, Volume 236, Issue 1, pp 143–161 | Cite as

A precision medicine approach to pharmacological adjuncts to extinction: a call to broaden research

  • Gabrielle KingEmail author
  • Kathryn D. Baker
  • Madelyne A. Bisby
  • Diana Chan
  • Caitlin S. M. Cowan
  • Anthea A. Stylianakis
  • Kelsey S. Zimmermann
  • Rick Richardson


There is a pressing need to improve treatments for anxiety. Although exposure-based therapy is currently the gold-standard treatment, many people either do not respond to this therapy or experience a relapse of symptoms after treatment has ceased. In recent years, there have been many novel pharmacological agents identified in preclinical research that have potential as adjuncts for exposure therapy, yet very few of these are regularly integrated into clinical practice. Unfortunately, the robust effects observed in the laboratory animal often do not translate to a clinical population. In this review, we discuss how age, sex, genetics, stress, medications, diet, alcohol, and the microbiome can vary across a clinical population and yet are rarely considered in drug development. While not an exhaustive list, we have focused on these factors because they have been shown to influence an individual’s vulnerability to anxiety and alter the neurotransmitter systems often targeted by pharmacological adjuncts to therapy. We argue that for potential adjuncts to be successfully translated from the lab to the clinic empirical research must be broadened to consider how individual difference factors will influence drug efficacy.


Extinction Stress Sex Pharmacological adjuncts Genetics Microbiome 



We thank the funding bodies that supported our work: Australian Government Research Training Program Scholarships to GK, MAB, DC, and AAS; a Project Grant from the National Health and Medical Research Council to RR and KB (NHMRC; APP1086855), an Australian Research Council Discovery Early Career Researcher Award to KB (DE170100392), and an Australian Research Council Discovery grant to RR (DP150104835).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

213_2018_4999_MOESM1_ESM.docx (80 kb)
ESM 1 (DOCX 80 kb)


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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PsychologyThe University of New South WalesSydneyAustralia
  2. 2.APC Microbiome InstituteUniversity College CorkCorkIreland

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