Abstract
Abstract Anxiety disorders (ADs) are characterized by increased chronicity and comorbidity with other ADs. Although exposure is the most effective therapy option for ADs, some patients show poor treatment response and a heightened vulnerability for relapse after treatment completion. Hence, significant research effort needs to be devoted to improve the long-term effectiveness of exposure effects. Recent attempts to increase exposure therapy efficacy use strategies aimed at promoting the acquisition and retrieval of extinction memories. The present review illustrates the value and limitations of such extinction-based therapy approaches. We present and discuss recent findings from translational studies using cortisol and self-efficacy enhancement as an add-on to exposure therapy. We illustrate how the integration of findings from experimental research on fear extinction learning and self-efficacy could advance the development of more optimized treatments for ADs.
Highlights
Anxiety disorders (ADs) are characterized by increased chronicity and comorbidity with other ADs
From an inhibitory learning perspective (Craske and Mystkowski, 2006, 2008), interindividual variability in exposure treatment outcome (Norton and Price, 2007) may be explained by the level of interindividual differences in fear extinction learning. In line with this idea, initial studies demonstrated that differences in extinction learning performance during a differential fear conditioning task were associated with variability in Cognitive behavioral therapy (CBT) outcomes in phobic children (Waters and Pine, 2016) and with the level of treatment gains during an exposure therapy analog in spider phobia (Forcadell et al, 2017)
Completers showed more pronounced fear extinction relative to noncompleters. This finding indicates that one subgroup of patients with specific phobia failed to accomplish exposure in a predetermined time possibly owing to deficient fear extinction
Summary
From an inhibitory learning perspective (Craske and Mystkowski, 2006, 2008), interindividual variability in exposure treatment outcome (Norton and Price, 2007) may be explained by the level of interindividual differences in fear extinction learning. The aforementioned findings suggest that the implementation of hormonal measurements and the systematic assessment of contraceptive use, which itself affects variability in exposure outcome, is important to derive a complete picture on the possible effects of cognitive enhancers in exposure therapy. This is especially true with regard to the effects of cortisol because OC use alters the effects of cortisol on fear learning (Merz et al, 2012, 2018). Since an adaptive processing of mastery experiences is fundamental to self-efficacy (Bandura, 1988), a better understanding of mechanisms underlying the storage and retrieval of personally relevant memories in patients with ADs would be highly valuable (Zlomuzica et al, 2014, 2016)
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