Editorial| Volume 52, ISSUE 10, P917-920, November 15, 2002

Learning and “unlearning” fears: preparedness, neural pathways, and patients

  • Michael W Otto
    Massachusetts General Hospital and Harvard Medical School, Cognitive-Behavior Therapy Program, WACC-812, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA
    Search for articles by this author
      Given the dramatic success of exposure-based treatments for the anxiety disorders, it is not surprising that clinical procedures advanced separately from developments in extinction research in animal laboratories. Bridging this gap between clinical and animal researchers was a major goal of the Satellite Symposium for the 2002 Anxiety Disorders Association of America (ADAA) conference. The title of the symposium, “Learning and ‘Unlearning’ Fears: Preparedness, Neural Pathways, and Patients,” reflects the consideration of this topic from evolutionary, neuroanatomic, learning, and clinical perspectives. This symposium was sponsored jointly by the ADAA, the ADAA Scientific Advisory Board, and the National Institute of Mental Health, and was supported by an unrestricted educational grant to the ADAA from Wyeth Pharmaceuticals.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barlow D.H.
        • Gorman J.M.
        • Shear M.K.
        • Woods S.W.
        • et al.
        Cognitive-behavioral therapy, imipramine, or their combination for panic disorder.
        JAMA. 2000; 283: 2529-2536
      1. Bouton ME (2002): Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biol Psychiatry 52:976–986

      2. Davis M, Myers KM (2002): The role of glutamate and gamma-aminobutyric acid in fear extinction: Clinical implications for exposure therapy. Biol Psychiatry 52:998–1007

      3. Foa EB, Franklin ME, Moser J (2002): Context in the clinic: How well do cognitive-behavioral therapies and medications work in combination? Biol Psychiatry 52:987–997

        • Foa E.B.
        • Kozak M.J.
        Emotional processing of fear.
        Psychol Bull. 1986; 99: 20-35
        • Gardenswartz C.A.
        • Craske M.G.
        Prevention of panic disorder.
        Behav Ther. 2001; 32: 725-737
      4. Grillon C (2002): Startle reactivity and anxiety disorders: Aversive conditioning, context, and neurobiology. Biol Psychiatry 52:958–975

      5. Kent JM, Mathew SJ, Gorman JM (2002): Molecular targets in the treatment of anxiety. Biol Psychiatry 52:1008–1030

        • Marks I.M.
        • Swinson R.P.
        • Basaglu M.
        • Kuch K.
        • Nasirvani H.
        • O’Sullivan G.
        • et al.
        Alprazolam and exposure alone and combined in panic disorder with agoraphobia.
        Br J Psychiatry. 1993; 162: 776-787
      6. McNally RJ (2002): Anxiety sensitivity and panic disorder. Biol Psychiatry 52:938–946

      7. Mineka S, Öhman A (2002): Phobias and preparedness: The selective, automatic, and encapsulated nature of fear. Biol Psychiatry 52:927–937

        • Otto M.W.
        • Pollack M.H.
        • Sabatino S.A.
        • et al.
        Maintenance of remission following cognitive-behavior therapy for panic disorder.
        Behav Ther. 1996; 27: 473-482
        • Otto M.W.
        • Hong J.J.
        • Safren S.A.
        • et al.
        Benzodiazepine discontinuation difficulties in panic disorder.
        Curr Pharm Des. 2002; 8: 75-80
        • Pitman R.K.
        • Sanders K.M.
        • Zusman R.M.
        • Healy A.R.
        • Cheema F.
        • Lasko N.B.
        • et al.
        Pilot study of secondary prevention of posttraumatic stress disorder with propranolol.
        Biol Psychiatry. 2002; 51: 189-192
      8. Rapee RM (2002): The development and modification of temperamental risk for anxiety disorders: Prevention of a lifetime of anxiety? Biol Psychiatry 52:947–957

        • Schmidt N.B.
        • Wollaway-Bickel K.
        • Trakowski J.H.
        • Santiago H.T.
        • Vasey M.
        • et al.
        Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder.
        Behav Res Ther. 2002; 40: 67-73
        • Wells A.
        • Clark D.M.
        • Salkovskis P.
        • Ludgate J.
        • Hackmann A.
        • Gelder M.
        • et al.
        Social phobia.
        Behav Ther. 1995; 26: 153-161
        • Wells A.
        • Papageorgiou C.
        Social phobia.
        Behav Ther. 1998; 29: 357-370