PDF(Pubmed)
Abstract：
Prolonged exposure (PE) therapy is a first-line treatment for posttraumatic stress disorder (PTSD) and involves repeated presentation of trauma-related cues without aversive outcomes. A primary learning mechanism of PE is fear extinction (new learning that a dangerous cue is now safe) and its retention (maintaining this new learning over time). Extant research suggests extinction is impaired in PTSD patients. In this study, we employed an established fear-potentiated startle-based paradigm to examine fear acquisition, extinction learning and retention before and after completion of intensive outpatient treatment. First, PTSD patients undergoing PE (n = 55) were compared to trauma-exposed patients without PTSD (n = 57). We identified excessive fear in PTSD patients during acquisition and extinction before treatment compared to non-PTSD patients. At post-treatment, we examined the return of fear after extinction in PTSD patients showing high or low treatment response to PE (≥50% change in PTSD symptom severity vs. < 50%). High PE responders maintained fear extinction learning whereas low PE responders showed significant return of fear at post-treatment. These results replicate and extend previous findings of impaired extinction in PTSD and provide support for the proposed theoretical link between fear extinction and PE response.
摘要：
长期暴露（PE）疗法是创伤后应激障碍（PTSD）的一线治疗方法，涉及反复出现与创伤相关的线索，而没有令人厌恶的结果。体育的主要学习机制是恐惧灭绝（新学习，危险提示现在是安全的）及其保留（随着时间的推移保持这种新学习）。现有研究表明，PTSD患者的灭绝受到损害。在这项研究中,我们采用了一种既定的恐惧增强的基于惊吓的范式来检查恐惧习得，强化门诊治疗前后的灭绝学习和保留。首先,将接受PE的PTSD患者（n=55）与没有PTSD的创伤暴露患者（n=57）进行比较。与非PTSD患者相比，我们发现PTSD患者在治疗前的获取和灭绝过程中过度恐惧。在治疗后,我们检查了对PE表现出高或低治疗反应的PTSD患者在灭绝后恐惧的恢复（PTSD症状严重程度与≥50％的变化<50%)。高PE反应者保持恐惧消退学习，而低PE反应者在治疗后表现出明显的恐惧回归。这些结果复制并扩展了PTSD中灭绝受损的先前发现，并为恐惧灭绝与PE反应之间的拟议理论联系提供了支持。
