Enhancing exposure therapy for anxiety disorders with glucocorticoids: From basic mechanisms of emotional learning to clinical applications

Bentz, Dorothée; Michael, Tanja; Quervain, Dominique J.‐F. de; Wilhelm, Frank H.

doi:10.1016/j.janxdis.2009.10.011

Cited by 122 publications

(69 citation statements)

References 80 publications

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“…In phobic individuals, exposure to a phobic stimulus almost invariably provokes retrieval of stimulus-associated fear memory, which leads to the fear response (6)(7)(8)(9). Exposure-based behavioral therapy of phobia is thought to rely on extinction of these fear responses (10)(11)(12)(13). Extinction occurs when conditioned responding to a stimulus decreases when the reinforcer is omitted (12,14).…”

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confidence: 99%

Glucocorticoids enhance extinction-based psychotherapy

Quervain

Bentz

Michael

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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Behavioral exposure therapy of anxiety disorders is believed to rely on fear extinction. Because preclinical studies have shown that glucocorticoids can promote extinction processes, we aimed at investigating whether the administration of these hormones might be useful in enhancing exposure therapy. In a randomized, doubleblind, placebo-controlled study, 40 patients with specific phobia for heights were treated with three sessions of exposure therapy using virtual reality exposure to heights. Cortisol (20 mg) or placebo was administered orally 1 h before each of the treatment sessions. Subjects returned for a posttreatment assessment 3-5 d after the last treatment session and for a follow-up assessment after 1 mo. Adding cortisol to exposure therapy resulted in a significantly greater reduction in fear of heights as measured with the acrophobia questionnaire (AQ) both at posttreatment and at follow-up, compared with placebo. Furthermore, subjects receiving cortisol showed a significantly greater reduction in acute anxiety during virtual exposure to a phobic situation at posttreatment and a significantly smaller exposure-induced increase in skin conductance level at follow-up. The present findings indicate that the administration of cortisol can enhance extinction-based psychotherapy.memory | retrieval | consolidation P hobic disorders can be characterized as disorders involving disturbed emotional learning and memory resulting in an enhanced fear response. A central mechanism in the pathogenesis of anxiety disorders is associative learning or conditioning that leads to formation of a fear memory (1-5). In phobic individuals, exposure to a phobic stimulus almost invariably provokes retrieval of stimulus-associated fear memory, which leads to the fear response (6-9). Exposure-based behavioral therapy of phobia is thought to rely on extinction of these fear responses (10-13). Extinction occurs when conditioned responding to a stimulus decreases when the reinforcer is omitted (12,14). Accordingly, fear reduction induced by exposure therapy is the result of decrements in the conditioned response over successive extinction trials. Extinction leads to the formation of an alternative set of nonfearful memory associations (extinction memory) that competes with, but does not erase original fear memory associations (14, 15). Considering the importance of extinction learning for exposure therapy, pharmacological interventions aimed at enhancing extinction processes are promising approaches to enhance exposure therapy, as it has been demonstrated with D-cycloserine (16-18).Glucocorticoids (cortisol in humans, corticosterone in rodents) are stress hormones released from the adrenal cortex and it has long been recognized that they readily enter the brain and affect learning and memory (19-24). Importantly, basic research studies in animals and humans have shown that the mnemonic effects of glucocorticoids can facilitate extinction processes (22,(25)(26)(27)(28)(29). Therefore, we aimed at investigating whether the administrati...

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confidence: 99%

Glucocorticoids enhance extinction-based psychotherapy

Quervain

Bentz

Michael

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

234

148

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“…Hierzu gehören z.B. die Verwendung von D-Cycloserin zur Beschleunigung der Extinktion bei der Expositionsbehandlung von Angststörungen [Rodrigues et al, 2014], die Gabe von Glukokortikoiden bei der Behandlung der posttraumatischen Belastungsstö-rung [Bentz et al, 2010] oder die Verwendung von Oxytocin zur Verbesserung sozialer Kognition [Perez-Rodriguez et al, 2015]. Wichtig ist hier festzuhalten, dass diese Kombinationstherapien eine klare theoretische Grundlage haben, über einen befristeten Zeitraum Verwendung finden und sich somit auch Nebenwirkungen und andere negative Effekte von Psychopharmaka minimieren lassen.…”

Section: Psychotherapie Kann Mit Somatischen Verfahren Kombiniert Nocunclassified

Lost in Translation: Psychologische Mechanismen und Psychotherapie

Flor

2015

Verhaltenstherapie

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In diesem Artikel möchte ich zu den folgenden Punkten Stellung nehmen: 1. Psychische Störungen basieren auf psychologischen Mechanismen und müssen aus diesen heraus verstanden werden 2. Psychische Störungen sind keine Hirnerkrankungen - jedoch kann das Verständnis psychischer Störungen durch die Kenntnis biologischer Prozesse verbessert werden. 3. Psychotherapie muss an diesen Mechanismen ansetzen und sollte von einer störungsorientierten zu einer mechanismenorientierten Therapie kommen. 4. Dies setzt eine mechanismenorientierte Diagnostik voraus. Der RDoc-Ansatz ist ein wichtiger Versuch, aber er greift zu kurz, was die psychologischen Mechanismen betrifft. 5. Pharmakotherapie und andere somatische Therapien können Psychotherapie unterstützen, wenn sie zur Veränderung der psychologischen Mechanismen eingesetzt werden. 6. Psychotherapie kann auch bei organischen Erkrankungen wirksam eingesetzt werden. 7. Wir sind noch weit davon entfernt, die Erkenntnisse der Grundlagenforschung in der Psychologie und den Neurowissenschaften in die Konstruktion neuer Psychotherapien einzubauen. Dafür brauchen wir bessere Förderinstrumente als die bislang zur Verfügung stehenden und eine politische und finanzielle Priorität für die Therapieforschung.

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“…Innovative approaches in this area further suggest that the simultaneous application of these techniques can result in vastly improved treatment effects (e.g. precortisol treatment during exposure in order to increase the coping capacity of an individual) [68,69]. …”

Section: Areas In Need Of Researchmentioning

confidence: 99%