How can neurobiology of fear extinction inform treatment?

Abstract

The neurobiology of extinction learning has been translated to inform the delivery of exposure therapy, the gold-standard treatment for fear and anxiety disorders. The inhibitory retrieval model suggests that extinction leads to the formation of a new inhibitory memory which competes with the original fear memory that remains intact, resulting in potential return of fear over time and across different contexts. Implications for exposure therapy include behavioral and pharmacological strategies to 1) maximize prediction error through expectancy violation, and 2) enhance consolidation, generalization, and retrievability of extinction learning. Yet, not all individuals respond to treatment. In order to enhance the effectiveness and durability of exposure-based treatments, future research on reward processing, stimulus valuation, and decision-making is needed. Understanding the complex relationships among threat, reward, and cognitive processes holds promise for developing personalized treatments to meet the needs of individuals with fear and anxiety disorders.

Keywords: Anxiety; Exposure therapy; Extinction generalization; Extinction learning; Inhibitory retrieval; Memory consolidation.