Neural mechanisms of extinction

Quirk, G.J. & Mueller, D. (2007). Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology Reviews, 1-17.

The simplest form of emotional regulation is extinction, is which conditioned responding to a stimulus decreases when the reinforcer is omitted. Exinction, like any learning process, occurs in 3 phases: acquisition, consolidation, and retrieval. Cannabinoid and opioid receptors appear to be implicated in the acquisition of extinction since anandamide and opioid antagonists impair within-session extinction of fear. Consolidation appears to depend on protein synthesis within the BLA, frequency bursting of the infralimbic region (IL) of the vmPFC shortly after extinction, and general involvement of the hippocampus, especially in tasks such as inhibitory avoidance and contextual fear. Retrieval of extinction memories involves the expression of inhibitory circuitry and is highly context-specific. Inhibition circuitry within the amygdala includes local inhibitory neurons within the BLA and CE, as well as islands of GABAergic neurons between these two sites known as the intercalated (ITC) cells. ITC cells could serve as a site of extinction memory since they inhibit CE output neurons and BLA neurons, acting as an off-switch for the amygdala. ITC cells receive strong projection from the IL mPFC, and IL activity is correlated with the extent of extinction retrieval. In fact, electrical stimulation of IL reduces conditioned fear and strengthens extinction memory. The prelimbic (PL) mPFC, on the other hand, excites fear expression and can augment fear expression via projections to the basal nucleus of the amygdala. Thus, the PFC can fully control overall fear expression. Individuals with PTSD show reduced vmPFC and hippocampal volume and activity, as well as increased amygdala activity. Stress may also impair extinction, since chronic stress is shown to decrease dendritic branching and spine count in hippocampus and mPFC, but increase it in BLA, which could be expected to increase conditioning and impair extinction. Pharmacological adjuncts to current extinction-based exposure therapies may accelerate and strengthen extinction. Among them D-cycloserine, yohimbine, sulpiride, and methylene blue show promise. Administration of glucocorticoids such as cortisol before exposure therapy may also help.