Enhancing exposure-based therapy from a translational research perspective

Abstract

Combining an effective psychological treatment with conventional anxiolytic medication is typically not more effective than unimodal therapy for treating anxiety disorders. However, recent advances in the neuroscience of fear reduction have led to novel approaches for combining psychological therapy and pharmacological agents. Exposure-based treatments in humans partly rely on extinction to reduce the fear response in anxiety disorders. Animal studies have shown that D-cycloserine (DCS), a partial agonist at the glycine recognition site of the glutamatergic N-methyl-D-aspartate receptor facilitates extinction learning. Similarly, recent human trials have shown that DCS enhances fear reduction during exposure therapy of some anxiety disorders. This article discusses the biological and psychological mechanisms of extinction learning and the therapeutic value of DCS as an augmentation strategy for exposure therapy. Areas of future research will be identified.

Figures

Fig. 1

Schematic depiction of the NMDA receptor that is co-activated by d-cycloserine. NMDA receptors require the binding of two molecules of glutamate or aspartate and two molecules of glycine or glycine agonists.

Fig. 2

Means and standard errors of the Social Phobia and Anxiety Inventory (SPAI) at pre-test, post-test and 1-month follow-up assessment of treatment completers. From Hofmann, Meuret et al. (2006). Reprint permission has been requested.