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However, even after successful extinction, old fear associations can return under other stressful circumstances. This might involve the development of PTSD or a relapse after successful psychotherapy. Kalisch has found that L-dopa, a drug to treat Parkinson's disease, can prevent this effect and could therefore possibly be used to prevent relapse in treated PTSD or phobia patients. L-dopa is taken up by the brain and transformed into dopamine that not only controls the brain's reward and pleasure centers and helps regulate movement, but also affects memory formation. The person receiving L-dopa after extinction will thus create a stronger secondary positive memory of the extinction experience and will thus be able to more easily replace the negative memory. This raises new questions about the role of primary fear memories and secondary prevention by L-dopa. "We would like to be able to enhance the long-term effects of psychotherapy by combining it with L-dopa," said Professor Raffael Kalisch. To this end, he is about to start a clinical study of people with a spider phobia to determine the effects of L-dopa on therapy outcome. "Manipulating the dopamine system in the brain is a promising avenue to boost primary and secondary preventive strategies based on the extinction procedure," he continued.