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A Meta-Analysis of D-Cycloserine and the Facilitation of Fear Extinction and Exposure Therapy
Abstract
Background Translational research suggests that D-cycloserine (DCS), a partial N-methyl-D-aspartate (NMDA) receptor agonist, might facilitate fear extinction and exposure therapy by either enhancing NMDA receptor function during extinction or by reducing NMDA receptor function during fear memory consolidation. This article provides a quantitative review of DCS-augmented fear extinction and exposure therapy literature.Methods English-language journal articles that examined DCS augmented with fear extinction or exposure therapy were identified through public databases from June 1998 through September 2007, through references of originally identified articles and contact with DCS investigators. Data were extracted for study author, title, and year; trial design; type of subject (animal vs. human; clinical vs. nonclinical); sample size, DCS dose, and timing in relation to extinction/exposure procedures; dependent variable; group means and SDs at post-extinction/exposure; and follow-up outcome.Results D-cycloserine enhances fear extinction/exposure therapy in both animals and anxiety-disordered humans. Gains generally were maintained at follow-up, although some lessening of efficacy was noted. D-cycloserine was more effective when administered a limited number of times and when given immediately before or after extinction training/exposure therapy.Conclusions This meta-analysis suggests that DCS is a useful target for translational research on augmenting exposure-based treatment via compounds that impact neuroplasticity. D-cycloserine 's major contribution to exposure-based therapy might be to increase its speed or efficiency, because the effects of DCS seem to decrease over repeated sessions. This information might guide translational researchers in discovering more selective and/or effective agents that effectively enhance (or reduce) NMDA receptor function.
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“we know that the human amygdala plays a role in extinction learning.”
From Prefrontal cortex, amygdala, and threat processing: implications for PTSD (2022) · cites this paper as [104]
In the citing paper
“From rodent research showing that intra-amygdala infusion of the NMDA receptor agonist d-cycloserine, which enhances NMDA-dependent plasticity, facilitates extinction learning, and successful translation of this work to humans (see [104] for review), we know that the human amygdala plays a role in extinction learning.”
From Prefrontal cortex, amygdala, and threat processing: implications for PTSD (2022) · cites this paper as [104]
In the citing paper
“Pre-session dosing has been the strategy employed in all studies to date (1).”
From D-cycloserine enhancement of fear extinction is specific to successful exposure sessions: evidence from the treatment of height phobia (2013) · cites this paper as [1]
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Metadata
- Authors
- Norberg, M. M., Krystal, J. H., & Tolin, D. F.
- Affiliations
- Yale University (US)
- Corresponding author
- Tolin, David F.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 63
- Issue
- 12
- Pages
- 1118-1126
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2159630298
- Cited by
- 510
- References
- 121
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 8 · 2023: 8 · 2022: 15 · 2021: 13 · 2020: 12 · 2019: 16 · 2018: 28 · 2017: 28 · 2016: 23 · 2015: 50 · 2014: 37 · 2013: 53 · 2012: 51
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- D-cycloserine, fear extinction, exposure therapy, NMDA receptor agonist, anxiety disorders, fear memory consolidation, neuroplasticity, augmentation therapy, translational research
- MeSH terms
- Animals, Anxiety Disorders, Combined Modality Therapy, Cycloserine, Desensitization, Psychologic, Extinction, Psychological, Fear, Humans, Implosive Therapy, Neuronal Plasticity, Receptors, N-Methyl-D-Aspartate, Treatment Outcome
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