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State-of-the-art and future directions for extinction as a translational model for fear and anxiety

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Craske, Michelle G., Hermans, Dirk, Vervliet, Bram·2018·Philosophical Transactions of the Royal Society B: Biological Sciences
DOI 10.1098/rstb.2017.0025PMC PMC5790824
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Abstract

Through advances in both basic and clinical scientific research, Pavlovian fear conditioning and extinction have become an exemplary translational model for understanding and treating anxiety disorders. Discoveries in associative and neurobiological mechanisms underlying extinction have informed techniques for optimizing exposure therapy that enhance the formation of inhibitory associations and their consolidation and retrieval over time and context. Strategies that enhance formation include maximizing prediction-error correction by violating expectancies, deepened extinction, occasional reinforced extinction, attentional control and removal of safety signals/behaviours. Strategies that enhance consolidation include pharmacological agonists of NMDA (i.e. d -cycloserine) and mental rehearsal. Strategies that enhance retrieval include multiple contexts, retrieval cues, and pharmacological blockade of contextual encoding. Stimulus variability and positive affect are posited to influence the formation and the retrieval of inhibitory associations. Inhibitory regulation through affect labelling is considered a complement to extinction. The translational value of extinction will be increased by more investigation of elements central to extinction itself, such as extinction generalization, and interactions with other learning processes, such as instrumental avoidance reward learning, and with other clinically relevant cognitive–emotional processes, such as self-efficacy, threat appraisal and emotion regulation, will add translational value. Moreover, framing fear extinction and related processes within a developmental context will increase their clinical relevance. This article is part of a discussion meeting issue ‘Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.

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  • The majority of research on mechanisms of exposure and relapse has examined Pavlovian processes, with very little research on operant contributions to relapse.

    “However, the majority of this research has examined Pavlovian processes, with very little research on operant contributions to relapse (Craske, Hermans, & Vervliet, 2018; Dymond, 2019).”

    From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Craske, Hermans, & Vervliet, 2018

  • Strategies to reduce the valence of cues for fear and avoidance may include affect labelling and other related defusion-like exercises from behavior therapies such as ACT.

    “Strategies to reduce the valence of cues for fear and avoidance may include affect labelling (Craske et al., 2018), where participants are taught to tact 'angry' faces and emotions (e.g., 'I feel angry'), and other related defusion-like exercises from behavior therapies such as ACT.”

    From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Craske et al., 2018

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Sorted by citations

Authors
Craske, M. G., Hermans, D., & Vervliet, B.
Affiliations
  • University of California, Los Angeles (US)
  • KU Leuven (BE)
Corresponding author
Craske, Michelle G.
ORCID
Venue
Philosophical Transactions of the Royal Society B: Biological Sciences
Publisher
The Royal Society
Published
2018-01-29
Volume
373
Issue
1742
Pages
20170025
ISSN
  • 0962-8436 (ISSN-L)
  • 1471-2970
DOI
10.1098/rstb.2017.0025
PMC
PMC5790824
OpenAlex
W2785245623
Cited by
373
References
25
Citations by year
2026: 32 · 2025: 45 · 2024: 49 · 2023: 47 · 2022: 73 · 2021: 47 · 2020: 43 · 2019: 26 · 2018: 10
FWCI
4.21
Type
journal article
Language
en
Update notices
correction (2018-10-08)
Open access
Licence
royalsociety.org/journals/ethics-policies/data-sharing-mining/ (tdm)
Locations
  • Philosophical Transactions of the Royal Society B Biological Sciences (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Lirias (submittedVersion)
Funders
  • University of Leuven (PF/10/005)
  • European Community Framework Programme, Marie Curie International Outgoing Fellowship (PIOF-GA-2013-627743)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
Keywords
fear extinction, fear conditioning, anxiety disorders, exposure therapy, prediction error, D-cycloserine, mental practice, extinction consolidation, extinction retrieval, contextual encoding, stimulus variability, positive affect, avoidance learning, threat appraisal, emotion regulation, developmental context, translational model
MeSH terms
Animals, Anxiety Disorders, Conditioning, Classical, Extinction, Psychological, Fear, Humans, Mice, Translational Research, Biomedical

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