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Fear extinction underlies prolonged exposure, one of the most well-studied treatments for posttraumatic stress disorder (PTSD). There has been increased interest in exploring pharmacological agents to enhance fear extinction learning in humans and their potential as adjuncts to PE. The objective of such adjuncts is to augment the clinical impact of PE on the durability and magnitude of symptom reduction. In this study, we examined whether hydrocortisone (HC), a corticosteroid, and D-Cycloserine (DCS), an N-methyl-D-aspartate receptor partial agonist, enhance fear extinction learning and consolidation in individuals with PTSD. In a double-blind placebo-controlled 3-group experimental design, 90 individuals with full or subsyndromal PTSD underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS-) with shock. Extinction learning occurred 72 h later and extinction retention was tested one week after extinction. HC 25 mg, DCS 50 mg or placebo was administered one hour prior to extinction learning. During extinction learning, the DCS and HC groups showed a reduced differential CS+/CS- skin conductance response (SCR) compared to placebo (b = -0.19, CI = -0.01 to -37, p = 0.042 and b = -0.25, CI = -08 to -0.43, p = 0.005, respectively). A nonsignificant trend for a lower differential CS+/CS- SCR in the DCS group, compared to placebo, (b = -0.25, CI = 0.04 to -0.55, p = 0.089) was observed at retention testing, one week later. A single dose of HC and DCS facilitated fear extinction learning in participants with PTSD symptoms. While clinical implications have yet to be determined, our findings suggest that glucocorticoids and NMDA agonists hold promise for facilitating extinction learning in PTSD.

Background: The ability to extinguish a maladaptive conditioned fear response is crucial for healthy emotional processing and resiliency to aversive experiences. Therefore, enhancing fear extinction learning has immense potential emotional and health benefits. Mindfulness training enhances both fear conditioning and recall of extinguished fear; however, its effects on fear extinction learning are unknown. Here we investigated the impact of mindfulness training on brain mechanisms associated with fear-extinction learning, compared to an exercise-based program. Methods: We investigated BOLD activations in response to a previously learned fear-inducing cue during an extinction paradigm, before and after an 8-week mindfulness-based stress reduction program (MBSR, n = 49) or exercise-based stress management education program (n = 27). Results: The groups exhibited similar reductions in stress, but the MBSR group was uniquely associated with enhanced activation of salience network nodes and increased hippocampal engagement. Conclusions: Our results suggest that mindfulness training increases attention to anticipatory aversive stimuli, which in turn facilitates decreased aversive subjective responses and enhanced reappraisal of the memory. [ABSTRACT FROM AUTHOR]

Moisture plays a key role in rock decay in the built and natural environments. Rock-cut sites are particularly vulnerable to moisture-related weathering as they are carved into rock outcrops and do not have impermeable foundations or roofs to retard the flow of moisture. To characterise the moisture dynamics and its influence on weathering of rock-cut sites, we undertook a moisture monitoring campaign using a non-destructive Microwave Moisture Measurement System (MMMS) at two monolithic rock-cut churches in Lalibela, Ethiopia. The results showed that the walls were more saturated at depth than on the surface during the wet season. This suggests that low surface temperature and higher moisture content at depth will lead to constant-rate drying and accumulation of salts on the surface of the walls during the wet season. In the dry season, there was higher saturation near the surface than at depth (falling-rate drying). High rock surface temperature during the dry season contributes to subsurface drying and accumulation of salts below the surface. This seasonally shifting moisture dynamics will lead to a complex and dynamic damage profile. This study highlights the significant wetting facilitated by a lack of impermeable roofs and foundations at rock-cut structures during rainy periods. [ABSTRACT FROM AUTHOR]

In their letter to the editor, Steenen and colleagues (1) argue that the conclusions of our meta-analysis (2) on the clinical efficacy of reconsolidation impairment using propranolol are 'incorrect in [...]