Department of Psychology, Swansea University, UK.
Atlanta Veterans Affairs Medical Center, Mental Health Service Line, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
Prog Neuropsychopharmacol Biol Psychiatry. 2019 Jan 10;88:339-351. doi: 10.1016/j.pnpbp.2018.08.014. Epub 2018 Aug 19.
The classical conditioning paradigm of fear learning has spawned a number of experimental variations for the explanation of posttraumatic stress disorder (PTSD) etiology. These paradigms include extinction learning and recall, fear inhibition, fear generalization, and conditioned avoidance. As such, each of these paradigms have significant applications for understanding the development, maintenance, treatment, and relapse of the fear-related features of PTSD. In the present review, we describe each of these conditioning-based paradigms with reference to the clinical applications, and supported by case examples from patients with severe PTSD symptoms. We also review the neurobiological models of conditioning and extinction in animals, psychiatrically healthy humans, and PTSD patients, and discuss the current balance of evidence suggesting a number of biological, behavioral, and cognitive mechanisms/moderators of the conditioning and extinction process in experimental and clinical contexts.
恐惧学习的经典条件作用范式为创伤后应激障碍（PTSD）病因学的解释产生了许多实验变化。这些范式包括消退学习和回忆、恐惧抑制、恐惧泛化和条件回避。因此，这些范式中的每一个都对理解 PTSD 的恐惧相关特征的发展、维持、治疗和复发具有重要意义。在本综述中，我们描述了这些基于条件作用的范式，参考了临床应用，并通过严重 PTSD 症状患者的病例示例进行了支持。我们还回顾了动物、精神健康人类和 PTSD 患者的条件作用和消退的神经生物学模型，并讨论了目前的证据平衡，这些证据表明在实验和临床环境中，条件作用和消退过程存在许多生物学、行为和认知机制/调节剂。
