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

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.

<p>Conditioned taste aversion memory extinction temporally induces insular cortical BDNF release and inhibits neuronal apoptosis</p>

“…47 In addition, a number of psychiatric disorders such as panic disorder, phobias, social anxiety disorder (SAD), and posttraumatic stress disorder, share a failure of memory extinction. [48][49][50] In this study, the impaired CTA extinction after inhibition of BDNF-TrkB further confirmed the involvement of BDNF in the psychiatric disorders.…”

Treatment augmentation for posttraumatic stress disorder: A systematic review

“…Personalized medicine developments, such as machine learning techniques, will provide insights into subgroups of individuals who may benefit most from an augmentation strategy that targets associated difficulties in PTSD (Lebois, Seligowski, Wolff, Hill, & Ressler, ). Such approaches will also support the individualization of PTSD augmentation approaches.…”

From Extinction Learning to Anxiety Treatment: Mind the Gap

“…These include the identification of brain regions critical for inhibiting conditioned defensive responses, the development of a framework and corresponding techniques for improving the retention of extinction learning, the translation of the medication DCS from the animal laboratory to the clinic, and a growing understanding of how to target reconsolidation processes in concert with extinction to edit fear memories. Each of these areas of success has opened up new lines of research that have the potential to advance treatment, many of which involve novel ways of manipulating the brain circuitry involved in extinction [50].…”

“…Early studies have shown such an approach can decrease fear responses to laboratory conditioned fears [48] as well as pre-existing fears of specific animals (e.g., snakes, cockroaches) [49]. Although investigation of these techniques for fear and anxiety-based disorders is still in its early stages, such approaches show intriguing potential for augmenting extinction learning processes in the context of clinical treatments [50].…”