LAUSR

Significance Conventional therapies for the treatment of anxiety disorders are aversive, and as a result, many patients terminate treatment prematurely. We have developed an unconscious method to bypass the unpleasantness in conscious exposure using functional magnetic resonance imaging neural reinforcement. Using this method, participants learn to generate brain patterns similar to the multivariate brain pattern of a feared animal. We demonstrate in a double-blind placebo-controlled experiment that neural reinforcement can lead to reliable reductions in physiological fear responses. Crucially, this intervention can be achieved completely unconsciously and without any aversive reaction. Extending our approach to other forms of psychopathologies, such as posttraumatic stress disorders, might eventually provide another means of intervention for patients currently receiving insufficient exposure treatments. Can “hardwired” physiological fear responses (e.g., for spiders and snakes) be reprogramed unconsciously in the human brain? Currently, exposure therapy is among the most effective treatments for anxiety disorders, but this intervention is subjectively aversive to patients, causing many to drop out of treatment prematurely. Here we introduce a method to bypass the subjective unpleasantness in conscious exposure, by directly pairing monetary reward with unconscious occurrences of decoded representations of naturally feared animals in the brain. To decode physiological fear representations without triggering excessively aversive reactions, we capitalize on recent advancements in functional magnetic resonance imaging decoding techniques, and use a method called hyperalignment to infer the relevant representations of feared animals for a designated participant based on data from other “surrogate” participants. In this way, the procedure completely bypasses the need for a conscious encounter with feared animals. We demonstrate that our method can lead to reliable reductions in physiological fear responses, as measured by skin conductance as well as amygdala hemodynamic activity. Not only do these results raise the intriguing possibility that naturally occurring fear responses can be “reprogrammed” outside of conscious awareness, importantly, they also create the rare opportunity to rigorously test a psychological intervention of this nature in a double-blind, placebo-controlled fashion. This may pave the way for a new approach combining the appealing rationale and proven efficacy of conventional psychotherapy with the rigor and leverage of clinical neuroscience.