Enhanced Mental Reinstatement of Exposure to Improve Extinction Generalization: A Study on Claustrophobia and MRI Fear

Fear of enclosed spaces prevents many people from receiv-ing magnetic resonance imaging (MRI) scans. Although exposure therapy can effectively treat such fears, reductions in fear during exposure often do not generalize beyond the context in which they took place. This study tested a strat-egy designed to increase generalization, which involved revisiting the memory of a prior exposure to enhance retrie-val of extinction learning. Forty-five participants with claus - trophobia that included fear of MRI scans underwent a series of exposures lying inside a narrow cabinet. One week later, participants were randomly assigned to enhanced mental reinstatement (EMR) or control procedures. Prior to entering a mock MRI scanner, EMR participants recalled the memory of exposure training and listened to an audio recording of themselves describing what they learned, whereas control participants recalled a neutral memory. Compared to the control condition, EMR led to signifi-cantly reduced heart rate reactivity in the mock MRI scan-ner, but not self-reported fear or avoidance. There were no differences between conditions in claustrophobia symp-toms or MRI fear at 1-month follow-up. Results suggest some benefits of mental reinstatement for improving gener-alization of gains following exposure training for claustro-phobia, with measures of subjective fear and physiological arousal showing discordant outcomes.