A mechanism for persistence and resolution of anxiety after exposure therapy

Exposure therapy works for anxiety, but fear often creeps back months or years later—this project aims to find out why and how to stop it. The problem is a stubborn gap in mental health treatment. Exposure therapy is the most effective option for anxiety disorders, yet many patients experience spontaneous recovery of fear and even full relapse over time. Two modifications—spacing sessions apart and using memory retrieval cues—have been shown to reduce this return of fear, but the underlying mechanism has remained unclear. Without knowing *why* these modifications work, clinicians cannot reliably design treatments that prevent relapse. The researchers propose that spontaneous recovery results from selective remembering of adverse events. They will test this across three randomised-controlled studies, using behavioural experiments, MEG brain imaging, and clinical assessments. If they confirm that spacing and retrieval cues work by reducing the relative advantage of fearful memories over safe ones, it would provide a concrete, testable target for improving exposure therapy. That could lead to more durable treatments for the millions of people with anxiety disorders, reducing the need for repeated courses of therapy and lowering relapse rates. This is fundamental science with a clear clinical pathway—understanding a cognitive mechanism to make an existing treatment last longer.