Symposium 4 - Translational Fear Extinction Research in Anxiety, OCD, and PTSD: Expanding Reach to Understudied Populations and Promoting Rigorous and Reproducible Science

Chair(s)

• 

  M. Alexandra Kredlow, Ph.D. (she/her/hers)

  Dean of Arts and Sciences Assistant Professor
  Tufts University
  Medford, Massachusetts, United States

Discussant(s)

• 

  Michelle Craske, Ph.D.

  Professor of Psychology, Psychiatry and Biobehavioral Sciences
  University of California Los Angeles
  Los Angeles, CA, United States

Presenter(s)

• CR

  Candace Raio, Ph.D. (she/her/hers)

  NYU Grossman School of Medicine
  New York, NY, United States
• SN

  Seth Norrholm, Ph.D. (he/him/his)

  Associate Professor
  Wayne State University School of Medicine
  Detroit, MI, United States
• 

  Ryan Jacoby, Ph.D. (she/her/hers)

  Clinical Psychologist
  Massachusetts General Hospital
  Boston, MA, United States
• XX

  Xiaoqian Xiao, Ph.D.

  Postdoc
  University of Washington, Seattle
  Redmond, WA, United States

  Handouts
• 

  M. Alexandra Kredlow, Ph.D. (she/her/hers)

  Dean of Arts and Sciences Assistant Professor
  Tufts University
  Medford, Massachusetts, United States

Fear conditioning is a paradigmatic tool, included in the NIH Research Domain Criteria matrix, that is used to advance transdiagnostic understanding of fear-related disorders, such as anxiety, OCD, and PTSD. The extinction phase of fear conditioning has long been considered an analog for exposure (Beckers et al., 2023; Benito et al., 2024). This has led to an abundance of research on strategies to enhance extinction in the laboratory with the goal of translating this work to the clinic to enhance exposure therapy (Craske et al., 2022). Researchers have also used the fear conditioning model to understand clinically relevant predictors of extinction learning and return of fear. Yet, the number of fear extinction studies conducted in non-clinical populations still far exceeds the number conducted in clinical samples (Duits et al., 2015), limiting clinical conclusions that can be drawn. Certain populations (e.g., GAD, OCD, military sexual trauma-related PTSD) are particularly understudied and despite the fact that fear-related disorders are more prevalent in females, fear extinction is still most often studied in males (Velasco et al., 2019). The goal of this symposium is to highlight advances in fear extinction research with a focus on studies aimed at promoting translation to or conducted in populations with fear-related disorders. We especially highlight studies in diverse and understudied subgroups.

We will begin with two studies that characterize and examine predictors of extinction in under-studied populations. First, Dr. Raio will present on fear extinction and return of fear in a population with GAD. Then, Dr. Norrholm will present on fear extinction and extinction recall in female veterans who have experienced military sexual trauma with and without PTSD. Next, we will hear from Dr. Jacoby who is using extinction learning as a tool to examine mechanisms of change. She will present on exposure and response prevention-related changes in fMRI activation during the different phases of fear extinction learning in OCD, with the ultimate goal being to identify a potential neural treatment target for combination therapies (e.g., ERP plus transcranial magnetic stimulation). Subsequently, we will hear about extinction enhancement research as a tool for identifying potential strategies to enhance exposure therapy. Dr. Fang will present the results of a study using oxytocin to enhance vicarious extinction in social anxiety disorder, specifically examining sex differences in fMRI activation during vicarious extinction, with and without oxytocin. Finally, Dr. Kredlow will present data on the reliability and validity of the Human Extinction Workgroup protocol which was designed for extinction enhancement research with the goal of reducing barriers to entry, promoting rigorous and reproducible research, and facilitating collaborative well-powered studies of extinction in clinical populations. Finally, our discussant Dr. Craske, an expert on harnessing extinction learning research to maximize the efficacy of exposure therapy, will discuss implications of this work. These talks represent rigorous translational science/neuroscience and have implications for improving exposure therapy across multiple diagnoses and diverse groups.

Presentations:

• 10:05 AM - 10:22 AM CST

  (SYM 4) Factors Associated with the Extinction of Conditioned Threat Responses in Adults with Generalized Anxiety Disorder
  

  Speaker: Candace M. Raio, Ph.D. (she/her/hers) – NYU Grossman School of Medicine

  Co-author: Jiyan Mao, MA – NYU Grossman School of Medicine

  Co-author: Sophia Vranos, BA – NYU Grossman School of Medicine

  Co-author: Matthew Irwin, B.S. – NYU School of Medicine

  Co-author: Leo Almada-Makebish, B.A. – NYU Langone Health

  Co-author: Andrea Badillo Perez, B.S., B.A. – NYU Grossman School of Medicine

  Co-author: Mary Schadegg, PhD – NYU Grossman School of Medicine

  Co-author: Kristin L. Szuhany, Ph.D. (she/her/hers) – NYU School of Medicine

  Co-author: Naomi M. Simon, M.D. – NYU Grossman School of Medicine
• 10:22 AM - 10:39 AM CST

  (SYM 4) Female Veterans with Military Sexual Trauma History and Posttraumatic Stress Disorder Display Impaired Fear Extinction Learning
  

  Speaker: Seth D. Norrholm, Ph.D. (he/him/his) – Wayne State University School of Medicine

  Co-author: Michelle Szewczuk, BS (she/her/hers) – Wayne State School of Medicine

  Co-author: Jenna Laymon, MA (they/them/theirs) – Wayne State School of Medicine

  Co-author: John Noetzel, BS (he/him/his) – Wayne State School of Medicine

  Co-author: Leah Weingast, MA, LMSW (she/her/hers) – Atlanta Center for Wellness

  Co-author: Ron Acierno, Ph.D., Other – University of Texas Health Science Center at Houston

  Co-author: Lori Davis, MD (she/her/hers) – Birmingham VA Health Care System
• 10:39 AM - 10:56 AM CST

  (SYM 4) Mechanisms of Action of Exposure and Response Prevention on Fear Extinction Behavioral and Circuit Processes in OCD
  

  Speaker: Ryan J. Jacoby, Ph.D. (she/her/hers) – Massachusetts General Hospital

  Co-author: Jennifer Greenberg, PsyD – Massachusetts General Hospital / Harvard Medical School

  Co-author: Aura Maria Hurtado-Puerto, MD – The Neuromodulation Initiative

  Co-author: Kristen Ellard, PhD – Massachusetts General Hospital

  Co-author: Edward Pace-Schott, PhD – Massachusetts General Hospital

  Co-author: Katelyn Oliver, BS – Emory University

  Co-author: Mohammed Milad, Ph.D. – The University of Texas Health Science Center at Houston, McGovern Medical School

  Co-author: Sabine Wilhelm, Ph.D. (she/her/hers) – Massachusetts General Hospital

  Co-author: Joan Camprodon, MD, PhD – Massachusetts General Hospital
• 10:56 AM - 11:13 AM CST

  (SYM 4) Effect of Oxytocin on Neural Signals of Vicarious Extinction Learning in Social Anxiety Disorder: Gender and Clinical Moderator
  

  Speaker: Xiaoqian Xiao, Ph.D. – University of Washington, Seattle

  Co-author: Xiaoqian Xiao, Ph.D. – University of Washington, Seattle

  Co-author: Gillian Grennan, B.S. (she/her/hers) – University of Washington, Seattle

  Co-author: Angela Fang, Ph.D. – University of Washington, Seattle
• 11:13 AM - 11:30 AM CST

  (SYM 4) Validating the Human Extinction Workgroup Protocol for Extinction Enhancement Research and Implications for Translational Exposure Therapy Research
  

  Speaker: M. Alexandra Kredlow, Ph.D. (she/her/hers) – Tufts University

  Co-author: Meghan Whalen, B.S. (she/her/hers) – Tufts University

  Co-author: Patrick AF Laing, Ph.D. – The University of Texas at Austin

  Co-author: Samuel Cooper, Ph.D. (he/him/his) – University of Texas at Austin

  Co-author: Lingwei Ouyang, M.A. – University of Texas at Austin

  Co-author: Bram Vervliet, PhD – ku leuven

  Co-author: Joseph Dunsmoor, Ph.D. – University of Texas at Austin