Kitt Elizabeth R, Odriozola Paola, Gee Dylan G
Department of Psychology, Yale University, New Haven, CT, USA.
Curr Top Behav Neurosci. 2023;64:237-256. doi: 10.1007/7854_2023_430.
Alterations in extinction learning relate to the development and maintenance of anxiety disorders across the lifespan. While exposure therapy, based on principles of extinction, can be highly effective for treating anxiety, many patients do not show sufficient improvement following treatment. In particular, evidence suggests that exposure therapy does not work sufficiently for up to 40% of children who receive this evidence-based treatment.Importantly, fear learning and extinction, as well as the neural circuitry supporting these processes, undergo dynamic changes across development. An improved understanding of developmental changes in extinction learning and the associated neural circuitry may help to identify targets to improve treatment response in clinically anxious children and adolescents. In this chapter, we provide a brief overview of methods used to study fear learning and extinction in developmental populations. We then review what is currently known about the developmental changes that occur in extinction learning and related neural circuitry. We end this chapter with a discussion of the implications of these neurodevelopmental changes for the characterization and treatment of pediatric anxiety disorders.
消退学习的改变与焦虑症在整个生命周期中的发展和维持有关。虽然基于消退原理的暴露疗法对治疗焦虑症可能非常有效，但许多患者在治疗后并未显示出足够的改善。特别是，有证据表明，暴露疗法对高达40%接受这种循证治疗的儿童效果不佳。重要的是，恐惧学习和消退，以及支持这些过程的神经回路，在整个发育过程中会发生动态变化。更好地理解消退学习和相关神经回路的发育变化，可能有助于确定改善临床焦虑儿童和青少年治疗反应的靶点。在本章中，我们简要概述了用于研究发育人群中恐惧学习和消退的方法。然后，我们回顾目前已知的关于消退学习和相关神经回路中发生的发育变化。本章最后讨论这些神经发育变化对儿童焦虑症的特征描述和治疗的影响。
