Cited by 1,063Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMemory and Neural MechanismsPosttraumatic Stress Disorder Research

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Cognitive Enhancers as Adjuncts to Psychotherapy: Use of D-Cycloserine in Phobic Individuals to Facilitate Extinctionof Fear

Abstract

BACKGROUND: Traditional pharmacological approaches to treating psychiatric disorders focus on correcting presumed biochemical abnormalities. However, some disorders, particularly the anxiety-related disorders exemplified by specific phobia, have an emotional learning component to them that can be facilitated with psychotherapy. OBJECTIVE: To determine whether D-cycloserine (DCS), a partial agonist at the N-methyl-d-aspartate receptor that has previously been shown to improve extinction of fear in rodents, will also improve extinction of fear in human phobic patients undergoing behavioral exposure therapy. DESIGN: Randomized, double-blind, placebo-controlled trial examining DCS vs placebo treatment in combination with a precisely controlled exposure paradigm. SETTING: Participants were recruited from the general community to a research clinic. PARTICIPANTS: Twenty-eight subjects with acrophobia diagnosed by the Structured Clinical Interview for DSM-IV were enrolled. INTERVENTIONS: After we obtained pretreatment measures of fear, subjects were treated with 2 sessions of behavioral exposure therapy using virtual reality exposure to heights within a virtual glass elevator. Single doses of placebo or DCS were taken prior to each of the 2 sessions of virtual reality exposure therapy. Subjects, therapists, and assessors were blind to the treatment condition. Subjects returned at 1 week and 3 months posttreatment for measures to determine the presence and severity of acrophobia symptoms. MAIN OUTCOME MEASURES: Included were measures of acrophobia within the virtual environment, measures of acrophobia in the real world, and general measures of overall improvement. An objective measure of fear, electrodermal skin fluctuation, was also included during the virtual exposure to heights. Symptoms were assessed by self-report and by independent assessors at approximately 1 week and 3 months posttreatment. RESULTS: Exposure therapy combined with DCS resulted in significantly larger reductions of acrophobia symptoms on all main outcome measures. Subjects receiving DCS had significantly more improvement compared with subjects receiving placebo within the virtual environment (1 week after treatment, P</=.001; 3 months later, P</=.05). Subjects receiving DCS also showed significantly greater decreases in posttreatment skin conductance fluctuations during the virtual exposure (P</=.05). Additionally, subjects receiving DCS had significantly greater improvement compared with subjects receiving placebo on general measures of real-world acrophobia symptoms (acrophobia avoidance [P</=.02], acrophobia anxiety [P</=.01], attitudes toward heights [P</=.04], clinical global improvement [P</=.01], and number of self-exposures to real-world heights [P</=.01]); the improvement was evident early in treatment and was maintained at 3 months. CONCLUSION: These pilot data provide initial support for the use of acute dosing of DCS as an adjunct to exposure-based psychotherapy to accelerate the associative learning processes that contribute to correcting psychopathology.

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Crossref · 10.1001/archpsyc.61.11.1136

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Metadata

Authors
Ressler, K. J., Rothbaum, B. O., Tannenbaum, L., Anderson, P., Graap, K., Zimand, E., Hodges, L., & Davis, M.
Affiliations
  • Emory University (US)
  • Virtually Better (US)
  • University of North Carolina at Charlotte (US)
Venue
Archives of General Psychiatry
Published
2004-11-01
Volume
61
Issue
11
Pages
1136
ISSN
0003-990X (ISSN-L)
OpenAlex
W2156900283
Cited by
1,063
References
45
Citations by year
2026: 4 · 2025: 13 · 2024: 14 · 2023: 17 · 2022: 54 · 2021: 20 · 2020: 20 · 2019: 31 · 2018: 35 · 2017: 53 · 2016: 30 · 2015: 52 · 2014: 62 · 2013: 74 · 2012: 79
FWCI
82.58
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (MH-047840, MH069884, K01MH069884)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
D-cycloserine, acrophobia, specific phobia, NMDA receptor partial agonist, fear extinction, virtual reality exposure therapy, nootropic drugs, adjunctive pharmacotherapy, skin conductance, anxiety disorders, fear learning, avoidance behavior, medication adherence
MeSH terms
Adult, Combined Modality Therapy, Cycloserine, Desensitization, Psychologic, Double-Blind Method, Extinction, Psychological, Fear, Female, Humans, Male, Middle Aged, Phobic Disorders, Pilot Projects, Placebos, Psychiatric Status Rating Scales, Receptors, N-Methyl-D-Aspartate, Treatment Outcome

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