Article

Extinction retention predicts improvement in social anxiety symptoms following exposure therapy

Department of Psychology, Southern Methodist University, Dallas, TX 75275, USA.
Depression and Anxiety (Impact Factor: 4.29). 01/2009; 26(1):22-7. DOI: 10.1002/da.20511
Source: PubMed

ABSTRACT Several researchers have argued that basic research on extinction learning can guide efforts to enhance the efficacy of exposure-based therapy. At the basis of this translational research paradigm is the assumption that extinction retention is important to the outcome of exposure-based therapy. This study is the first to examine the relationship between extinction retention, which comprises the amount of fear reduction that is retained between two exposure sessions and improvement in anxiety symptoms following exposure treatment.
Adults (N=90), participating in two separate studies, who received three sessions of repeated exposure to public speaking provided ratings of peak fear during exposure treatment and completed the Liebowitz Social Anxiety Scale Self-Report version, LSAS-SR, Baker et al. [2002: Behav Res Ther 40:701-715] at baseline, posttreatment, and follow-up.
After controlling for within-session extinction, extinction retention accounted for significant variance in the improvement of LSAS-SR scores over time.
Our findings suggest that the consolidation of extinction learning into long-term memory is associated with improvements in fear and avoidance related to social situations following exposure therapy. Implications for exposure therapy augmentation studies are discussed.

0 Bookmarks
 · 
73 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The most common pathologic manifestation of fear is posttraumatic stress disorder (PTSD). Developing PTSD is closely related with predisposing factors such as genes and early traumatic experiences. In PTSD, enhanced fear learning and poor extinction are common. Fear is manifested through autonomic responses and persistent memories of the traumatic event. These manifestations are related to stress responses modulated by the hypothalamic-pituitary-adrenal axis. This article evaluates the role of fear and stress in the course of PTSD. Findings on fear learning and extinction are presented in order to guide future treatments of patients with PTSD. Copyright © 2014 Elsevier Inc. All rights reserved.
    Psychiatric Clinics of North America 12/2014; 37(4). DOI:10.1016/j.psc.2014.08.010 · 2.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Fear extinction learning is a highly adaptive process that involves the integrity of frontolimbic circuitry. Its disruption has been associated with emotional dysregulation in stress and anxiety disorders. In this article we consider how age, genetics and experiences shape our capacity to regulate fear in cross-species studies. Evidence for adolescent-specific diminished fear extinction learning is presented in the context of immature frontolimbic circuitry. We also present evidence for less neural plasticity in fear regulation as a function of early-life stress and by genotype, focusing on the common brain derived neurotrophin factor (BDNF) Val66Met polymorphism. Finally, we discuss this work in the context of exposure-based behavioral therapies for the treatment of anxiety and stress disorders that are based on principles of fear extinction. We conclude by speculating on how such therapies may be optimized for the individual based on the patient's age, genetic profile and personal history to move from standard treatment of care to personalized and precision medicine.
    Developmental Cognitive Neuroscience 08/2014; 11. DOI:10.1016/j.dcn.2014.07.006 · 3.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In recent years the gap between psychological and psychiatric research and practice has lessened. In turn, greater attention has been paid toward how psychological and pharmacological treatments interact. Unfortunately, the majority of research has indicated no additive effect of anxiolytics and antidepressants when combined with psychological treatments, and in many cases pharmacological treatments attenuate the effectiveness of psychological treatments. However, as psychology and psychiatry have come closer together, research has started to investigate the neural and molecular mechanisms underlying psychological treatments. Such research has utilised preclinical models of psychological treatments, such as fear extinction, in both rodents and humans to determine multiple neural and molecular changes that may be responsible for the long-term cognitive and behavioural changes that psychological treatments induce. Currently, researchers are attempting to identify pharmacological agents that directly augment these neural/molecular changes, and which may be more effective adjuncts to psychological treatments than traditional anxiolytics and antidepressants. In this review we describe the research that has led to this new wave of thinking about combined psychological/pharmacological treatments. We also argue that an increased emphasis on identifying individual difference factors that predict the effectiveness of pharmacological adjuncts is critical in facilitating the translation of this preclinical research into clinical practice.
    Behaviour Research and Therapy 11/2014; DOI:10.1016/j.brat.2014.07.012 · 3.85 Impact Factor

Full-text (2 Sources)

Download
6 Downloads
Available from
Oct 7, 2014