Abstract
Cortisol is a stress hormone and potent modulator of learning and memory processes. If administered after learning, cortisol can enhance memory consolidation. Yet it is unknown whether cortisol administration after fear extinction learning strengthens extinction memory. Extinction is a crucial mechanism underlying psychotherapy of posttraumatic stress disorder (PTSD). The present study examined whether extinction can be enhanced by administering cortisol after extinction training. In a registered, randomized, double-blind and placebo controlled trial, 50 healthy participants were exposed to a differential fear-conditioning paradigm with neutral faces as conditioned stimuli (CS) and traumatic film clips as unconditioned stimuli (US). They received either cortisol (n = 25) or placebo (n = 25) immediately after extinction. The cortisol group showed less fear during a return of fear manipulation (reinstatement) evidenced by attenuated fear potentiated startle responses and US-expectancy ratings than the placebo group. Results indicate that cortisol administration after fear extinction strengthens extinction memory and suggest that it might be advantageous to administer cortisol subsequent to successful exposure treatment sessions.
Highlights
Exposure-based therapies are effective treatment approaches for posttraumatic stress disorder (PTSD)[1]
This study aimed to examine if cortisol administration facilitates the consolidation of extinction learning in a naturalistic fear-conditioning paradigm
This result integrates well with the findings that heightened cortisol levels enhance the success of exposure therapy in patients with anxiety disorders[18,19,21,22,23,39] and PTSD24,25
Summary
Exposure-based therapies are effective treatment approaches for posttraumatic stress disorder (PTSD)[1]. Fear extinction is thought to be one of the mechanisms underlying the effectiveness of exposure therapies[4,5]. Cortisol is wellknown for its memory modulating effects; it enhances the consolidation of newly acquired memories and inhibits the retrieval of previously learned material[10]. Cortisol may act on exposure therapy (1) by promoting the consolidation of extinction learning, and (2) by inhibiting fear memory retrieval. Only few studies examined the effect of cortisol on fear extinction in humans[15,16,17]. Two studies investigated the effects of heightened cortisol levels prior to extinction learning. Bentz and colleagues[16] showed that endogenously heightened cortisol levels prior to extinction training led to reduced conditioned fear in a memory retrieval test in men. A study by Merz and colleagues[15]
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