Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Neurosci Biobehav Rev. 2023 Jan;144:105005. doi: 10.1016/j.neubiorev.2022.105005. Epub 2022 Dec 19.
Laboratory threat extinction paradigms and exposure-based therapy both involve repeated, safe confrontation with stimuli previously experienced as threatening. This fundamental procedural overlap supports laboratory threat extinction as a compelling analogue of exposure-based therapy. Threat extinction impairments have been detected in clinical anxiety and may contribute to exposure-based therapy non-response and relapse. However, efforts to improve exposure outcomes using techniques that boost extinction - primarily rodent extinction - have largely failed to date, potentially due to fundamental differences between rodent and human neurobiology. In this review, we articulate a comprehensive pre-clinical human research agenda designed to overcome these failures. We describe how connectivity guided depolarizing brain stimulation methods (i.e., TMS and DBS) can be applied concurrently with threat extinction and dual threat reconsolidation-extinction paradigms to causally map human extinction relevant circuits and inform the optimal integration of these methods with exposure-based therapy. We highlight candidate targets including the amygdala, hippocampus, ventromedial prefrontal cortex, dorsal anterior cingulate cortex, and mesolimbic structures, and propose hypotheses about how stimulation delivered at specific learning phases could strengthen threat extinction.
实验室威胁消除范式和暴露疗法都涉及重复、安全地面对以前被视为威胁的刺激。这种基本的程序重叠支持实验室威胁消除作为暴露疗法的有力模拟。在临床焦虑中已经检测到威胁消除障碍,并且可能导致暴露疗法无反应和复发。然而,迄今为止,使用旨在增强消除的技术(主要是啮齿动物消除)来改善暴露结果的努力基本上都失败了,这可能是由于啮齿动物和人类神经生物学之间存在根本差异。在这篇综述中,我们阐述了一个全面的临床前人类研究议程,旨在克服这些失败。我们描述了如何将连接导向去极化脑刺激方法(即 TMS 和 DBS)应用于威胁消除和双重威胁再巩固-消除范式,以因果映射人类与消除相关的回路,并为这些方法与暴露疗法的最佳整合提供信息。我们强调了包括杏仁核、海马体、腹内侧前额叶皮层、背侧前扣带皮层和中脑边缘结构在内的候选靶点,并提出了关于在特定学习阶段施加刺激如何增强威胁消除的假设。
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