach-avoidance conflict
Behavioral: In vivo exposure
Behavioral: Exposure

Trial contacts and locations

1

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Central trial contact

Thomas Ågren, PhD; Johannes Björkstrand, PhD

Data sourced from clinicaltrials.gov

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