McLean Hospital, Harvard Medical School, Belmont, Mass.
Am J Psychiatry. 2020 Mar 1;177(3):214-222. doi: 10.1176/appi.ajp.2020.20010055.
Anxiety and fear-related disorders are common and disabling, and they significantly increase risk for suicide and other causes of morbidity and mortality. However, there is tremendous potential for translational neuroscience to advance our understanding of these disorders, leading to novel and powerful interventions and even to preventing their initial development. This overview examines the general circuits and processes thought to underlie fear and anxiety, along with the promise of translational research. It then examines some of the data-driven "next-generation" approaches that are needed for discovery and understanding but that do not always fit neatly into established models. From one perspective, these disorders offer among the most tractable problems in psychiatry, with a great deal of accumulated understanding, across species, of neurocircuit, behavioral, and, increasingly, genetic mechanisms, of how dysregulation of fear and threat processes contributes to anxiety-related disorders. One example is the progressively sophisticated understanding of how extinction underlies the exposure therapy component of cognitive-behavioral therapy approaches, which are ubiquitously used across anxiety and fear-related disorders. However, it is also critical to examine gaps in our understanding between reasonably well-replicated examples of successful translation, areas of significant deficits in knowledge, and the role of large-scale data-driven approaches in future progress and discovery. Although a tremendous amount of progress is still needed, translational approaches to understanding, treating, and even preventing anxiety and fear-related disorders offer great opportunities for successfully bridging neuroscience discovery to clinical practice.
焦虑和恐惧相关障碍很常见且具有致残性，它们会显著增加自杀和其他发病率和死亡率的风险。然而，转化神经科学有巨大的潜力来增进我们对这些障碍的理解，从而产生新的、强大的干预措施，甚至可以预防它们的最初发展。本篇综述考察了被认为是恐惧和焦虑的基础的一般回路和过程，以及转化研究的前景。然后，它检查了一些数据驱动的“下一代”方法，这些方法对于发现和理解是必要的，但并不总是符合既定模型。从一个角度来看，这些障碍提供了精神病学中最具可操作性的问题之一，具有大量跨物种的神经回路、行为以及越来越多的遗传机制的积累理解，即恐惧和威胁过程的失调如何导致与焦虑相关的障碍。一个例子是如何逐渐深入地理解，为什么消退是认知行为疗法暴露疗法的组成部分，这种方法在焦虑和恐惧相关障碍中被广泛使用。然而，检查成功转化的合理复制例子、知识的重大缺陷领域以及大规模数据驱动方法在未来进展和发现中的作用之间的理解差距也是至关重要的。尽管仍需要取得巨大的进展，但理解、治疗甚至预防焦虑和恐惧相关障碍的转化方法为成功地将神经科学发现与临床实践联系起来提供了巨大的机会。
