Multimodal Categorical and Dimensional Approaches to Understanding Threat Conditioning and Its Extinction in Individuals With Anxiety Disorders

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Abstract
Anxiety disorders, such as specific phobia, social anxiety disorder, generalized anxiety disorder, and panic disorder, differ from each other based on various DSM-IV criteria ranging from the focus or trigger of the anxiety to the context and durability of the anxious response and its associated symptoms.1 The threat conditioning and extinction paradigm has been used to study anxiety and fear-based disorders because of its relevance to the etiology, the sustainability of symptoms, and the exposure-based cognitive behavioral therapies used to treat these disorders.2-6 Threat conditioning and extinction are modulated by a network of brain regions, including the insular cortex, amygdala, hippocampus, dorsal anterior cingulate cortex (dACC), and ventromedial prefrontal cortex (vmPFC).2,6,7 The functional activation of these brain regions has been reported to be impaired within the context of threat extinction learning and retention across a number of disorders, including posttraumatic stress disorder (PTSD),8-12 obsessive-compulsive disorder,13 and anxiety disorders.14,15

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