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Editorial
August 2016

Schrödinger’s Cat and d-Cycloserine to Augment Exposure Therapy—Both Are Alive and Dead

Author Affiliations
  • 1Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
JAMA Psychiatry. 2016;73(8):771-772. doi:10.1001/jamapsychiatry.2016.1132

Pediatric obsessive-compulsive disorder (OCD) is treated effectively with cognitive behavior therapy (CBT). However, there is clearly room for further improvement, and the exposure strategies used in this treatment are often distressing to patients. Therefore, it is desirable to improve the efficacy of CBT or to accelerate the treatment response. Attempts to improve the efficacy of CBT with traditional anxiolytic pharmacological agents, such as selective serotonin reuptake inhibitors, have been disappointing. A more promising strategy to augment CBT might be with the use of a cognitive enhancer, which was the objective of the study by Storch and colleagues1 in this issue of JAMA Psychiatry. One important therapeutic strategy during CBT for anxiety disorders is repeated or prolonged exposure to threat cues, which is based on extinction learning.2 The results of preclinical studies suggest that extinction learning is modulated by activity of the glutamatergic N-methyl-d-aspartate receptor in the amygdala. d-cycloserine (d-4-amino-3-isoxazolidinone), a partial agonist at the glycine recognition site of the glutamatergic N-methyl-d-aspartate receptor partial agonists, enhances this learning process (eg, see the study by Walker et al3). Therefore, clinical researchers have examined whether d-cycloserine might also enhance exposure procedures in humans.

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