Augmentation of Extinction and Inhibitory Learning in Anxiety and Trauma-Related Disorders

Annu Rev Clin Psychol. 2019 May 7;15:257-284. doi: 10.1146/annurev-clinpsy-050718-095634. Epub 2019 Jan 30.

Abstract

Although the fear response is an adaptive response to threatening situations, a number of psychiatric disorders feature prominent fear-related symptoms caused, in part, by failures of extinction and inhibitory learning. The translational nature of fear conditioning paradigms has enabled us to develop a nuanced understanding of extinction and inhibitory learning based on the molecular substrates to systems neural circuitry and psychological mechanisms. This knowledge has facilitated the development of novel interventions that may augment extinction and inhibitory learning. These interventions include nonpharmacological techniques, such as behavioral methods to implement during psychotherapy, as well as device-based stimulation techniques that enhance or reduce activity in different regions of the brain. There is also emerging support for a number of psychopharmacological interventions that may augment extinction and inhibitory learning specifically if administered in conjunction with exposure-based psychotherapy. This growing body of research may offer promising novel techniques to address debilitating transdiagnostic fear-related symptoms.

Keywords: PTSD; amygdala; exposure; extinction; fear conditioning; inhibitory learning.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Amygdala* / physiopathology
  • Anxiety Disorders* / metabolism
  • Anxiety Disorders* / physiopathology
  • Anxiety Disorders* / therapy
  • Brain* / drug effects
  • Brain* / metabolism
  • Brain* / physiopathology
  • Conditioning, Classical / physiology*
  • Electric Stimulation Therapy*
  • Extinction, Psychological / physiology*
  • Fear / physiology*
  • Humans
  • Implosive Therapy*
  • Inhibition, Psychological*
  • Stress Disorders, Traumatic* / metabolism
  • Stress Disorders, Traumatic* / physiopathology
  • Stress Disorders, Traumatic* / therapy
  • Transcranial Magnetic Stimulation*