Fear learning-induced brain dynamics predict individual extinction memory expression following transcranial magnetic stimulation

Fear learning and extinction unfold as time-dependent processes. Herein, we examined whether fear learning dynamically reorganizes brain activity and whether such reorganization predicts subsequent extinction-memory expression under transcranial magnetic stimulation (TMS)-modulated extinction. Eighty-seven healthy adults completed a three-day Pavlovian threat-learning protocol with resting-state fMRI, TMS-modulated extinction, and extinction-memory fMRI. Using coactivation pattern analysis with a hidden Markov model, we identified a fear-learning-induced brain state characterized by increased engagement and transition uncertainty after conditioning. Functional connectivity reorganization within this state predicted individual differences in extinction recall- and renewal-related brain activation under TMS-modulated extinction (cross-validated; recall r = 0.47, p = 0.001; renewal r = 0.37, p = 0.01; permutation-tested), but not natural extinction. In separate brain-behavior correlation analyses, the neural variates identified in the TMS-modulated extinction were associated with behavioral expression. These findings demonstrate that fear learning reshapes brain-state dynamics and identifies a candidate biomarker of neuromodulation-linked extinction-memory expression.