Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.
Research Centre of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.
Curr Top Behav Neurosci. 2023;64:157-178. doi: 10.1007/7854_2023_432.
This chapter reviews the literature on the impact of stress and exercise on fear extinction. Given that key brain regions of the fear circuitry (e.g., hippocampus, amygdala and frontal cortex) can be modulated by stress hormones, it is important to investigate how stress influences this process. Laboratory-based studies performed in healthy adults have yielded mixed results, which are most likely attributable to various methodological factors. Among these factors, inter-individual differences modulating the stress response and timing of stressor administration with respect to the task may contribute to this heterogeneity. Given that fear is a core manifestation of various psychopathologies and that exposure-based therapy relies on fear extinction principles, several studies have attempted to assess the role of stress hormones on exposure-based therapy in patients suffering from post-traumatic stress disorder or anxiety disorders. These studies tend to suggest a beneficial impact of stress hormones (through either natural endogenous variations or synthetic administration) on exposure-based therapy as assessed mostly by subjective fear measures. Similar to stress, exercise can have an impact on many physiological and biological systems in humans. Of note, exercise modulates biomarkers such as brain-derived neurotrophic factor (BDNF) and anandamide (EAE) that act on brain regions implicated in the fear circuitry, supporting the importance of studying the impact of exercise on fear extinction. Overall, the results converge and indicate that fear extinction (tested in the laboratory or via exposure-based therapy in clinical populations) can be enhanced with exercise. Further research is needed to understand the mechanisms by which stress and exercise modulate fear learning and extinction processes, as well as to maximize the applicability to clinical contexts.
这一章回顾了关于压力和锻炼对恐惧消退影响的文献。鉴于恐惧回路的关键大脑区域（例如海马体、杏仁核和前额叶皮层）可以被应激激素调节，因此研究压力如何影响这个过程非常重要。在健康成年人中进行的基于实验室的研究得出了混合的结果，这很可能归因于各种方法学因素。在这些因素中，调节应激反应的个体差异以及应激源相对于任务的给药时间可能导致这种异质性。由于恐惧是各种精神病理学的核心表现，并且暴露疗法依赖于恐惧消退原则，因此一些研究试图评估应激激素对创伤后应激障碍或焦虑障碍患者暴露疗法的作用。这些研究倾向于表明应激激素（通过自然内源性变化或合成给药）对暴露疗法有有益的影响，这主要通过主观恐惧测量来评估。与压力相似，运动可以对人类的许多生理和生物系统产生影响。值得注意的是，运动调节了脑源性神经营养因子（BDNF）和内源性大麻素（EAE）等生物标志物，这些标志物作用于与恐惧回路相关的大脑区域，支持研究运动对恐惧消退的影响的重要性。总体而言，结果趋于一致，并表明恐惧消退（在实验室中测试或通过临床人群的暴露疗法测试）可以通过运动得到增强。需要进一步研究来了解压力和运动调节恐惧学习和消退过程的机制，并最大限度地将其应用于临床环境。
