Philadelphia, PA, July 20, 2015 - Exposure therapy is a commonly used and effective treatment for anxiety disorders, including posttraumatic stress disorder, obsessive-compulsive disorder, and phobias.
The goal of such therapy is to extinguish fear, which is accomplished by presenting cues that are known to predict a negative experience in the absence of that experience. Over time, learning that the 'danger cue' is no longer dangerous produces extinction of the fearful response.
However, fears and the associated defensive behaviors resulting from that fear often return after they have been extinguished, undermining the long-term effectiveness of treatment.
This led a team of researchers at New York University to hypothesize that, as opposed to traditional extinction where the threat is omitted during therapeutic training, extinction could be successfully enhanced by instead replacing the potential threat with a neutral one. They were right, and their research is now published in the current issue of Biological Psychiatry.
Professor Elizabeth Phelps and her colleagues designed and conducted similar experiments in both rats and healthy humans. The subjects were initially 'trained' to associate an aversive stimulus (the danger cue) with an electrical shock. Later, half the subjects then underwent standard extinction, where the danger cue was presented but the shock was eliminated. For the other half of the subjects, the electric shock was replaced with a new, neutral outcome when the same cue was presented.
In both rats and humans, the modified fear extinction procedure was more effective in preventing the return of fear than simply omitting the electric shock.
The authors also found that the extent to which people were intolerant with the uncertainty of being shocked was related to their risk that the fear of the danger cue would return. In other words, their sensitivity to uncertain threat influenced their recovery.
These data provide cross-species evidence that extinction can be successfully augmented by replacing, rather than omitting, an expected threat.
"The paper by Dunsmoor and colleagues highlights that we are still learning important information about how to maintain the benefits of cognitive behavioral therapy," said Dr. John Krystal, Editor of Biological Psychiatry. "It shows that it is not only important to break the links between environmental cues and fear, but also to substitute new learning about safety that prevents fears from encroaching on hard-won therapeutic gains."
The article is "Novelty-Facilitated Extinction: Providing a Novel Outcome in Place of an Expected Threat Diminishes Recovery of Defensive Responses" by Joseph E. Dunsmoor, Vinn D. Campese, Ahmet O. Ceceli, Joseph E. LeDoux, and Elizabeth A. Phelps (doi: 10.1016/j.biopsych.2014.12.008). The article appears in Biological Psychiatry, Volume 78, Issue 3 (August 1, 2015), published by Elsevier.
Full text of the article is available to credentialed journalists upon request; contact Rhiannon Bugno at +1 214 648 0880 or Biol.Psych@utsouthwestern.edu. Journalists wishing to interview the authors may contact Elizabeth Phelps at +1 212 998 8317 or firstname.lastname@example.org.
The authors' affiliations, and disclosures of financial and conflicts of interests are available in the article.
John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.
About Biological Psychiatry
Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.
The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.
Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 6th out of 140 Psychiatry titles and 10th out of 252 Neurosciences titles in the Journal Citations Reports® published by Thomson Reuters. The 2014 Impact Factor score for Biological Psychiatry is 10.255.
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