Using Exercise to Enhance Consolidation of Exposure-Based Therapeutic Learning in PTSD

Project Summary The proposed R61/R33 project would build on our published pilot data and animal models to demonstrate that moderate intensity physical exercise delivered after exposure therapy engages fear circuitry and enhances the consolidation of therapeutic safety learning, thereby enabling enhanced symptom reduction for PTSD. In the R61 target engagement phase, adults with PTSD related to interpersonal violence (IPV) exposure would complete an initial session of imaginal exposure to traumatic memory cues adapted for an MRI setting. This would be followed by 30-mins of moderate intensity exercise or low intensity walking control. Participants would return 24-hrs later to complete a second session of imaginal exposure with MRI. We hypothesize greater between-session reductions in fear responding and fear circuit activation to traumatic memory cues 24-hrs later among those who exercised following the first session compared to those in the walking control condition. The R33 phase will build upon successful target engagement and adapt a brief version of prolonged exposure (PE) therapy to include moderate-intensity exercise or walking control after imaginal exposure. We hypothesize that PE with exercise will result in more rapid and larger reductions in PTSD symptoms and reduced fear- related neurocircuitry activation and affective arousal to trauma cues compared to PE plus walking control. Overall, this project is designed to demonstrate that a novel intervention (moderate intensity exercise) engages key mechanisms of therapeutic exposure, thereby enhancing the efficacy of exposure therapy.