scholarly journals Stress modulation of fear and extinction in psychopathology and treatment

Neuroforum ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Shira Meir Drexler ◽  
Christian J. Merz ◽  
Valerie L. Jentsch ◽  
Oliver T. Wolf
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Post Traumatic Stress ◽  
Substantial Evidence ◽  
Beneficial Effects ◽  
Major Player ◽  
Contextual Dependency ◽  
Post Traumatic ◽  
Extinction Memory

AbstractThe glucocorticoid cortisol, a major player in the development of stress-related psychopathology, can also be used for the augmentation of extinction-based psychotherapies (e.g., exposure therapy). Substantial evidence supports its beneficial effects in the treatment of post-traumatic stress disorder and specific phobias. In this review, we first present the role of stress and cortisol in the development of maladaptive emotional memories. Then, we describe the mechanisms that may account for the cortisol-induced augmentation of exposure, namely, the enhancement of extinction memory consolidation and the reduction of the contextual dependency of the extinction memory. Finally, we discuss several considerations and limitations for the use of cortisol in psychotherapy, focusing on the possible adverse effects of cortisol in a reconsolidation-based (as opposed to extinction-based) intervention.

scholarly journals Genes and hormones of the hypothalamic–pituitary–adrenal axis in post-traumatic stress disorder. What is their role in symptom expression and treatment response?

2021 ◽  
Author(s):  
Susanne Fischer ◽  
Tabea Schumacher ◽  
Christine Knaevelsrud ◽  
Ulrike Ehlert ◽  
Sarah Schumacher
Keyword(s):  
Hpa Axis ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Alternative Treatments ◽  
Hypothalamic Pituitary Adrenal ◽  
Post Traumatic

Abstract Background Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic–pituitary–adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT). Methods This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment. Results Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment. Conclusions Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.

Outline of This Treatment Program

2014 ◽  
pp. 25-42
Author(s):  
Sudie E. Back ◽  
Edna B. Foa ◽  
Therese K. Killeen ◽  
Katherine L. Mills ◽  
Maree Teesson ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Substance Use Disorder ◽  
Treatment Program ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Focus Questions

This chapter provides the therapist with an outline of the COPE treatment and components of each session (e.g. check-in, review homework, post-traumatic stress disorder [PTSD] focus, substance use disorder focus). Questions regarding who can deliver the therapy are addressed, as well as questions regarding the role of medications. Finally, special considerations for delivering treatment to patients with PTSD and comorbid substance use disorders are reviewed for the therapist.

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