Fear Extinction as a Model for Translational Neuroscience: Ten Years of Progress
Open accessAbstract
The psychology of extinction has been studied for decades. Approximately 10 years ago, however, there began a concerted effort to understand the neural circuits of extinction of fear conditioning, in both animals and humans. Progress during this period has been facilitated by a high degree of coordination between rodent and human researchers examining fear extinction. Here we review the major advances and highlight new approaches to understanding and exploiting fear extinction. Research in fear extinction could serve as a model for translational research in other areas of behavioral neuroscience.
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vmPFC supports extinction while cACC supports increased aversive processing.
“A closely related domain of research on conditioning and extinction in both rodents and humans also suggests that ventromedial PFC (vmPFC), an area neighboring rACC, supports extinction while cACC supports increased aversive processing (Milad and Quirk, 2012; see Figure 7).”
From Top-Down Dysregulation—From ADHD to Emotional Instability (2016) · cites this paper as Milad and Quirk, 2012
The section on the human vmPFC reports that its activation correlates with extinction recall. The section on the dorsal anterior cingulate reports dACC involvement in conditioned fear expression and responses to aversive stimuli, but the paper does not identify that region as cACC or establish a broader role in increased aversive processing. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe vmPFC is proposed to be the homologue for the IL in rodents and serves to inhibit threat responses produced by the amygdala.
“The vmPFC is proposed to be the homologue for the IL in rodents [87] and serves to inhibit threat responses produced by the amygdala.”
From Prefrontal cortex, amygdala, and threat processing: implications for PTSD (2022) · cites this paper as [87]
vmPFC modulates amygdala processing of conditioned fear by suppressing fear responses.
“The vmPFC is thought to modulate amygdala processing of conditioned fear by suppressing fear responses through a set of amygdala neurons in the intercalated region between the basolateral and central amygdala nucleus (Milad and Quirk, 2012).”
From Top-Down Dysregulation—From ADHD to Emotional Instability (2016) · cites this paper as Milad and Quirk, 2012
The vmPFC is activated during retrieval of extinction learning and down-regulates the amygdala.
“The vmPFC is activated during retrieval of extinction learning and down-regulates the amygdala”
From Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience (2014) · cites this paper as Milad and Quirk, 2012
In PTSD, there is both hyperactivation of the fear expression and hypoactivation of the extinction memory networks.
“Therefore, in PTSD, there is both hyperactivation of the fear expression and hypoactivation of the extinction memory networks [59, 60].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [59]
Extinction represents formation of a new memory, an extinction memory, signifying CS-no US, that competitively inhibits the memory of the CS-US contingency and expression of its associated CR when the CS is again encountered.
“However, rather than erasing the CS-US association, extinction represents formation of a new memory, an “extinction memory,” signifying “CS-no US,” that competitively inhibits the memory of the CS-US contingency and expression of its associated CR when the CS is again encountered [51–59].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [59]
A deficit in the ability to encode, consolidate, or retrieve extinction memory is believed to play a role in the development and perpetuation of anxiety and trauma-related disorders.
“A deficit in the ability to encode, consolidate, or retrieve extinction memory is believed to play a role in the development and perpetuation of such disorders [6, 59, 61, 87].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [59]
Neuroimaging research using de novo fear-conditioning and extinction paradigms has revealed areas in the brain associated with experiencing conditioned fear (a fear expression network) in the amygdala and dorsal anterior cingulate cortex (dACC) and other areas associated with memory for the extinction (inhibition) of this fear (an extinction memory network) that includes the hippocampus and ventro
“Neuroimaging research using de novo fear-conditioning and extinction paradigms has revealed areas in the brain associated with experiencing conditioned fear (a “fear expression network”) in the amygdala and dorsal anterior cingulate cortex (dACC) and other areas associated with memory for the extinction (inhibition) of this fear (an “extinction memory network”) that includes the hippocampus and”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [59]
Brain circuitry at the core of threat discrimination learning includes areas within the amygdala and medial prefrontal cortex (mPFC).
“Brain circuitry at the core of threat discrimination learning includes areas within the amygdala and medial prefrontal cortex (mPFC)1.”
From Multimodal evidence for delayed threat extinction learning in adolescence and young adulthood (2019) · cites this paper as [1]
During threat extinction training, presenting the CS without the aversive outcome results in reduced amygdala responses to the CS over time.
“During threat extinction training, the CS is presented without the aversive outcome, which results in reduced amygdala responses to the CS over time3, with the mPFC playing a critical role1,4,5.”
From Multimodal evidence for delayed threat extinction learning in adolescence and young adulthood (2019) · cites this paper as [1]
The mPFC plays a critical role in threat extinction training.
“During threat extinction training, the CS is presented without the aversive outcome, which results in reduced amygdala responses to the CS over time3, with the mPFC playing a critical role1,4,5.”
From Multimodal evidence for delayed threat extinction learning in adolescence and young adulthood (2019) · cites this paper as [1]
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- Linnman C Zeidan MA Pitman RK Milad MR Cingulate and amygdala resting metabolism correlate with autonomic and functional activation during fear conditioning. Biol. Psychiatry 2011b in press
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“, 2004), and increased vmPFC activity during such recall is associated with dampened amygdala activity (Milad et al., 2007, 2009; Milad and Quirk, 2012).”
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Child Maltreatment and Neural Systems Underlying Emotion Regulation
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Altered fear learning across development in both mouse and human
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“1) (Milad & Quirk, 2012), and anxiety disorders are associated with an inability to extinguish learned fear and to respond adequately to safety signals (Jovanovic et al., 2012; Michael et al., 2007; Milad et al., 2009; Milad et al., 2013; Wessa & Flor, 2007) [reviewed in (Holmes & Singewald, 2013)].”
BackgroundMethodInfluentialRevisiting the Role of Infralimbic Cortex in Fear Extinction with Optogenetics
Do-Monte, F. H., Manzano-Nieves, G., Quiñones-Laracuente, K., Ramos-Medina, L., & Quirk, G. J. (2015) · The Journal of Neuroscience · doi:10.1523/jneurosci.3137-14.2015 · Cited by 385 · see citing works
Self-citationDisruption of Reconsolidation Erases a Fear Memory Trace in the Human Amygdala
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Sex differences in anxiety disorders: Interactions between fear, stress, and gonadal hormones
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Self-citationConscious and Unconscious Memory Systems
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Mechanisms contributing to prefrontal cortex maturation during adolescence
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The birth, death and resurrection of avoidance: a reconceptualization of a troubled paradigm
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Prefrontal cortex, amygdala, and threat processing: implications for PTSD
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“The vmPFC is proposed to be the homologue for the IL in rodents [87] and serves to inhibit threat responses produced by the amygdala.”
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Circuit-Based Corticostriatal Homologies Between Rat and Primate
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Self-citationDistinct hippocampal engrams control extinction and relapse of fear memory
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Fear extinction in the human brain: A meta-analysis of fMRI studies in healthy participants
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Self-citationEarly-life stress has persistent effects on amygdala function and development in mice and humans
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The amygdala and medial prefrontal cortex: partners in the fear circuit
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Extinction during reconsolidation of threat memory diminishes prefrontal cortex involvement
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“Consistent with a role in the modulation of affective and visceral functions, the mPFC and amygdala share reciprocal connections (Milad and Quirk, 2012; Phelps and LeDoux, 2005; Price and Drevets, 2010).”
BackgroundInteroception and drug addiction
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Blockade of Estrogen by Hormonal Contraceptives Impairs Fear Extinction in Female Rats and Women
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Self-citationFear extinction and BDNF: translating animal models of PTSD to the clinic
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The impact of sugar consumption on stress driven, emotional and addictive behaviors
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Self-citationThe neural and computational systems of social learning
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The touchscreen operant platform for assessing executive function in rats and mice
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Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory
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“A deficit in the ability to encode, consolidate, or retrieve extinction memory is believed to play a role in the development and perpetuation of such disorders [6, 59, 61, 87].”
BackgroundSelf-citationAmygdala Inhibitory Circuits Regulate Associative Fear Conditioning
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Very long-term memories may be stored in the pattern of holes in the perineuronal net
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Prefrontal inputs to the amygdala instruct fear extinction memory formation
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Fear extinction requires infralimbic cortex projections to the basolateral amygdala
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Adult Hippocampal Neurogenesis, Fear Generalization, and Stress
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Stress-induced plasticity and functioning of ventral tegmental dopamine neurons
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“physiological measures are of continued importance in understanding emotional behavior and have been exceedingly successful in combination with neuroimaging paradigms (e.g., Critchley and Harrison, 2013; Milad and Quirk, 2012).”
Effects of sleep on memory for conditioned fear and fear extinction.
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“Human studies of fear conditioning and extinction have generally used skin conductance response (SCR), a reliable measure of sympathetic activation (Milad & Quirk, 2012), or fear potentiation of the blink startle response (Grillon & Baas, 2003; Jovanovic & Ressler, 2010) as psychophysiological CR…”
BackgroundInfluentialSelf-citationOxytocin facilitates the extinction of conditioned fear in humans
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Optogenetic dissection of medial prefrontal cortex circuitry
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Mechanisms of estradiol in fear circuitry: implications for sex differences in psychopathology
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Noradrenergic Modulation of Fear Conditioning and Extinction
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Hippocampal–Prefrontal BDNF and Memory for Fear Extinction
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Self-citationAbstract context representations in primate amygdala and prefrontal cortex
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Putting the “mental” back in “mental disorders”: a perspective from research on fear and anxiety
Taschereau‐Dumouchel, V., Michel, M., Lau, H. C., Hofmann, S. G., & LeDoux, J. E. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01395-5 · Cited by 182 · see citing works
Salinas-Hernández, X. I., Vogel, P., Betz, S., Kalisch, R., Sigurdsson, T., & Duvarci, S. (2018) · eLife · doi:10.7554/elife.38818 · Cited by 181 · see citing works
Top-Down Dysregulation—From ADHD to Emotional Instability
Petrovic, P., & Castellanos, F. X. (2016) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2016.00070 · Cited by 179 · see citing works
“Such signals are dependent on amygdala and ventral striatum, sub-cortical regions that often are co-activated with insula and ACC (Paulus et al., 2005; Paulus and Stein, 2006; Kable and Glimcher, 2007; Milad and Quirk, 2012).”
BackgroundInfluentialFunctional Neuroanatomy of Emotion and Its Regulation in PTSD
Fitzgerald, J. M., DiGangi, J. A., & Phan, K. L. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000185 · Cited by 177 · see citing works
Williams, Z. J., He, J. L., Cascio, C. J., & Woynaroski, T. G. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.11.030 · Cited by 175 · see citing works
Powers, J. P., & LaBar, K. S. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.04.023 · Cited by 173 · see citing works
Anterior cingulate cortex and its input to the basolateral amygdala control innate fear response
Jhang, J., Lee, H., Kang, M. S., Lee, H.-S., Park, H., & Han, J. (2018) · Nature Communications · doi:10.1038/s41467-018-05090-y · Cited by 173 · see citing works
Bernier, B. E., Lacagnina, A. F., Ayoub, A., Shue, F., Zemelman, B. V., Krasne, F. B., & Drew, M. R. (2017) · The Journal of Neuroscience · doi:10.1523/jneurosci.3029-16.2017 · Cited by 168 · see citing works
The Cognitive Neuroscience of Placebo Effects: Concepts, Predictions, and Physiology
Geuter, S., Koban, L., & Wager, T. D. (2017) · Annual Review of Neuroscience · doi:10.1146/annurev-neuro-072116-031132 · Cited by 167 · see citing works
A learning theory of attachment: Unraveling the black box of attachment development
Bosmans, G., Bakermans‐Kranenburg, M. J., Vervliet, B., Verhees, M. W. F. T., & van IJzendoorn, M. H. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.03.014 · Cited by 167 · see citing works
Haaker, J., Gaburro, S., Sah, A., Gartmann, N., Lonsdorf, T. B., Meier, K., Singewald, N., Pape, H.-C., Morellini, F., & Kalisch, R. (2013) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1303061110 · Cited by 166 · see citing works
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Dunsmoor, J. E., Campese, V. D., Ceceli, A. O., LeDoux, J. E., & Phelps, E. A. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2014.12.008 · Cited by 165 · see citing works
Understanding clinical fear and anxiety through the lens of human fear conditioning
Beckers, T., Hermans, D., Lange, I., Luyten, L., Scheveneels, S., & Vervliet, B. (2023) · Nature Reviews Psychology · doi:10.1038/s44159-023-00156-1 · Cited by 165 · see citing works
Child abuse, neural structure, and adolescent psychopathology: a longitudinal study
Busso, D. S., McLaughlin, K. A., Brueck, S., Peverill, M., Gold, A. L., & Sheridan, M. A. (2017) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2017.01.013 · Cited by 164 · see citing works
Childhood abuse and reduced cortical thickness in brain regions involved in emotional processing
Gold, A. L., Sheridan, M. A., Peverill, M., Busso, D. S., Lambert, H. K., Alves, S., Pine, D. S., & McLaughlin, K. A. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12630 · Cited by 164 · see citing works
Cannabinoid facilitation of fear extinction memory recall in humans
Rabinak, C. A., Angstadt, M., Sripada, C. S., Abelson, J. L., Liberzon, I., Milad, M. R., & Phan, K. L. (2013) · Neuropharmacology · doi:10.1016/j.neuropharm.2012.06.063 · Cited by 163 · see citing works
Self-citationViewpoints: Dialogues on the functional role of the ventromedial prefrontal cortex
Delgado, M. R., Beer, J. S., Fellows, L. K., Huettel, S. A., Platt, M. L., Quirk, G. J., & Schiller, D. (2016) · Nature Neuroscience · doi:10.1038/nn.4438 · Cited by 163 · see citing works
Self-citation
- Authors
- Milad, M. R., & Quirk, G. J.
- Affiliations
- Harvard University (US)
- University of Puerto Rico, Medical Sciences Campus (PR)
- Venue
- Annual Review of Psychology
- Publisher
- Annual Reviews
- Published
- 2012-01-10
- Volume
- 63
- Issue
- 1
- Pages
- 129-151
- ISSN
- 0066-4308 (ISSN-L)
- 1545-2085
- PMC
- PMC4942586
- OpenAlex
- W2160253364
- Semantic Scholar
- 3e1b47b5a0d8ab9823c918aa6f6ce64eb2eba033
- Cited by
- 1,466
- References
- 228
- Citations by year
- 2026: 105 · 2025: 96 · 2024: 80 · 2023: 96 · 2022: 110 · 2021: 114 · 2020: 131 · 2019: 120 · 2018: 109 · 2017: 102 · 2016: 100 · 2015: 105 · 2014: 88 · 2013: 73 · 2012: 36
- FWCI
- 5.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annual Review of Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p50mh086400-05, 5r01mh081975-05)
- National Institute of Mental Health (P-50-MH-086400, K01-MH08036, R01-MH081975, R01MH058883, K01MH080346)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Keywords
- fear extinction, fear conditioning, neural circuits, translational neuroscience, psychobiology, anxiety disorders
- MeSH terms
- Brain, Conditioning, Psychological, Extinction, Psychological, Fear, Humans, Magnetic Resonance Imaging, Neurosciences
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