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Behav Res Ther. 2014 Nov;62:17-23. doi: 10.1016/j.brat.2014.08.006. Epub 2014 Aug 23.

Neuroscience of fear extinction: implications for assessment and treatment of fear-based and anxiety related disorders.

Author information

1
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 149 13th St., Charlestown, MA 02129, USA. Electronic address: milad@nmr.mgh.harvard.edu.
2
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 149 13th St., Charlestown, MA 02129, USA.
3
Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, USA.

Abstract

Current exposure-based therapies aimed to reduce pathological fear and anxiety are now amongst the most effective interventions for trauma and anxiety related disorders. Nevertheless, they can be further improved to enhance initial and long-term outcomes. It is now widely accepted that a greater understanding of the neurobiological mechanisms of fear extinction is needed to further develop and identify novel effective targeted treatments as well as prevention strategies for fear-based and anxiety-related disorders. Guided by elegant mechanistic, cellular, and molecular preclinical reports, data from imaging studies are beginning to shape our understanding of how fear is quelled in the human brain. In this article, we briefly review the neural circuits underlying fear extinction in rodents and healthy humans. We then review how these circuits may fail to extinguish fear in patients with anxiety disorders. We end with a discussion examining how fear extinction research may lead to significant advances of current therapeutics for anxiety disorders.

KEYWORDS:

Amygdala; DCS; Exposure therapy; Fear conditioning; Yohimbine; vmPFC

PMID:
25204715
DOI:
10.1016/j.brat.2014.08.006
[Indexed for MEDLINE]

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