Emerging treatments
D-cycloserine
D-cycloserine is a partial N-methyl-D-aspartate agonist shown in several small studies to enhance exposure-based treatments when used in low doses just before or just after a session of exposure, purportedly by facilitating memory consolidation.[107][108] Other similar studies have found either detriment or lack of benefit from the treatment. In one study, the medication was detrimental if administered when fear levels remained elevated after an exposure, while it was beneficial if administered when fear levels had fallen after an exposure.[109] One 2015 Cochrane review found no evidence for a difference between D-cycloserine and placebo administration during exposure therapy, while a 2017 review and meta-analysis of individual participant data concluded D-cycloserine administration was associated with a small augmentation effect on exposure therapy.[110][111] Research is needed to clarify mechanisms of action and determine whether there are particular conditions under which D-cycloserine administration might prove reliably beneficial.
Glucocorticoids
Glucocorticoids are thought to enhance fear extinction and reduce fear memory retrieval.[112] Several small placebo-controlled studies on individuals with phobias to spiders and heights found that administration of cortisol 1 hour prior to exposure therapy resulted in superior outcomes in those individuals who received cortisol versus placebo.[113][114] Glucocorticoid administration in conjunction with exposure therapy for other disorders, such as post-traumatic stress disorder, has also been found to be beneficial.[112] More studies are warranted to determine whether these findings are reproducible and to calculate the optimal timing and dosing of glucocorticoid administration.
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