The influence of acute stress on the regulation of conditioned fear

Drug-Induced Glucocorticoids and Memory for Substance Use

The biological stress response of the body forms one of the foundations of adaptive behavior, including promoting (and impairing) different forms of memory. This response transcends stressful experiences and underlies reactions to challenges and even reinforcers such as addictive substances. Nevertheless, drug-induced stress responses are rarely incorporated into models of addiction. We propose here that drug-induced stress responses (particularly glucocorticoids) play a crucial role in addictive behavior by modulating the formation of memories for substance-use experiences. We review the contributions of amygdala-, striatum-, and hippocampus-based memory systems to addiction, and reveal common effects of addictive drugs and acute stress on these different memories. We suggest that the contributions of drug-induced stress responses to memory may provide insights into the mechanisms driving addictive behavior.

Threat-related disorders as persistent motivational states of defense

Defensive motivation, broadly defined as the orchestrated optimization of defensive functions, encapsulates core components of threat-related psychopathology. The exact relationship between defensive functions and stress-induced symptoms, however, is not entirely clear. Here we review how some of the most important behavioral and neurological findings related to threat-related disorders -- lowering response threshold to threats, facilitated learning and generalization to new threatening cues, reduced appetitive sensitivity, and resistance to extinction of the defensive state -- map onto defensive motivational states, highlighting evidence that supports conjecturing threat-related disorders as persistent motivational states. We propose a mechanism for the perpetuation of the motivational state, progressively converting temporary defensive functions into persistent defensive states associated with distress and impairment.

Glucocorticoid receptor-mediated amygdalar metaplasticity underlies adaptive modulation of fear memory by stress

Glucocorticoid receptor (GR) is crucial for signaling mediated by stress-induced high levels of glucocorticoids. The lateral nucleus of the amygdala (LA) is a key structure underlying auditory-cued fear conditioning. Here, we demonstrate that genetic disruption of GR in the LA (LAGRKO) resulted in an auditory-cued fear memory deficit for strengthened conditioning. Furthermore, the suppressive effect of a single restraint stress (RS) prior to conditioning on auditory-cued fear memory in floxed GR (control) mice was abolished in LAGRKO mice. Optogenetic induction of long-term depression (LTD) at auditory inputs to the LA reduced auditory-cued fear memory in RS-exposed LAGRKO mice, and in contrast, optogenetic induction of long-term potentiation (LTP) increased auditory-cued fear memory in RS-exposed floxed GR mice. These findings suggest that prior stress suppresses fear conditioning-induced LTP at auditory inputs to the LA in a GR-dependent manner, thereby protecting animals from encoding excessive cued fear memory under stress conditions.

The Neural Basis of Fear Promotes Anger and Sadness Counteracts Anger

In contrast to cognitive emotion regulation theories that emphasize top-down control of prefrontal-mediated regulation of emotion, in traditional Chinese philosophy and medicine, different emotions are considered to have mutual promotion and counteraction relationships. Our previous studies have provided behavioral evidence supporting the hypotheses that “fear promotes anger” and “sadness counteracts anger”; this study further investigated the corresponding neural correlates. A basic hypothesis we made is the “internal versus external orientation” assumption proposing that fear could promote anger as its external orientation associated with motivated action, whereas sadness could counteract anger as its internal or homeostatic orientation to somatic or visceral experience. A way to test this assumption is to examine the selective involvement of the posterior insula (PI) and the anterior insula (AI) in sadness and fear because the posterior-to-anterior progression theory of insular function suggests that the role of the PI is to encode primary body feeling and that of the AI is to represent the integrative feeling that incorporates the internal and external input together. The results showed increased activation in the AI, parahippocampal gyrus (PHG), posterior cingulate (PCC), and precuneus during the fear induction phase, and the activation level in these areas could positively predict subsequent aggressive behavior; meanwhile, the PI, superior temporal gyrus (STG), superior frontal gyrus (SFG), and medial prefrontal cortex (mPFC) were more significantly activated during the sadness induction phase, and the activation level in these areas could negatively predict subsequent feelings of subjective anger in a provocation situation. These results revealed a possible cognitive brain mechanism underlying “fear promotes anger” and “sadness counteracts anger.” In particular, the finding that the AI and PI selectively participated in fear and sadness emotions was consistent with our “internal versus external orientation” assumption about the different regulatory effects of fear and sadness on anger and aggressive behavior.

Anticipatory prefrontal cortex activity underlies stress-induced changes in Pavlovian fear conditioning

Excessive stress exposure often leads to emotional dysfunction, characterized by disruptions in healthy emotional learning, expression, and regulation processes. A prefrontal cortex (PFC)-amygdala circuit appears to underlie these important emotional processes. However, limited human neuroimaging research has investigated whether these brain regions underlie the altered emotional function that develops with stress. Therefore, the present study used functional magnetic resonance imaging (fMRI) to investigate stress-induced changes in PFC-amygdala function during Pavlovian fear conditioning. Participants completed a variant of the Montreal Imaging Stress Task (MIST) followed (25 min later) by a Pavlovian fear conditioning task during fMRI. Self-reported stress to the MIST was used to identify three stress-reactivity groups (Low, Medium, and High). Psychophysiological, behavioral, and fMRI signal responses were compared between the three stress-reactivity groups during fear conditioning. Fear learning, indexed via participant expectation of the unconditioned stimulus during conditioning, increased with stress reactivity. Further, the High stress-reactivity group demonstrated greater autonomic arousal (i.e., skin conductance response, SCR) to both conditioned and unconditioned stimuli compared to the Low and Medium stress-reactivity groups. Finally, the High stress group did not regulate the emotional response to threat. More specifically, the High stress-reactivity group did not show a negative relationship between conditioned and unconditioned SCRs. Stress-induced changes in these emotional processes paralleled changes in dorsolateral, dorsomedial, and ventromedial PFC function. These findings demonstrate that acute stress facilitates fear learning, enhances autonomic arousal, and impairs emotion regulation, and suggests these stress-induced changes in emotional function are mediated by the PFC.

Noradrenergic Modulation of Fear Conditioning and Extinction

The locus coeruleus norepinephrine (LC-NE) system plays a broad role in learning and memory. Here we begin with an overview of the LC-NE system. We then consider how both direct and indirect manipulations of the LC-NE system affect cued and contextual aversive learning and memory. We propose that NE dynamically modulates Pavlovian conditioning and extinction, either promoting or impairing learning aversive processes under different levels of behavioral arousal. We suggest that under high levels of stress (e.g., during/soon after fear conditioning) the locus coeruleus (LC) promotes cued fear learning by enhancing amygdala function while simultaneously blunting prefrontal function. Under low levels of arousal, the LC promotes PFC function to promote downstream inhibition of the amygdala and foster the extinction of cued fear. Thus, LC-NE action on the medial prefrontal cortex (mPFC) might be described by an inverted-U function such that it can either enhance or hinder learning depending on arousal states. In addition, LC-NE seems to be particularly important for the acquisition, consolidation and extinction of contextual fear memories. This may be due to dense adrenoceptor expression in the hippocampus (HPC) which encodes contextual information, and the ability of NE to regulate long-term potentiation (LTP). Moreover, recent work reveals that the diversity of LC-NE functions in aversive learning and memory are mediated by functionally heterogeneous populations of LC neurons that are defined by their projection targets. Hence, LC-NE function in learning and memory is determined by projection-specific neuromodulation that accompanies various states of behavioral arousal.

Pavlovian conditioned diminution of the neurobehavioral response to threat

An important function of emotion is that it motivates us to respond more effectively to threats in our environment. Accordingly, healthy emotional function depends on the ability to appropriately avoid, escape, or defend against threats we encounter. Thus, from a functional perspective, it is important to understand the emotional response to threat. However, prior work has largely focused on the emotional response in anticipation of threat, rather than the emotional response to the threat itself. The current review is focused on recent behavioral, psychophysiological, and neural findings from Pavlovian conditioning research that is centered on the expression and regulation of the emotional response to threat. The current evidence suggests that a neural network that includes the prefrontal cortex, hippocampus, and amygdala underlies learning, expression, and regulation processes that modulate emotional responses to threat. This line of research has important implications for our understanding of emotion regulation and stress resilience.

Cortisol responses enhance negative valence perception for ambiguous facial expressions

Stress exposure elicits a prolonged neuroendocrine response, marked by cortisol release, which can influence important forms of affective decision-making. Identifying how stress reactivity shapes subjective biases in decisions about emotional ambiguity (i.e., valence bias) provides insight into the role stress plays in basic affective processing for healthy and clinical populations alike. Here, we sought to examine how stress reactivity affects valence decisions about emotional ambiguity. Given that stress prioritizes automatic emotional processing which, in the context of valence bias, is associated with increased negativity, we tested how individual differences in acute stress responses influence valence bias and how this decision process evolves over time. Participants provided baseline ratings of clear (happy, angry) and ambiguous (surprised) facial expressions, then re-rated similar stimuli after undergoing an acute stress or control manipulation a week later; salivary cortisol was measured throughout to assay stress reactivity. Elevations in cortisol were associated with more negative ratings of surprised faces, and with more direct response trajectories toward negative ratings (i.e., less response competition). These effects were selectively driven by the stress group, evidencing that increased stress reactivity is associated with a stronger negativity bias during ambiguous affective decision-making.

Stress attenuates the flexible updating of aversive value

In a dynamic environment, sources of threat or safety can unexpectedly change, requiring the flexible updating of stimulus-outcome associations that promote adaptive behavior. However, aversive contexts in which we are required to update predictions of threat are often marked by stress. Acute stress is thought to reduce behavioral flexibility, yet its influence on the modulation of aversive value has not been well characterized. Given that stress exposure is a prominent risk factor for anxiety and trauma-related disorders marked by persistent, inflexible responses to threat, here we examined how acute stress affects the flexible updating of threat responses. Participants completed an aversive learning task, in which one stimulus was probabilistically associated with an electric shock, while the other stimulus signaled safety. A day later, participants underwent an acute stress or control manipulation before completing a reversal learning task during which the original stimulus-outcome contingencies switched. Skin conductance and neuroendocrine responses provided indices of sympathetic arousal and stress responses, respectively. Despite equivalent initial learning, stressed participants showed marked impairments in reversal learning relative to controls. Additionally, reversal learning deficits across participants were related to heightened levels of alpha-amylase, a marker of noradrenergic activity. Finally, fitting arousal data to a computational reinforcement learning model revealed that stress-induced reversal learning deficits emerged from stress-specific changes in the weight assigned to prediction error signals, disrupting the adaptive adjustment of learning rates. Our findings provide insight into how stress renders individuals less sensitive to changes in aversive reinforcement and have implications for understanding clinical conditions marked by stress-related psychopathology.

Stress promotes generalization of older but not recent threat memories

Stress broadly affects the ability to regulate emotions and may contribute to generalization of threat-related behaviors to harmless stimuli. Behavioral generalization also tends to increase over time as memory precision for recent events gives way to more gist-like representations. Thus, acute stress coupled with a delay in time from a negative experience may be a strong predictor of the transition from normal to generalized fear expression. Here, we investigated the effect of a single-episode acute stressor on generalization of aversive learning when stress is administered either immediately after an aversive learning event or following a delay. In a between-subjects design, healthy adult volunteers underwent threat (fear) conditioning using a tone-conditioned stimulus paired with an electric shock to the wrist and another tone not paired with shock. Behavioral generalization was tested to a range of novel tones either on the same day (experiment 1) or 24 h later (experiment 2) and was preceded by either an acute stress induction or a control task. Anticipatory sympathetic arousal [i.e., skin conductance responses (SCRs)] and explicit measures of shock expectancy served as dependent measures. Stress administered shortly after threat conditioning did not affect behavioral generalization. In contrast, stress administered following a delay led to heightened arousal and increased generalization of SCRs and explicit measures of shock expectancy. These findings show that acute stress increases generalization of older but not recent threat memories and have clinical relevance to understanding overgeneralization characteristics of anxiety and stress-related disorders.

Characterization of the amplificatory effect of norepinephrine in the acquisition of Pavlovian threat associations

The creation of auditory threat Pavlovian memory requires an initial learning stage in which a neutral conditioned stimulus (CS), such as a tone, is paired with an aversive one (US), such as a shock. In this phase, the CS acquires the capacity of predicting the occurrence of the US and therefore elicits conditioned defense responses. Norepinephrine (NE), through β-adrenergic receptors in the amygdala, enhances threat memory by facilitating the acquisition of the CS–US association, but the nature of this effect has not been described. Here we show that NE release, induced by the footshock of the first conditioning trial, promotes the subsequent enhancement of learning. Consequently, blocking NE transmission disrupts multitrial but not one-trial conditioning. We further found that increasing the time between the conditioning trials eliminates the amplificatory effect of NE. Similarly, an unsignaled footshock delivered in a separate context immediately before conditioning can enhance learning. These results help define the conditions under which NE should and should not be expected to alter threat processing and fill an important gap in the understanding of the neural processes relevant to the pathophysiology of stress and anxiety disorders.

Effects of electroacupuncture on stress and anxiety-related responses in rats

The aim of this work was to investigate if eletroacupuncture at PC6 would modulate the stress-induced anxiety-like behavior and the level of activation of several brain areas. Rats were distributed in groups: control; submitted to immobilization; submitted to immobilization and eletroacupuncture at PC6 or at the tail. Immobilization increased grooming and decreased stretched attend postures and the time spent in the open arms of the ele-vated plus-maze. Eletroacupuncture at PC6 or tail canceled the effect of immobilization on grooming and attenuated the stretched attend posture. Immobilization increased Fos-immunoreactivity in the prefrontal cortex, medial and central amygdala, paraventricular and dorsomedial nuclei of the hypothalamus, lateral hypothalamus, dentate gyrus, CA1, CA2 and CA3 hippocampal areas. The activation of paraventricular, dorsomedial nuclei and prefrontal cortex by immobilization was canceled by electroacupuncture at PC6 and attenuated by electroacupuncture in the tail. The activation of the other areas was canceled by electroacupuncture in PC6 or the tail. It is concluded that immobilization induced anxiety-like behavior that was moderately attenuated by eletroacupuncture with difference between the stimulation in PC6 or the rat tail. Eletroacupuncture showed specificity concerning to the attenuation of the effects of immobilization in the CNS areas related to the stress response, anxiety and cardiovascular system.

The Influence of State Anxiety on Fear Discrimination and Extinction in Females

Formal theories have linked pathological anxiety to a failure in fear response inhibition. Previously, we showed that aberrant response inhibition is not restricted to anxiety patients, but can also be observed in anxiety-prone adults. However, less is known about the influence of currently experienced levels of anxiety on inhibitory learning. The topic is highly important as state anxiety has a debilitating effect on cognition, emotion, and physiology and is linked to several anxiety disorders. In the present study, healthy female volunteers performed a fear conditioning task, after being informed that they will have to perform the Trier Social Stress Test task (n = 25; experimental group) or a control task (n = 25; control group) upon completion of the conditioning task. The results showed that higher levels of state anxiety corresponded with a reduced discrimination between a stimulus (CS+) typically followed by an aversive event and a stimulus (CS-) that is never followed by an aversive event both during the acquisition and the extinction phase. No effect of state anxiety on the skin conductance response associated with CS+ and CS- was found. Additionally, higher levels of state anxiety coincided with more negative valence ratings of the CSs. The results suggest that increased stress-induced state anxiety might lead to stimulus generalization during fear acquisition, thereby impairing associative learning.

Dynamic expression of FKBP5 in the medial prefrontal cortex regulates resiliency to conditioned fear

The factors influencing resiliency to the development of post-traumatic stress disorder (PTSD) remain to be elucidated. Clinical studies associate PTSD with polymorphisms of the FK506 binding protein 5 (FKBP5). However, it is unclear whether changes in FKBP5 expression alone could produce resiliency or susceptibility to PTSD-like symptoms. In this study, we used rats as an animal model to examine whether FKBP5 in the infralimbic (IL) or prelimbic (PL) medial prefrontal cortex regulates fear conditioning or extinction. First, we examined FKBP5 expression in IL and PL during fear conditioning or extinction. In contrast to the stable expression of FKBP5 seen in PL, FKBP5 expression in IL increased after fear conditioning and remained elevated even after extinction suggesting that IL FKBP5 levels may modulate fear conditioning or extinction. Consistent with this possibility, reducing basal FKBP5 expression via local infusion of FKBP5–shRNA into IL reduced fear conditioning. Furthermore, reducing IL FKBP5, after consolidation of the fear memory, enhanced extinction memory indicating that IL FKBP5 opposed formation of the extinction memory. Our findings demonstrate that lowering FKBP5 expression in IL is sufficient to both reduce fear acquisition and enhance extinction, and suggest that lower expression of FKBP5 in the ventral medial prefrontal cortex could contribute to resiliency to PTSD.

The birth, death and resurrection of avoidance: a reconceptualization of a troubled paradigm

Research on avoidance conditioning began in the late 1930s as a way to use laboratory experiments to better understand uncontrollable fear and anxiety. Avoidance was initially conceived of as a two-factor learning process in which fear is first acquired through Pavlovian aversive conditioning (so-called fear conditioning), and then behaviors that reduce the fear aroused by the Pavlovian conditioned stimulus are reinforced through instrumental conditioning. Over the years, criticisms of both the avoidance paradigm and the two-factor fear theory arose. By the mid-1980s, avoidance had fallen out of favor as an experimental model relevant to fear and anxiety. However, recent progress in understanding the neural basis of Pavlovian conditioning has stimulated a new wave of research on avoidance. This new work has fostered new insights into contributions of not only Pavlovian and instrumental learning but also habit learning, to avoidance, and has suggested that the reinforcing event underlying the instrumental phase should be conceived in terms of cellular and molecular events in specific circuits rather than in terms of vague notions of fear reduction. In our approach, defensive reactions (freezing), actions (avoidance) and habits (habitual avoidance) are viewed as being controlled by unique circuits that operate nonconsciously in the control of behavior, and that are distinct from the circuits that give rise to conscious feelings of fear and anxiety. These refinements, we suggest, overcome older criticisms, justifying the value of the new wave of research on avoidance, and offering a fresh perspective on the clinical implications of this work.

Modulation of Fear Extinction by Stress, Stress Hormones and Estradiol: A Review

Fear acquisition and extinction are valid models for the etiology and treatment of anxiety, trauma- and stressor-related disorders. These disorders are assumed to involve aversive learning under acute and/or chronic stress. Importantly, fear conditioning and stress share common neuronal circuits. The stress response involves multiple changes interacting in a time-dependent manner: (a) the fast first-wave stress response [with central actions of noradrenaline, dopamine, serotonin, corticotropin-releasing hormone (CRH), plus increased sympathetic tone and peripheral catecholamine release] and (b) the second-wave stress response [with peripheral release of glucocorticoids (GCs) after activation of the hypothalamus-pituitary-adrenocortical (HPA) axis]. Control of fear during extinction is also sensitive to these stress-response mediators. In the present review, we will thus examine current animal and human data, addressing the role of stress and single stress-response mediators for successful acquisition, consolidation and recall of fear extinction. We report studies using pharmacological manipulations targeting a number of stress-related neurotransmitters and neuromodulators [monoamines, opioids, endocannabinoids (eCBs), neuropeptide Y, oxytocin, GCs] and behavioral stress induction. As anxiety, trauma- and stressor-related disorders are more common in women, recent research focuses on female sex hormones and identifies a potential role for estradiol in fear extinction. We will thus summarize animal and human data on the role of estradiol and explore possible interactions with stress or stress-response mediators in extinction. This also aims at identifying time-windows of enhanced (or reduced) sensitivity for fear extinction, and thus also for successful exposure therapy.

Stress and Fear Extinction

Stress has a critical role in the development and expression of many psychiatric disorders, and is a defining feature of posttraumatic stress disorder (PTSD). Stress also limits the efficacy of behavioral therapies aimed at limiting pathological fear, such as exposure therapy. Here we examine emerging evidence that stress impairs recovery from trauma by impairing fear extinction, a form of learning thought to underlie the suppression of trauma-related fear memories. We describe the major structural and functional abnormalities in brain regions that are particularly vulnerable to stress, including the amygdala, prefrontal cortex, and hippocampus, which may underlie stress-induced impairments in extinction. We also discuss some of the stress-induced neurochemical and molecular alterations in these brain regions that are associated with extinction deficits, and the potential for targeting these changes to prevent or reverse impaired extinction. A better understanding of the neurobiological basis of stress effects on extinction promises to yield novel approaches to improving therapeutic outcomes for PTSD and other anxiety and trauma-related disorders.

Could Stress Contribute to Pain-Related Fear in Chronic Pain?

Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that: (1) extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal) likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favor overgeneralization; (2) acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories; (3) stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4) these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such depression or anxiety in patients with chronic pain.

Increased skin conductance responses and neural activity during fear conditioning are associated with a repressive coping style

The investigation of individual differences in coping styles in response to fear conditioning is an important issue for a better understanding of the etiology and treatment of psychiatric disorders. It has been assumed that an avoidant (repressive) coping style is characterized by increased emotion regulation efforts in context of fear stimuli as compared to a more vigilant coping style. However, no study so far has investigated the neural correlates of fear conditioning of repressors and sensitizers. In the present fMRI study, 76 participants were classified as repressors or as sensitizers and were exposed to a fear conditioning paradigm, in which the CS+ predicted electrical stimulation, while another neutral stimulus (CS-) did not. In addition, skin conductance responses (SCRs) were measured continuously. As the main findings, we found increased neural activity in repressors as compared to sensitizers in the ventromedial prefrontal cortex and the anterior cingulate cortex (ACC) during fear conditioning. In addition, elevated activity to the CS+ in amygdala, insula, occipital, and orbitofrontal cortex (OFC) as well as elevated conditioned SCRs were found in repressors. The present results demonstrate increased neural activations in structures linked to emotion down-regulation mechanisms like the ventromedial prefrontal cortex, which may reflect the increased coping effort in repressors. At the same time, repressors showed increased activations in arousal and evaluation-associated structures like the amygdala, the occipital cortex (OCC), and the OFC, which was mirrored in increased SCRs. The present results support recent assumptions about a two-process model of repression postulating a fast vigilant response to fear stimuli, and a second process associated with the down-regulation of emotional responses.