Using Cognitive Enhancers to Improve the Treatment of Anxiety Disorders in Young People: Examining the Potential for D-Cycloserine to Augment Exposure for Child Anxiety

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Byrne, Simon P
Farrell, Lara J
Rapee, Ronald M
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Tracey Wade
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Cognitive-behavioural therapies have shown to be generally effective in treating anxious young people. Yet there is considerable room for improvement, as many clients do not achieve complete remission. This article examines the potential use of D-cycloserine (DCS) to augment exposure-based therapies for anxious young people. DCS is a "cognitive-enhancing" medication believed to consolidate fear-extinction learning into memory. This consolidation may "immunise" against the return of their fear and speed remission. This article describes what DCS is and how it is believed to work. It describes the "translational research" in animals that led to its development for consolidating fear extinction. It reviews the current state of evidence for DCS augmentation and examines the applicability of DCS to enhance psychological treatments for paediatric anxiety disorders. Studies currently under way at Macquarie University and Griffith University in Australia are reviewed. Future directions for this promising research area are briefly considered. A promising development in the treatment of anxiety disorders is the use of "cognitive-enhancing" medications like D-cycloserine (DCS) to improve conventional psychological therapies. Exposure therapies relying upon the principles of "fear extinction" are a cornerstone in the treatment of anxiety: people suffering anxiety are encouraged to gradually "face their fears" in order to overcome them. These principles have shown to be generally effective in treating many forms of anxiety; however, there is considerable room for improvement, as many clients do not achieve complete remission or prematurely drop out of therapy. Cognitive enhancers like DCS may represent a safe and effective means for clients to consolidate treatment gains and speed their recovery. Young people suffering anxiety would arguably be the greatest beneficiaries of a more effective treatment model, as there are considerable benefits associated with early intervention (e.g., Rapee, Kennedy, Ingram, Edwards, & Sweeney, 2005). With this consideration in mind, groups of Australian researchers are currently investigating the use of DCS to improve treatment outcomes in clinically anxious children and adolescents. Skills-based cognitive-behavioural interventions for anxious children have been shown to be generally effective, with 55-60% of children becoming diagnosis-free post-treatment (James, Soler, & Weatherall, 2006; Rapee, Schniering, & Hudson, 2009). Yet few treated children report symptoms as low as non-clinical populations and around 40% remain diagnosable after treatment (e.g., Rapee et al., 2009). An intuitive means to improve treatment outcomes in this population is to combine psychotherapy with medications known to reduce anxiety symptoms (for example, using antidepressants or minor tranquilisers). Yet pharmacological augmentation of psychological treatments for anxiety have shown generally disappointing results (see Otto, Smits, & Reese, 2005 for review). Furthermore, the use of psychotropic medications in a young population is not without risk, and parents may be unwilling to expose their children to these medications over prolonged periods. Targeted use of DCS may represent a safe and effective treatment alternative to consolidate treatment gains made during exposure therapy.

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Clinical Psychologist
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Cognitive and computational psychology
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