Cognitive Enhancers as Adjuncts to Psychotherapy

Ressler, Kerry J.; Rothbaum, Barbara O.; Tannenbaum, Libby; Anderson, Page L.; Graap, Ken; Zimand, Elana; Hodges, Larry F.; Davis, Michael

doi:10.1001/archpsyc.61.11.1136

Cited by 1,016 publications

(314 citation statements)

References 47 publications

(85 reference statements)

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“…Exposure-based psychotherapy of phobia is thought to rely on extinction of fear responses (Ressler et al 2004;McNally, 2007), a learning mechanism that has been shown to be significantly delayed in phobias and other anxiety disorders. In animals, the important role of sleep for extinction learning is well established.…”

Section: Discussionmentioning

confidence: 99%

“…However, some patients do not respond to this form of treatment, achieve only partial symptom remission, or fear often returns following initially successful therapy (Mystkowski et al 2002. Consequently, the development of novel and innovative approaches to increase therapeutic effectiveness is a primary challenge in current research on treatment of anxiety disorders (Ressler et al 2004;McNally, 2007;De Quervain, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Sleep enhances exposure therapy

et al. 2013

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Background: Sleep benefits memory consolidation. Here, we tested the beneficial effect of sleep on memory consolidation following exposure psychotherapy of phobic anxiety. Method: A total of 40 individuals afflicted with spider phobia according to DSM-IV underwent a one-session virtual reality exposure treatment and either slept for 90 min or stayed awake afterwards. Results: Sleep following exposure therapy compared with wakefulness led to better reductions in self-reported fear (p = 0.045, d = 0.47) and catastrophic spider-related cognitions (p = 0.026, d = 0.53) during approaching a live spider, both tested after 1 week. Both reductions were associated with greater percentages of stage 2 sleep. Conclusions: Our results indicate that sleep following successful psychotherapy, such as exposure therapy, improves therapeutic effectiveness, possibly by strengthening new non-fearful memory traces established during therapy. These findings offer an important non-invasive alternative to recent attempts to facilitate therapeutic memory extinction and consolidation processes with pharmacological or behavioral interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sleep enhances exposure therapy

et al. 2013

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“…Finally, Rothbaum et al (2014) compared the effects of five VRET sessions augmented by D-cycloserine (DCS), which has been found to facilitate extinction in other fear-based disorders (Ressler et al, 2004), alprazolam, and placebo in a study with 156 OIF/OIF Veterans with PTSD. Although there were no differences in treatment outcome across medication conditions, with the exception of posttreatment and three-month follow-up CAPS scores indicating that the alprazolam group showed a higher rate of PTSD than the placebo group, PTSD symptoms significantly improved across all conditions at posttreatment and at the three-, six-, and 12-month follow-ups.…”

Section: Vret Research Outcomesmentioning

confidence: 99%

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

Rizzo

Shilling

2017

European Journal of Psychotraumatology

154

107

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Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.

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“…For example, administration of D-cycloserine (DCS), a partial agonist at the strychnine insensitive glycinebinding site of the NMDA receptor enhances extinction when administered either pre-or post-extinction (for review, see Richardson et al 2004). Moreover, DCS administration has been successfully used in recent clinical studies aimed at developing pharmacotherapeutic approaches to facilitating extinction of fear responses in anxiety disorders (Ressler et al 2004;Hofmann et al 2006). Whereas some extinction therapies used in clinical settings involve training in the presence of overt behavioral responses, other approaches are based on developing cognitive control over maladaptive behaviors, and this latter form of learning may not require overt responding during extinction training.…”

mentioning

confidence: 99%

“…Finally, pre-extinction training administration of DCS has been used successfully in conjunction with exposure therapy in the treatment of acrophobia (Ressler et al 2004) and social anxiety disorder (Hofmann et al 2006). The ability of DCS to enhance cognitive memory processes such as those putatively involved in latent extinction suggest that the drug may potentially have efficacy when used in conjunction with relatively "nonbehavioral" therapeutic strategies such as cognitive restructuring.…”

mentioning

confidence: 99%

D-Cycloserine enhances memory consolidation of hippocampus-dependent latent extinction

Gabriele¹,

Packard²

2007

Learn. Mem.

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Adult male Long-Evans rats were trained to run in a straight-alley maze for food reward and subsequently received hippocampus-dependent latent extinction training. Immediately following latent extinction, rats received peripheral injections of the NMDA receptor partial agonist D-cycloserine (DCS, 15 mg/kg), or saline. Twenty-four hours later, rats received four extinction "probe" trials. Relative to saline controls, latencies to reach the goal box on probe trials were significantly higher in rats that had received DCS. These findings indicate that memory consolidation underlying hippocampus-dependent latent extinction, a cognitive form of learning in which the previously rewarded response is not made during extinction training, can be enhanced by NMDA-receptor agonism.Behavioral extinction is operationalized as a reduction of a previously acquired response, and this process can involve new learning (for review, see Bouton 2004). The initial acquisition of learned behavior involves multiple memory systems (for review, see Packard 2001) and we have recently expanded this view to the study of the new learning underlying behavioral extinction (Gabriele and Packard 2006). We used a task in which extinction of the same overt behavior could be achieved using either a "response" or "latent" extinction training procedure. In contrast to typical extinction training that involves performance of a previously reinforced response, during latent extinction training no overt response is made. For example, a food-rewarded approach response in a straight-alley maze can be extinguished by placing the animal in the goal box in the absence of reward (Seward and Levy 1949). Consistent with the hypothesis that multiple memory systems play a role in the learning that occurs during extinction, we observed that the learning underlying response and latent extinction of runway behavior is neuroanatomically dissociable. Specifically, neural inactivation of the hippocampus prevented latent extinction of maze runway behavior, but did not block response extinction of the same behavior (Gabriele and Packard 2006). Latent extinction is conducive to a cognitive learning process in which an expectancy (Tolman 1932) of food reward can be altered without performance of the previously acquired response (Seward and Levy 1949). According to the multiple memory systems hypothesis, the hippocampus is selectively involved in cognitive learning and memory (e.g., Hirsh 1974;Mishkin and Petri 1984), and the impairment of latent extinction produced by hippocampal inactivation is consistent with this view.Although our previous study using a reversible lesion technique implicates the hippocampus in latent extinction, the findings do not provide any information concerning the neurochemical basis of this form of cognitive learning. Various neurotransmitter systems play a role in extinction (for review, see Mason 1983) and several recent studies have focused on the role of glutamatergic neurotransmission (for review, see Davis and Myers 2002). For example, adminis...

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Cognitive Enhancers as Adjuncts to Psychotherapy

Abstract: 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.

Cited by 1,016 publications

References 47 publications

Sleep enhances exposure therapy

Sleep enhances exposure therapy

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

D-Cycloserine enhances memory consolidation of hippocampus-dependent latent extinction

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