Stress modulation of fear and extinction in psychopathology and treatment

Abstract

The glucocorticoid cortisol, a major player in the development of stress-related psychopathology, can also be used for the augmentation of extinction-based psychotherapies (e.g., exposure therapy). Substantial evidence supports its beneficial effects in the treatment of post-traumatic stress disorder and specific phobias. In this review, we first present the role of stress and cortisol in the development of maladaptive emotional memories. Then, we describe the mechanisms that may account for the cortisol-induced augmentation of exposure, namely, the enhancement of extinction memory consolidation and the reduction of the contextual dependency of the extinction memory. Finally, we discuss several considerations and limitations for the use of cortisol in psychotherapy, focusing on the possible adverse effects of cortisol in a reconsolidation-based (as opposed to extinction-based) intervention.

Trait salivary alpha-amylase activity levels define the conditions for facilitation by L-DOPA of extinction consolidation

“…4b) and without influences of group (ps>.30). Hence, the sCORT analyses only corroborate a previously reported positive influence of HPA axis activity on extinction consolidation 35,40 , but do not speak for an interaction with dopamine levels.…”

“…4b) and without influences of group (ps>.30). Hence, the sCORT analyses only corroborate a previously reported positive influence of HPA axis activity on extinction consolidation 35,40 , but do not speak for an interaction with dopamine levels. sAA and sCORT originate from two different stress systems, the first being faster and more sensitive in responding to stressors, while the second responds more slowly and to more stressful tasks.…”

“…1c). Arousal and stress have been suggested to affect consolidation processes in general and extinction consolidation in particular [33][34][35] . We had previously observed L-DOPA main effects in two out of three MRI experiments 14,16,17 , while two purely behavioral experiments showed only conditional L-DOPA effects, moderated by prior extinction success 18 , and one other behavioral study showed no effect 19 .…”

Theory for Anxiety Disorders

“…Where: Norepinephrine," also identified as noradrenaline," is a "hormone" released by the "adrenal glands," and it is also a "neurotransmitter chemical messenger" that helps transmit nerve signals across nerve cells, muscle cells, or gland cells. "Norepinephrine" travels directly and indirectly to the brain, influencing learning and memory processes, and is involved in the initiation and maintenance of "fear" and "anxiety", modulating "episodic memory", fear conditioning, and fear reconsolidation [14]. "Adrenaline", also known as "epinephrine," is a hormone produced by the "adrenal medulla" inside the "adrenal glands".…”

Replication study on the role of dopamine-dependent prefrontal reactivations in human extinction memory retrieval

“…1c ). The activity of these systems, linked to arousal and stress, have been suggested to affect consolidation processes in general and extinction consolidation in particular 33 – 35 . We had previously observed L-DOPA main effects in two out of three MRI experiments 14 , 16 , 17 , while two purely behavioral experiments showed only conditional L-DOPA effects, moderated by prior extinction success 18 , and one other behavioral study showed no significant effect 19 .…”