title: Fear extinction and memory reconsolidation as critical components in behavioral treatment for posttraumatic stress disorder and potential augmentation of these processes.
abstract: Posttraumatic stress disorder (PTSD) is associated with alterations in critical brain regions such as the amygdala, hippocampus, and prefrontal cortex. This brief review has two objectives: (1) to discuss research examining extinction and reconsolidation processes as mechanisms in PTSD psychotherapy, and (2) present possibilities for augmenting extinction and reconsolidation within treatment through alterations to therapeutic interventions and novel approaches. A key component of many effective PTSD therapies is exposure, which involves intentional confrontation and processing of the traumatic memory. Our review suggests that extinction and reconsolidation processes underlie effective exposure-based treatment, but the neurobiological mechanisms of these processes in behavioral treatments for PTSD remains unclear. We argue that enhancing extinction and/or disrupting reconsolidation of a feared memory may improve the efficacy of existing treatments (e.g., increased change for limited/non-responders, faster/greater changes for responders), which can be done through multiple channels. Potential avenues for augmentation of the processes of extinction and reconsolidation in PTSD psychotherapies are reviewed, including behavioral modifications, pharmacotherapy agents, and the use of devices during therapy. We further suggest that investigations towards understanding the extent to which extinction and reconsolidation processes are necessary in effective PTSD psychotherapy is an important future direction for enhancing clinical care among PTSD populations.
authors.affiliation: James A. Haley Veterans Hospital, Tampa, FL, USA; University of South Florida, Morsani College of Medicine, Department of Psychiatry and Behavioral Neurosciences, Tampa, FL, USA.
authors.forename: Noelle B
authors.initials: NB
authors.lastname: Smith
authors.affiliation: National Center for PTSD Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Doran
authors.affiliation: National Center for PTSD Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Sippel
authors.affiliation: National Center for PTSD Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA; VA Northeast Program Evaluation Center, West Haven, CT, USA. Electronic address: ilan.harpaz-rotem@yale.edu.
authors.forename: Ilan
authors.initials: I
authors.lastname: Harpaz-Rotem
mesh_terms: D000818:Animals; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D003214:Conditioning, Classical; D005108:Extinction, Psychological / Q000187:drug effects; D005239:Fear; D006801:Humans; D000069077:Memory Consolidation / Q000187:drug effects; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*
keywords: Extinction; Neurobiology; Posttraumatic stress disorder; Psychotherapy; Reconsolidation; Treatment