Behaviorally spontaneous confabulation (BSpC) is a disorder characterized by reality confusion; patients are disoriented, act according to memories that do not pertain to ongoing reality and fail to adapt their behavior when reality contradicts their anticipations. The present thesis aimed to test the hypothesis that BSpC and disorientation are associated with the ability to learn that a previously valid anticipation no longer applies ("extinction capacity"). Then, the neural correlates of extinction capacity in healthy participants and the interaction between this capacity and the perception of potentially harmful stimuli were investigated. Clinical studies indicated that disorientation and behavioral spontaneous confabulation are strongly associated with extinction capacity. Electrophysiological studies showed that a rapid orbitofrontal signal reflected the brain's integration of the absence of anticipated outcomes into behavior, irrespective of the emotional quality of the outcomes. However, the processing of the emotional quality had privilege over the processing of the behavioral meaning of outcomes. The results indicate that adaptation of thought and behavior to reality seems to depend on extinction capacity and that potentially harmful stimuli override the influence of other behaviorally relevant stimuli.