Clinically, the principles of extinction learning form much of the foundation for the most effective behavioral therapies for fear-related anxiety disorders. Within the general class of anxiety disorders, posttraumatic stress disorder (PTSD) is unique in the sense that the precipitating traumatic event may provide the opportunity for acute intervention before the onset of symptoms and before memories have been consolidated. The use of propranolol to treat individuals with posttraumatic stress symptoms was initially described in a case series of physically and sexually abused children with severe symptoms of agitation. An alternative consolidation-blockade approach to the use of propranolol involves the administration of glucocorticoids to trauma-exposed patients. Finally, clinically directed interference with initial memory consolidation through the use of beta-blockers or glucocorticoids following acute trauma exposure could prevent or attenuate the formation of traumatic emotional memory and reduce risk of PTSD.

Early life stress (ELS) and abuse are the most commonly assessed environmental exposures in psychiatric genes and environment (GxE) interaction studies, partly because of the strength of evidence that ELS plays a role in risk for multiple psychiatric disorders. The research on GxE interactions is organized by the presumed underlying neurobiological systems and by the broader classification of psychiatric outcomes (mood/anxiety disorders and externalizing disorders). This chapter discusses the importance of clearly defining and measuring both the proposed environmental risk/resilience factors as well as the predicted diagnostic and behavioral outcomes. This allows investigators to conduct GxE studies that better inform the understanding of the role of ELS in predicting psychiatric risk/resilience. The chapter focuses on childhood physical, sexual and emotional abuse, which is currently among the most well-researched environmental risk variables in human psychopathology research.