Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Depress Anxiety. 2014 Apr;31(4):269-78. doi: 10.1002/da.22252. Epub 2014 Mar 13.
Conditioned fear acquisition and extinction paradigms have been widely used both in animals and humans to examine the neurobiology of emotional memory. Studies have also shown that patients suffering from posttraumatic stress disorder (PTSD) exhibit deficient extinction recall along with dysfunctional activation of the fear extinction network, including the ventromedial prefrontal cortex, amygdala, and hippocampus. A great deal of overlap exists between this fear extinction network and brain regions associated with symptom severity in PTSD. This suggests that the neural nodes of fear extinction could be targeted to reduce behavioral deficits that may subsequently translate into symptom improvement. In this article, we discuss potential applications of brain stimulation and neuromodulation methods, which, combined with a mechanistic understanding of the neurobiology of fear extinction, could be used to further our understanding of the pathophysiology of anxiety disorders and develop novel therapeutic tools. To this end, we discuss the following stimulation approaches: deep-brain stimulation, vagus nerve stimulation, transcranial direct current stimulation, and transcranial magnetic stimulation. We propose new translational research avenues that, from a systems neuroscience perspective, aim to expand our understanding of circuit dynamics and fear processing toward the practical development of clinical tools, to be used alone or in combination with behavioral therapies.
条件性恐惧获得和消退范式已被广泛应用于动物和人类，以研究情绪记忆的神经生物学。研究还表明，患有创伤后应激障碍 (PTSD) 的患者表现出消退记忆缺陷，以及恐惧消退网络的功能障碍激活，包括腹内侧前额叶皮层、杏仁核和海马体。这个恐惧消退网络与 PTSD 中与症状严重程度相关的大脑区域之间存在大量重叠。这表明恐惧消退的神经节点可以作为靶点，以减少可能随后转化为症状改善的行为缺陷。在本文中，我们讨论了脑刺激和神经调节方法的潜在应用，这些方法结合对恐惧消退神经生物学的机制理解，可用于进一步了解焦虑障碍的病理生理学，并开发新的治疗工具。为此，我们讨论了以下刺激方法：深部脑刺激、迷走神经刺激、经颅直流电刺激和经颅磁刺激。我们提出了新的转化研究途径，从系统神经科学的角度来看，旨在扩大我们对电路动力学和恐惧处理的理解，朝着开发临床工具的实际方向发展，这些工具可单独使用或与行为疗法结合使用。
