Fear extinction learning as a predictor of response to cognitive behavioral therapy for pediatric obsessive compulsive disorder.
CBT
Fear extinction
OCD
Pediatric
Skin resistance
Journal
Journal of anxiety disorders
ISSN: 1873-7897
Titre abrégé: J Anxiety Disord
Pays: Netherlands
ID NLM: 8710131
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
22
06
2018
revised:
22
01
2019
accepted:
26
02
2019
pubmed:
11
3
2019
medline:
31
3
2020
entrez:
11
3
2019
Statut:
ppublish
Résumé
While cognitive behavior therapy (CBT) is an effective treatment for many children and adolescents with Obsessive Compulsive Disorder (OCD), therapeutic response is variable. Fear conditioning and extinction are central constructs underlying exposure-based CBT. Fear extinction learning assessed prior to CBT may be a useful predictor of CBT response for guiding treatment decisions. Sixty-four youth who participated in a randomized placebo-controlled trial of CBT with and without d-cycloserine (DCS) completed a fear conditioning task. Skin conductance response (SCR) scores were used to measure fear acquisition and extinction to determine whether extinction learning could predict CBT response. CBT responders and non-responders appeared to acquire conditioned fear SCRs in a similar manner. However, differences between treatment responders and non-responders emerged during the extinction phase. A responder (responder, non-responder) by conditioned stimulus type (CS+, CS-) interaction showed that CBT responders differentiated the stimulus paired with (CS+) and without (CS-) the unconditioned stimulus correctly during early and late extinction, whereas the CBT non-responders did not (p = .004). While the small sample size makes conclusions tentative, this study supports an emerging literature that differential fear extinction may be an important factor underlying clinical correlates of pediatric OCD, including CBT response.
Sections du résumé
BACKGROUND
While cognitive behavior therapy (CBT) is an effective treatment for many children and adolescents with Obsessive Compulsive Disorder (OCD), therapeutic response is variable. Fear conditioning and extinction are central constructs underlying exposure-based CBT. Fear extinction learning assessed prior to CBT may be a useful predictor of CBT response for guiding treatment decisions.
METHODS
Sixty-four youth who participated in a randomized placebo-controlled trial of CBT with and without d-cycloserine (DCS) completed a fear conditioning task. Skin conductance response (SCR) scores were used to measure fear acquisition and extinction to determine whether extinction learning could predict CBT response.
RESULTS
CBT responders and non-responders appeared to acquire conditioned fear SCRs in a similar manner. However, differences between treatment responders and non-responders emerged during the extinction phase. A responder (responder, non-responder) by conditioned stimulus type (CS+, CS-) interaction showed that CBT responders differentiated the stimulus paired with (CS+) and without (CS-) the unconditioned stimulus correctly during early and late extinction, whereas the CBT non-responders did not (p = .004).
CONCLUSIONS
While the small sample size makes conclusions tentative, this study supports an emerging literature that differential fear extinction may be an important factor underlying clinical correlates of pediatric OCD, including CBT response.
Identifiants
pubmed: 30852257
pii: S0887-6185(18)30253-6
doi: 10.1016/j.janxdis.2019.02.005
pmc: PMC7422704
mid: NIHMS1612173
pii:
doi:
Substances chimiques
Cycloserine
95IK5KI84Z
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-8Subventions
Organisme : NIMH NIH HHS
ID : R01 MH093381
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH093402
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.
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