D-cycloserine enhancement of fear extinction is specific to successful exposure sessions: evidence from the treatment of height phobia.
D-cycloserine enhancement of fear extinction is specific to successful exposure sessions: evidence from the treatment of height phobia.
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DOI：
10.1016/j.biopsych.2012.12.009
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发表时间：
2013-06-01
影响因子：
10.6
通讯作者：
Tart, Candyce D.
中科院分区：
文献类型：
--
作者：
Smits, Jasper A. J.;Rosenfield, David;Otto, Michael W.;Powers, Mark B.;Hofmann, Stefan G.;Telch, Michael J.;Pollack, Mark H.;Tart, Candyce D.
关键词：
Whereas some studies have shown clear evidence for an augmentation effect of d-cycloserine (DCS) on exposure therapy for anxiety disorders, other studies have shown weak effects or no effect at all. Some preclinical data suggest that the DCS augmentation effect is moderated by the success of the extinction trials. Therefore, we conducted a re-analysis of existing data to examine whether the effects of DCS on clinical outcome would vary as a function of response to the exposure session (i.e. exposure success). In a clinical trial, patients with height phobia received two sessions involving 30 minutes of virtual reality exposure therapy and were randomly assigned to a pill placebo (N=14) or 50 mg of DCS (N=15) immediately after each session. Mixed-effects regression analysis showed that the effects of DCS administration on clinical improvement was moderated by the level of fear experienced just prior to concluding exposure sessions. Patients receiving DCS exhibited significantly greater improvement in symptoms relative to patients who received placebo when subjective fear was low at the end of the exposure. In contrast, when end fear was still elevated, patients receiving DCS improved less compared to those receiving placebo. DCS appears to enhance the benefits of exposure treatment when applied after a successful session, but it seems to have detrimental effects when administered after inadequate/unsuccessful exposures. The Trial is registered at ClinicalTrials.gov (NCT01102803).
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