Plasticity induction in the ventromedial prefrontal cortex during REM sleep improves fear extinction memory consolidation

Anxiety disorders (ADs) are among the most prevalent mental health conditions, yet first-line treatments often yield only moderate effectiveness. The fear conditioning paradigm is commonly used to investigate fear and extinction learning, revealing deficits in these processes and dysfunctional activity in the ventromedial prefrontal cortex (vmPFC) and amygdala in individuals with ADs. The vmPFC plays a critical role in regulating activity of the amygdala and consolidation of fear extinction memory. Notably, transcranial direct current stimulation (tDCS) has shown promise in enhancing fear extinction by modulating vmPFC activity. Additionally, rapid eye movement (REM) sleep has been suggested to be crucial for fear extinction memory consolidation. This study investigated the role the vmPFC during REM sleep in fear extinction memory consolidation. Thirty-two participants underwent a 3-day differential fear conditioning paradigm, with tDCS or sham stimulation applied during REM sleep over the vmPFC. Outcome measures included skin conductance responses (SCR) and subjective ratings of arousal, fear, and valence. Results indicate that tDCS during REM sleep enhances fear extinction memory consolidation, as measured by SCR. Furthermore, participants reported an increased subjective arousal following tDCS. These findings suggest that tDCS during REM sleep may hold potential for improving exposure-based treatments for ADs by strengthening fear extinction memory.