Grant: CIHR Fellowship

Paediatric anxiety disorders are frequent, can be extremely impairing and may lead to increased risks for adult anxiety disorders. Exposure-based therapies (including cognitive behavioural therapy [CBT]) are the first-line treatment for paediatric anxiety disorders. However, some children do not adequately benefit from treatment, and some experience a relapse of symptoms following treatment cessation. There is clearly scope to enhance the efficacy and durability of exposure therapy in paediatric anxiety disorders. The reconsolidation update mechanism suggests that following initial encoding, a memory is stored, but does not necessarily remain stable. When the memory is reactivated, it becomes labile and sensitive to change for a window of time. New information presented during this window can disrupt the reconsolidation of this memory, updating the original memory trace with new information. Augmentation of the fear memory may improve the maintenance of treatment gains following exposure therapy, because the memory can be modified and replaced with a less anxiety-evoking one. Besides, deficits of executive functioning, that is, the cognitive functions allowing for goal achievement such as planning, inhibition, and cognitive flexibility, have been extensively reported in anxious individuals, and have been associated with treatment response. Moreover, enhancement of executive functioning has been observed after successful CBT. The present study aims to test the hypothesis that incorporating reconsolidation update mechanisms to exposure-based therapy will improve treatment response in anxious youths aged 9-17 years old. We will also investigate executive functioning in our sample and potential contributions to treatment response. Our results will contribute to ameliorate exposure-based therapy protocols, will allow identifying the most at-risk youth, and may lead to the development of better targeted interventions.