How does psychological therapy work? Exploring the neurobiological mechanisms underlying the reduction of experimental fear via spoken instructions.
Therapists improve mental health typically through verbal communication, which affect the thoughts and emotions of the patient. Our knowledge of the underlying neural processes of therapeutic change is limited, but feasible ways to study this have recently emerged. For example, research using fear conditioning has uncovered important emotional memory processes, which might be utilized in treatment. In fear conditioning, a fear memory is created by associating a neutral stimulus with an aversive outcome. This can later be removed through a process of repeated exposure, called extinction. We have proposed an extinction procedure based on verbal instructions which reduces fear as effectively as repeated exposure, and appears a valid experimental model for imaginal exposure, a widely used psychological treatment technique. Thus, this procedure provides an opportunity to study the impact of verbal instructions on emotional memory processes, using fear conditioning methodology. This project examines if extinction, driven by verbal instructions, utilizes the same neurobiological mechanisms as in vivo extinction, specifically regarding the dopaminergic dependence of memory consolidation, and the noradrenergic impact on extinction learning. In this way, the project contributes towards a neurobiological framework for some psychological treatments, and will provide pre-clinical proof-of-concept studies for drug-assisted verbal therapy, which can later be extended to clinical research.
Final report
How does psychological therapy work? Exploring the neurobiological mechanisms underlying the reduction of experimental fear via spoken instruction.
Psychological treatment is, in essence, a procedure where a therapists’ spoken language, together with the induced mental operations in the patient, bring about an improvement in mental health. Despite more than a century of psychological treatments, very little is known about their underlying neurobiological mechanisms. However, recent findings in memory research have enabled us to start unpacking the mechanisms of psychological treatments.
Many psychological treatments involve changing the impact of emotional memories on behaviour, that is, the patient strives to change the emotional impact of previous events, such as trauma or troublesome behaviour. Hence, to identify mechanisms of such psychological treatments, it is necessary to examine how verbally induced mental operations can affect the emotional response of memories. In this vein, we have shown that the emotional impact of both naturally occurring and conditioned fear memories can be changed using verbal instructions inducing mental imagery exposure (mental operations). Thus, we have started to identify procedures that verbally alter the emotional impact of memories and can be utilized in psychological treatments. The aim of this project was to map the neural mechanisms involved in these procedures.
Initially, this project was aimed to directly test the neural signalling involved in verbal fear reduction through dopaminergic and noradrenergic signalling. However, the project had to change due to the Covid-19 pandemic when all clinical studies were put on hold, and it was not clear for how long those conditions would last. Because of this, the project changed method and took a neuroimaging approach where whole-brain neural patterns were studied.
The project was carried out in collaboration with the 7 Tesla-facility in Lund, where neural mechanisms were mapped with high resolution functional magnetic resonance imaging (fmri). There, we examined the following: (i) neural activity during verbally induced fear reduction of fear conditioning memories; (ii) comparison of neural activity and behaviour between fear reduction during verbal and visual exposure of fearful stimuli (spiders); (iii) long-lasting verbal reduction of naturally occurring fear.
The main results were that the reduction of fear appeared to activate similar neural patterns during both verbally induced fear reduction and exposure treatment. This was true for fear conditioning memories as well as for the naturally occurring fear in participants with spider phobia. These activations were both similar to previous brain imaging results regarding exposure to fearful stimuli. The two methods also produced similar results in long-lasting fear reduction, which was observed when the participants with spider phobia were tested with re-exposure and an approach-avoidance task one week later.
These results suggest that regarding the brain measured with fMRI, fear appears to be produced and processed in the same way if it is wilfully created from within as when it is a product of stimuli from the world around us. Throughout most of the history of psychology, there has been a debate about how emotions are triggered and produced. Nowadays, most agree that emotions are products of the brain, but the results of this project suggest that the brain can wilfully create emotions that are equally real as emotions triggered from an external source. This has not before been shown to this extent and the result contributes to the debate over to which degree we are in control over our emotions and experiences.
The project also shows that controlled verbal communication procedures can create emotions that can be measured with fMRI and psychophysiology. This can be used to provide a neurobiological framework for the psychological treatments where the creation of emotions is part of the treatment. For example, it provides a neural underpinning for treatments during which internal rehearsal and simulation of events are used to encourage behaviour, such as in behavioural activation therapy and cognitive behaviour therapy, or to reduce fear, such as in prolonged exposure therapy. The result of this project points towards further research, where such methods are tested during neural and behavioural measurements, and where these measurements can be used to identify networks and neural structures central for psychological treatment.
Indeed, the results from this project encourages further studies of treatment methods where verbal communication induces and/or changes emotions. It suggests that the neural activations and the change of emotion that these methods bring about should be examined and that an attempt should be made to identify the neural networks and structures vital for emotion change. The data from this project will continue to be analysed for such networks and structures involved in verbally induced exposure, and such results will be published as they are discovered.
The main data collection took place over 2022-2023, that is, during the tail end of the Covid-19 pandemic. Trouble with moving and processing the large amount of data delayed the beginning of data analysis to 2024, when it was enabled through a collaboration with the Karolinska Institute. The preliminary first results of fear learning were presented on the European meeting of fear conditioning in 2024. Several publications are under production and will be published in high-ranking international journals. The project was started at Uppsala University, but as can be seen above, developed to include a network of scientists also from Lunds University and Karolinska Institute, giving the project a broad national foundation.
Psychological treatment is, in essence, a procedure where a therapists’ spoken language, together with the induced mental operations in the patient, bring about an improvement in mental health. Despite more than a century of psychological treatments, very little is known about their underlying neurobiological mechanisms. However, recent findings in memory research have enabled us to start unpacking the mechanisms of psychological treatments.
Many psychological treatments involve changing the impact of emotional memories on behaviour, that is, the patient strives to change the emotional impact of previous events, such as trauma or troublesome behaviour. Hence, to identify mechanisms of such psychological treatments, it is necessary to examine how verbally induced mental operations can affect the emotional response of memories. In this vein, we have shown that the emotional impact of both naturally occurring and conditioned fear memories can be changed using verbal instructions inducing mental imagery exposure (mental operations). Thus, we have started to identify procedures that verbally alter the emotional impact of memories and can be utilized in psychological treatments. The aim of this project was to map the neural mechanisms involved in these procedures.
Initially, this project was aimed to directly test the neural signalling involved in verbal fear reduction through dopaminergic and noradrenergic signalling. However, the project had to change due to the Covid-19 pandemic when all clinical studies were put on hold, and it was not clear for how long those conditions would last. Because of this, the project changed method and took a neuroimaging approach where whole-brain neural patterns were studied.
The project was carried out in collaboration with the 7 Tesla-facility in Lund, where neural mechanisms were mapped with high resolution functional magnetic resonance imaging (fmri). There, we examined the following: (i) neural activity during verbally induced fear reduction of fear conditioning memories; (ii) comparison of neural activity and behaviour between fear reduction during verbal and visual exposure of fearful stimuli (spiders); (iii) long-lasting verbal reduction of naturally occurring fear.
The main results were that the reduction of fear appeared to activate similar neural patterns during both verbally induced fear reduction and exposure treatment. This was true for fear conditioning memories as well as for the naturally occurring fear in participants with spider phobia. These activations were both similar to previous brain imaging results regarding exposure to fearful stimuli. The two methods also produced similar results in long-lasting fear reduction, which was observed when the participants with spider phobia were tested with re-exposure and an approach-avoidance task one week later.
These results suggest that regarding the brain measured with fMRI, fear appears to be produced and processed in the same way if it is wilfully created from within as when it is a product of stimuli from the world around us. Throughout most of the history of psychology, there has been a debate about how emotions are triggered and produced. Nowadays, most agree that emotions are products of the brain, but the results of this project suggest that the brain can wilfully create emotions that are equally real as emotions triggered from an external source. This has not before been shown to this extent and the result contributes to the debate over to which degree we are in control over our emotions and experiences.
The project also shows that controlled verbal communication procedures can create emotions that can be measured with fMRI and psychophysiology. This can be used to provide a neurobiological framework for the psychological treatments where the creation of emotions is part of the treatment. For example, it provides a neural underpinning for treatments during which internal rehearsal and simulation of events are used to encourage behaviour, such as in behavioural activation therapy and cognitive behaviour therapy, or to reduce fear, such as in prolonged exposure therapy. The result of this project points towards further research, where such methods are tested during neural and behavioural measurements, and where these measurements can be used to identify networks and neural structures central for psychological treatment.
Indeed, the results from this project encourages further studies of treatment methods where verbal communication induces and/or changes emotions. It suggests that the neural activations and the change of emotion that these methods bring about should be examined and that an attempt should be made to identify the neural networks and structures vital for emotion change. The data from this project will continue to be analysed for such networks and structures involved in verbally induced exposure, and such results will be published as they are discovered.
The main data collection took place over 2022-2023, that is, during the tail end of the Covid-19 pandemic. Trouble with moving and processing the large amount of data delayed the beginning of data analysis to 2024, when it was enabled through a collaboration with the Karolinska Institute. The preliminary first results of fear learning were presented on the European meeting of fear conditioning in 2024. Several publications are under production and will be published in high-ranking international journals. The project was started at Uppsala University, but as can be seen above, developed to include a network of scientists also from Lunds University and Karolinska Institute, giving the project a broad national foundation.