F ear extinction learning is a highly adaptive process that involves the integrity of frontolimbic circuitry. Its disruption has been associated with emotional dysregulation in stress and anxiety disorders. This presentation will examine how age, genetics and experiences shape our capacity to regulate fear in cross-species studies. Evidence for adolescent-specific diminished fear extinction learning will be presented in the context of immature frontolimbic circuitry. Evidence for less neural plasticity in fear regulation as a function of early life stress and genotype also will be presented. Finally, this work will be discussed in the context of exposure-based behavioral therapies for the treatment of anxiety and stress disorders, speculating on how such therapies may be optimized for the individual based on the patient’s age, genetic profile and personal history to move from standard treatment of care to personalized and precision medicine.