Implicit but not explicit extinction to threat‐conditioned stimulus prevents spontaneous recovery of threat‐potentiated startle responses in humans

Introduction It has long been posited that threat learning operates and forms under an affective and a cognitive learning system that is supported by different brain circuits. A primary drawback in exposure‐based therapies is the high rate of relapse that occurs when higher order areas fail to inhibit responses driven by the defensive circuit. It has been shown that implicit exposure of fearful stimuli leads to a long‐lasting reduction in avoidance behavior in patients with phobia. Despite the potential benefits of this approach in the treatment of phobias and posttraumatic stress disorder, implicit extinction is still underinvestigated. Methods Two groups of healthy participants were threat conditioned. The following day, extinction training was conducted using a stereoscope. One group of participants was explicitly exposed with the threat‐conditioned image, while the other group was implicitly exposed using a continuous flash suppression (CFS) technique. On the third day, we tested the spontaneous recovery of defensive responses using explicit presentations of the images. Results On the third day, we found that only the implicit extinction group showed reduced spontaneous recovery of defensive responses to the threat‐conditioned stimulus, measured by threat‐potentiated startle responses but not by the electrodermal activity. Conclusion Our results suggest that implicit extinction using CFS might facilitate the modulation of the affective component of fearful memories, attenuating its expression after 24 hr. The limitations of the CFS technique using threatful stimuli urge the development of new strategies to improve implicit presentations and circumvent such limitations. Our study encourages further investigations of implicit extinction as a potential therapeutic target to further advance exposure‐based psychotherapies. Exposure‐based therapies often fail when higher order structures are unable to inhibit the activity in the threat defensive circuit. Here, we show that implicit exposure of a threat conditioned stimulus can reduce the recovery of defensive responses in the startle reflex index. These results suggest that implicit extinction might facilitate the modulation of the affective component of fearful memories, representing an important therapeutic target to further advance exposure‐based psychotherapies.