Uncovering Neurocognitive Mechanisms and Enhancement of Exposure-based Fear Learning With Cognitive Training
September 3, 2026 updated by: Jessica Bomyea, University of California, San Diego
Anxiety disorders remain are among the most prevalent psychiatric conditions and are associated with negative outcomes spanning poor health to increased suicide risk.
While exposure therapy is recognized as a gold standard empirically supported treatment, many individuals fail to achieve adequate response.
Exposure therapy is grounded in fear extinction learning models, which suggest that anxiety diminishes when individuals repeatedly confront their fears.
To improve exposure-based interventions, it is critical to enhance our understanding of underlying mechanisms of fear extinction and how to better target these mechanisms.
Fear extinction requires basic neurocognitive abilities that allow individuals to learn from and adapt to experiences confronting feared situations.
Emerging cross sectional and experimental data suggest that working memory is a particularly important neurocognitive process that is associated with fear learning outcomes.
By enhancing working memory through experimental manipulations like cognitive training, we may improve the fear extinction learning processes essential for successful exposure therapy.
Unlike other neurocognitive enhancements (e.g., medications), computer-based working memory training offers high mechanistic precision, ease of administration, and low cost.
The long-term goal of this research is to develop a novel mechanistic understanding of the neurocognitive processes involved in exposure-based fear extinction learning, ultimately aiming to improve interventions for anxiety disorders.
This study will test the effects of manipulating working memory prior to a massed exposure paradigm, comparing working memory training plus massed exposure (WMT+Ex) to a sham training plus massed exposure (ST+Ex) condition.
Using public speaking anxiety as a clinical exemplar, we will employ a rigorous experimental trial design combined with a validated single-visit speech exposure paradigm to assess fear extinction learning outcomes through multiple measures, including behavioral, physiological, neural, and self-report.
The central hypothesis is that WMT+Ex will improve markers of fear extinction learning considered to underlie clinical response in exposure therapy.
Specific aims are to 1) determine the extent to which working memory training delivered prior to massed exposure improves behavioral and neural markers of fear extinction learning, and 2) evaluate the effects of working memory training delivered prior to massed exposure on fear extinction learning occurring during exposure.
This study is expected to achieve two goals: first, to advance our understanding of the neurocognitive mechanisms of fear extinction through a rigorous experimental design, and second, to validate a combined working memory training and exposure paradigm.
If successful in enhancing fear extinction, this approach could be further explored in therapeutic formats to assess its clinical effects.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
120
Phase
- Not Applicable
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- age 18-65
- fluent in English
- diagnosis of social anxiety disorder (generalized or performance-only) with Personal Report of Public Speaking Anxiety (PRPSA) score of ≥120 at screening
- 6-week stability if receiving other (non-anxiety focused) psychosocial treatment
Exclusion Criteria:
- past 3-mo diagnosis of moderate or greater alcohol or substance use disorder
- lifetime history of psychotic or bipolar I disorders
- acute suicidality necessitating immediate clinical intervention
- neurodegenerative or neurodevelopmental disorders
- history of neurological condition
- conditions that are unsafe for MRI (e.g., metal in body)
- currently receiving psychosocial treatment for anxiety or related condition
- currently receiving psychiatric pharmacotherapy
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Active Comparator: Cognitive training
Training to enhance cognitive functioning
|
Repeated practice with cognitive skills to enhance performance
Sham cognitive training
|
|
Sham Comparator: Sham training
Computer interface designed to control for general task parameters
|
Repeated practice with cognitive skills to enhance performance
Sham cognitive training
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Fear extinction
Time Frame: Change from baseline day 1 to post-intervention day 2
|
threat expectancy ratings to the CS+ during late extinction learning
|
Change from baseline day 1 to post-intervention day 2
|
|
Subjective Units of Distress
Time Frame: Change from baseline speech to post speech (all within day 1)
|
Ratings of distress during speeches
|
Change from baseline speech to post speech (all within day 1)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Estimated)
January 1, 2027
Primary Completion (Estimated)
June 1, 2031
Study Completion (Estimated)
September 1, 2031
Study Registration Dates
First Submitted
August 31, 2026
First Submitted That Met QC Criteria
September 3, 2026
First Posted (Actual)
September 4, 2026
Study Record Updates
Last Update Posted (Actual)
September 4, 2026
Last Update Submitted That Met QC Criteria
September 3, 2026
Last Verified
September 1, 2026
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 812820
- 1R01MH141088-01A1 (Other Grant/Funding Number: NIMH)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
NIH NDA
IPD Sharing Time Frame
see NIH for details
IPD Sharing Access Criteria
see NIH for details
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.