Wall Emily K, Virakorn Elizabeth A, Baker Kathryn D, Cohen E Myfanwy, Richardson Rick
School of Psychology, UNSW Sydney, Sydney, NSW 2052, Australia.
School of Psychology, UNSW Sydney, Sydney, NSW 2052, Australia; Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, VIC 3086, Australia.
Neurosci Biobehav Rev. 2025 May;172:106090. doi: 10.1016/j.neubiorev.2025.106090. Epub 2025 Mar 4.
Adolescence is a window of vulnerability for the development of anxiety disorders but also a window of opportunity for treatments to minimize the long-term impact of such disorders. Current first-line treatments, primarily exposure-based cognitive-behavioral therapy (CBT), have limited long-term efficacy in adolescents. The urgent need for more effective interventions is underscored by the frequent reports of extinction impairments in adolescents as well as the rising anxiety rates in youth, particularly post-COVID-19. Preclinical research on the extinction of learned fear in adolescents may contribute to developing better treatment approaches to anxiety in this age group. Unfortunately, this is still a largely under-explored area. However, both pharmacological and behavioral augmentation strategies can be used to enhance extinction learning and consolidation. Here we describe work exploring such adjuncts, focusing on pre-clinical work with rodents. Much of the research to date shows striking developmental differences in response to various pharmacological treatments, with only a few shown to be effective in adolescents. Further, recent experience of stress reduces the efficacy of these treatments in adolescence. This review highlights the necessity for tailored strategies, especially when it comes to pharmacological adjuncts, that address developmental differences in drug responses as well as the impact of stressful experiences on treatment efficacy.
青春期是焦虑症发展的脆弱期，但也是将此类疾病的长期影响降至最低的治疗机遇期。目前的一线治疗方法，主要是基于暴露的认知行为疗法（CBT），在青少年中的长期疗效有限。青少年频繁出现消退障碍的报道以及年轻人焦虑率的上升，尤其是在新冠疫情之后，凸显了对更有效干预措施的迫切需求。对青少年习得性恐惧消退的临床前研究可能有助于开发针对该年龄组焦虑症的更好治疗方法。不幸的是，这仍然是一个很大程度上未被探索的领域。然而，药理学和行为增强策略都可用于增强消退学习和巩固。在此，我们描述探索此类辅助手段的工作，重点是对啮齿动物的临床前研究。迄今为止的许多研究表明，对各种药物治疗的反应存在显著的发育差异，只有少数药物在青少年中显示有效。此外，近期的压力经历会降低这些治疗在青春期的疗效。本综述强调了采取量身定制策略的必要性，特别是在药理学辅助手段方面，这些策略要解决药物反应的发育差异以及压力经历对治疗效果的影响。
