Please enable JavaScript.
Coggle requires JavaScript to display documents.
Optimising treatments for anxiety (Fear conditioning and extinction (Fear…
Optimising treatments for anxiety
Treating anxiety disorders and PTSD
exposure based treatments are first line
aim is to reduce avoidance (main coping mechanism for anxiety and PTSD)
Different goals for different anxiety disorders
social--> social situations
panic--> interoceptive body signals
OCD--> feared situation plus response prevention
generalised anxiety
exposure to worry
important to understand mechanism behind specific disorders and what is maintaining them
interventions target maintaining factors
Fear conditioning and extinction
fear conditioning is a form of associative learning
classical conditioning: pairing an aversive stimuli with a neutral stimuli
learn to associate fear response with neutral stimuli (after repeated exposure)
Also involves operant conditioning
voluntary behaviours shaped by consequence of behaviour
reinforcement or punishment strengthens or weakens behaviour
In anxiety disorders, generalisation is greater than average but fear conditioning is not (meta-analysis)
PTSD
Many people will experience criterion A trauma in their lifetime but not all will develop PTSD
thought that people with PTSD have impaired fear extinction capacity
Fear extinction
gradual reduction of fear response with repeated exposure to stimuli without consequence
requires extensive training and is fragile
new context
over time
being re-exposed
context dependant: learning to reduce fear in one context does not reduce it in different contexts
does not erase original memory/ CS-US fear association
increased amygdala activity in fear extinction activity and reduced vmPFC
fear extinction and exposure therapy
fear extinction learning is a key component of exposure therapy
repeatedly confronting stimulus without the consequence
improvements in fear extinction correlated with activity in vmPFC
can normalise impaired vmPFC and amygdala activity after exposure therapy
optimising treatments
pharmacological adjuncts
D-cycloserine
partial NMDA receptor agonist
good results for specific phobia, and panic disorder
unclear how effective it is for PTSD, OCD and SP
cortisol
in anxiety disorders there is dysregulation of cortisol
cortisol--> increased negative feedback inhibition on HPA axis, lower chronic levels of cortisol-->impaired brake on sympathetic NS
research suggests that cortisol can reduce arousal during fear exposure.
high cortisol reactivity associated with lower PTSD and vice versa
nor-adrenaline
contradictory as NA helps consolidate emotional memories
increases arousal in brain, activates sympathetic NS and amygdala
Yohimbine which increases NA release
facilitates conditioning, extinction learning and retrieval
propranolol( beta-adrenergic receptor blocker) does opposite
focus on memory consolidation improvement
Oxytocin
involved in social cognition
acts on amygdala-prefrontal-hypthalamic regions to increase fear extinction
brain stimulation during exposure therapy
few studies supporting, some suggest that it increases fear generalisation