Division of Depression and Anxiety Disorders, Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts 02478, USA; email:
Annu Rev Clin Psychol. 2019 May 7;15:257-284. doi: 10.1146/annurev-clinpsy-050718-095634. Epub 2019 Jan 30.
Although the fear response is an adaptive response to threatening situations, a number of psychiatric disorders feature prominent fear-related symptoms caused, in part, by failures of extinction and inhibitory learning. The translational nature of fear conditioning paradigms has enabled us to develop a nuanced understanding of extinction and inhibitory learning based on the molecular substrates to systems neural circuitry and psychological mechanisms. This knowledge has facilitated the development of novel interventions that may augment extinction and inhibitory learning. These interventions include nonpharmacological techniques, such as behavioral methods to implement during psychotherapy, as well as device-based stimulation techniques that enhance or reduce activity in different regions of the brain. There is also emerging support for a number of psychopharmacological interventions that may augment extinction and inhibitory learning specifically if administered in conjunction with exposure-based psychotherapy. This growing body of research may offer promising novel techniques to address debilitating transdiagnostic fear-related symptoms.
尽管恐惧反应是对威胁情况的一种适应性反应,但许多精神疾病都以突出的与恐惧相关的症状为特征,部分原因是消退和抑制性学习的失败。恐惧条件反射范式的转化性质使我们能够根据分子基质、系统神经回路和心理机制,对消退和抑制性学习有更细致的理解。这一知识促进了新干预措施的发展,这些措施可能增强消退和抑制性学习。这些干预措施包括非药物技术,例如在心理治疗期间实施的行为方法,以及基于设备的刺激技术,这些技术可以增强或减少大脑不同区域的活动。越来越多的证据还支持一些精神药理学干预措施,这些措施可能会增强消退和抑制性学习,如果与基于暴露的心理治疗一起使用的话。这一不断增长的研究可能会为解决使人衰弱的跨诊断恐惧相关症状提供有前景的新方法。