Enhancement of psychosocial treatment with D-cycloserine: models, moderators, and future directions
Files
Accepted manuscript
Date
2016-08-15
Authors
Otto, Michael W.
Kredlow, M. Alexandra
Smits, Jasper A.J.
Hofmann, Stefan G.
Tolin, David F.
de Kleine, Rianne A.
van Minnen, Agnes
Evins, A. Eden
Pollack, Mark H.
Version
OA Version
Citation
Michael W Otto, M Alexandra Kredlow, Jasper AJ Smits, Stefan G Hofmann, David F Tolin, Rianne A de Kleine, Agnes van Minnen, A Eden Evins, Mark H Pollack. 2016. "Enhancement of Psychosocial Treatment With D-Cycloserine: Models, Moderators, and Future Directions.." Biol Psychiatry, Volume 80, Issue 4, pp. 274 - 283.
Abstract
Advances in the understanding of the neurobiology of fear extinction have resulted in the development of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure treatment. We review a decade of research that has focused on the efficacy of DCS for augmenting the mechanisms (e.g., fear extinction) and outcome of exposure treatment across the anxiety disorders. Following a series of small-scale studies offering strong support for this clinical application, more recent larger-scale studies have yielded mixed results, with some showing weak or no effects. We discuss possible explanations for the mixed findings, pointing to both patient and session (i.e., learning experiences) characteristics as possible moderators of efficacy, and offer directions for future research in this area. We also review recent studies that have aimed to extend the work on DCS augmentation of exposure therapy for the anxiety disorders to DCS enhancement of learning-based interventions for addiction, anorexia nervosa, schizophrenia, and depression. Here, we attend to both DCS effects on facilitating therapeutic outcomes and additional therapeutic mechanisms beyond fear extinction (e.g., appetitive extinction, hippocampal-dependent learning).