Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment.
Threat conditioning and extinction play an important role in anxiety disorders, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Although these conditions commonly affect children, threat conditioning and extinction have been primarily studied in adults. However, differences in phenomenology and neural architecture prohibit the generalization of adult findings to youth.



A comprehensive literature search using PubMed and PsycInfo was conducted to identify studies that have used differential conditioning tasks to examine threat acquisition and extinction in youth. The information obtained from this review helps to clarify the influence of these processes on the etiology and treatment of youth with OCD, PTSD and other anxiety disorders. Thirty studies of threat conditioning and extinction were identified Expert commentary: Youth with anxiety disorders, OCD, and PTSD have largely comparable threat acquisition relative to unaffected controls, with some distinctions noted for youth with PTSD or youth who have suffered maltreatment. However, impaired extinction was consistently observed across youth with these disorders and appears to be consistent with deficiencies in inhibitory learning. Incorporating strategies to improve inhibitory learning may improve extinction learning within extinction-based treatments like cognitive behavioral therapy (CBT). Strategies to improve inhibitory learning in CBT are discussed.
a Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA.
Joseph F
JF
McGuire
b Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA.
Scott P
SP
Orr
c Department of Psychology , University of California Los Angeles , Los Angeles , CA , USA.
Joey K-Y
JK
Essoe
a Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA.
James T
JT
McCracken
d Department of Pediatrics , University of South Florida , Tampa , FL , USA.|e Departments of Psychiatry and Behavioral Neurosciences , University of South Florida , Tampa , FL , USA.|f Department of Health Policy and Management , University of South Florida , Tampa , FL , USA.|g Rogers Behavioral Health , Tampa Bay.|h All Children's Hospital , Johns Hopkins Medicine , St. Petersburg , FL , USA.
Eric A
EA
Storch
a Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA.
John
J
Piacentini
D000293:Adolescent; D000328:Adult; D002648:Child; D002653:Child Behavior Disorders / Q000503:physiopathology / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D005108:Extinction, Psychological; D005239:Fear; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology / Q000523:psychology / Q000628:therapy
Conditioning; adolescence; anxiety disorders; exposure therapy; extinction; fear; inhibitory learning; obsessive compulsive disorder; post-traumatic stress disorder; threat