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. 2020 Mar 13;10(3):167.
doi: 10.3390/brainsci10030167.

Exposure Therapy for Post-Traumatic Stress Disorder: Factors of Limited Success and Possible Alternative Treatment

Sara Markowitz  1 , Michael Fanselow  1
Affiliations

Exposure Therapy for Post-Traumatic Stress Disorder: Factors of Limited Success and Possible Alternative Treatment

Sara Markowitz et al. Brain Sci. .

Abstract

Recent research indicates that there is mixed success in using exposure therapies on patients with post-traumatic stress disorder (PTSD). Our study argues that there are two major reasons for this: The first is that there are nonassociative aspects of PTSD, such as hyperactive amygdala activity, that cannot be attenuated using the exposure therapy; The second is that exposure therapy is conceptualized from the theoretical framework of Pavlovian fear extinction, which we know is heavily context dependent. Thus, reducing fear response in a therapist's office does not guarantee reduced response in other situations. This study also discusses work relating to the role of the hippocampus in context encoding, and how these findings can be beneficial for improving exposure therapies.

Keywords: exposure therapy; fear extinction; nonassociative; post-traumatic stress disorder.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mean percent freezing in animals assigned to either fear extinction (left) or different (right) context. Animals in the different context with systemically administered scopolamine did freeze at a percent that was significantly different from animals placed in the fear extinction context, indicating that they did not experience fear renewal (From Zelikowsky et al. 2012)
Figure 2
Figure 2
(a) Measurement of skin conductance response to CS onset during the final extinction session, context renewal test, and extinction retest. Participants who were administered 0.5 or 0.6 mg of scopolamine showed significantly lower response when the CS was presented in a novel context, indicating a lack of fear renewal (b) Measurement of skin conductance response to CS termination. Participants who were administered 0.6 mg of scopolamine showed significantly less response when the CS was presented in a novel context, indicating lack of renewal. This may also indicate that scopolamine’s efficacy for preventing fear renewal is dose dependent. (From Craske et al. [92]).
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