2 - (SYM 1) Enhancing Outcomes from CBT for Anxious Children: Conducting Exposure Therapy Within the Memory Consolidation Window

Suboptimal response and relapse of successfully treated cases remain key challenges for the sustainability of Cognitive Behaviour Therapy (CBT). Basic science research has shown that behavioural manipulation of normal memory reconsolidation processes might be one way to prevent the return of fear. This clinical translation study examined whether conducting exposure therapy within the memory reconsolidation window improves clinical outcomes and prevents relapse of anxiety in children. 

178 children (8-12 years) diagnosed with Social Anxiety Disorder (Performance Specifier) received a two-hour intensive exposure therapy session. Participants were randomly assigned to receive exposure therapy: 1) during the memory reconsolidation window (10mins after activation of the fear memory); 2) outside the memory reconsolidation window (7-9hours after fear memory activation), or: 3) without activation of the memory reconsolidation window (control). Symptom were re-assessed at post-treatment and 1-month follow-up. 

All groups showed improvement, with no significant group differences, and 65% of participants in remission at follow-up. There were significant groups differences in relapse rates, with those in the 10min group showing less relapse than controls (4% vs. 26%), although there was no significant difference compared to those in the 7-9hr group (8%). 
Conducting exposure therapy within the memory reconsolidation window may protect against relapse over time. However, the non-significant difference in relapse compared to when exposure was conducted outside of the reconsolidation window suggests that the effect may not be driven by memory reconsolidation update mechanisms. Instead, the memory activation procedure itself may have engaged a distinct mechanism that enhanced treatment effects.