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Open Access Highly Accessed Open Badges Review

D-Cycloserine as an augmentation strategy for cognitive behavioral therapy of anxiety disorders

Stefan G Hofmann*, Jade Q Wu and Hannah Boettcher

Author Affiliations

Department of Psychology, Boston University, Boston, MA, 02215-2002, USA

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Biology of Mood & Anxiety Disorders 2013, 3:11  doi:10.1186/2045-5380-3-11

Published: 15 June 2013


The goal of this review is to examine the clinical studies on d-cycloserine, a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure procedures during cognitive behavioral therapy for anxiety disorders. Although cognitive behavioral therapy and anxiolytic medications are more effective than placebo for treating anxiety disorders, there is still considerable room for further improvement. Traditional combination strategies typically yield disappointing results. However, recent studies based on translational research have shown promise to augment the neural circuitry underlying fear extinction with pharmacological means. We discuss the current state of the literature, including inconsistencies of findings and issues concerning the drug mechanism, dosing, and dose timing. D-cycloserine is a promising combination strategy for cognitive behavioral therapy of anxiety disorders by augmenting extinction learning. However, there is also evidence to suggest that d-cycloserine can facilitate reconsolidation of fear memory when exposure procedures are unsuccessful.

Anxiety disorder; Cognitive behavioral therapy; Glutamate; D-cycloserine; NMDA; Psychotherapy; Pharmacotherapy