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VanElzakker MB, Dahlgren MK, Davis FC, Dubois S, Shin LM. From Pavlov to PTSD: the extinction of conditioned fear in rodents, humans, and anxiety disorders. Neurobiol Learn Mem 2014; 113:3-18. [PMID: 24321650 PMCID: PMC4156287 DOI: 10.1016/j.nlm.2013.11.014] [Citation(s) in RCA: 305] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/31/2013] [Accepted: 11/24/2013] [Indexed: 01/08/2023]
Abstract
Nearly 100 years ago, Ivan Pavlov demonstrated that dogs could learn to use a neutral cue to predict a biologically relevant event: after repeated predictive pairings, Pavlov's dogs were conditioned to anticipate food at the sound of a bell, which caused them to salivate. Like sustenance, danger is biologically relevant, and neutral cues can take on great salience when they predict a threat to survival. In anxiety disorders such as posttraumatic stress disorder (PTSD), this type of conditioned fear fails to extinguish, and reminders of traumatic events can cause pathological conditioned fear responses for decades after danger has passed. In this review, we use fear conditioning and extinction studies to draw a direct line from Pavlov to PTSD and other anxiety disorders. We explain how rodent studies have informed neuroimaging studies of healthy humans and humans with PTSD. We describe several genes that have been linked to both PTSD and fear conditioning and extinction and explain how abnormalities in fear conditioning or extinction may reflect a general biomarker of anxiety disorders. Finally, we explore drug and neuromodulation treatments that may enhance therapeutic extinction in anxiety disorders.
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Affiliation(s)
- Michael B VanElzakker
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA; Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA.
| | - M Kathryn Dahlgren
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA; Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - F Caroline Davis
- Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - Stacey Dubois
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA
| | - Lisa M Shin
- Tufts University Psychology, 490 Boston Avenue, Medford, MA 02155, USA; Massachusetts General Hospital Psychiatry, 149 Thirteenth Street, Charlestown, MA 02129, USA
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Abstract
The well-replicated observation that many people maintain mental health despite exposure to severe psychological or physical adversity has ignited interest in the mechanisms that protect against stress-related mental illness. Focusing on resilience rather than pathophysiology in many ways represents a paradigm shift in clinical-psychological and psychiatric research that has great potential for the development of new prevention and treatment strategies. More recently, research into resilience also arrived in the neurobiological community, posing nontrivial questions about ecological validity and translatability. Drawing on concepts and findings from transdiagnostic psychiatry, emotion research, and behavioral and cognitive neuroscience, we propose a unified theoretical framework for the neuroscientific study of general resilience mechanisms. The framework is applicable to both animal and human research and supports the design and interpretation of translational studies. The theory emphasizes the causal role of stimulus appraisal (evaluation) processes in the generation of emotional responses, including responses to potential stressors. On this basis, it posits that a positive (non-negative) appraisal style is the key mechanism that protects against the detrimental effects of stress and mediates the effects of other known resilience factors. Appraisal style is shaped by three classes of cognitive processes--positive situation classification, reappraisal, and interference inhibition--that can be investigated at the neural level. Prospects for the future development of resilience research are discussed.
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The downside of strong emotional memories: How human memory-related genes influence the risk for posttraumatic stress disorder – A selective review. Neurobiol Learn Mem 2014; 112:75-86. [DOI: 10.1016/j.nlm.2013.08.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 11/19/2022]
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Ewald H, Glotzbach-Schoon E, Gerdes ABM, Andreatta M, Müller M, Mühlberger A, Pauli P. Delay and trace fear conditioning in a complex virtual learning environment-neural substrates of extinction. Front Hum Neurosci 2014; 8:323. [PMID: 24904363 PMCID: PMC4034409 DOI: 10.3389/fnhum.2014.00323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 04/30/2014] [Indexed: 11/13/2022] Open
Abstract
Extinction is an important mechanism to inhibit initially acquired fear responses. There is growing evidence that the ventromedial prefrontal cortex (vmPFC) inhibits the amygdala and therefore plays an important role in the extinction of delay fear conditioning. To our knowledge, there is no evidence on the role of the prefrontal cortex in the extinction of trace conditioning up to now. Thus, we compared brain structures involved in the extinction of human delay and trace fear conditioning in a between-subjects-design in an fMRI study. Participants were passively guided through a virtual environment during learning and extinction of conditioned fear. Two different lights served as conditioned stimuli (CS); as unconditioned stimulus (US) a mildly painful electric stimulus was delivered. In the delay conditioning group (DCG) the US was administered with offset of one light (CS+), whereas in the trace conditioning group (TCG) the US was presented 4 s after CS+ offset. Both groups showed insular and striatal activation during early extinction, but differed in their prefrontal activation. The vmPFC was mainly activated in the DCG, whereas the TCG showed activation of the dorsolateral prefrontal cortex (dlPFC) during extinction. These results point to different extinction processes in delay and trace conditioning. VmPFC activation during extinction of delay conditioning might reflect the inhibition of the fear response. In contrast, dlPFC activation during extinction of trace conditioning may reflect modulation of working memory processes which are involved in bridging the trace interval and hold information in short term memory.
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Affiliation(s)
- Heike Ewald
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Evelyn Glotzbach-Schoon
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Antje B. M. Gerdes
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
- Department of Clinical Psychology and Biological Psychology, School of Social Sciences, University of MannheimMannheim, Germany
| | - Marta Andreatta
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Mathias Müller
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
| | - Andreas Mühlberger
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
- Department of Experimental Psychology, Clinical Psychology and Psychotherapy, University of RegensburgRegensburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, University of WürzburgWürzburg, Germany
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Ullsperger M, Danielmeier C, Jocham G. Neurophysiology of performance monitoring and adaptive behavior. Physiol Rev 2014; 94:35-79. [PMID: 24382883 DOI: 10.1152/physrev.00041.2012] [Citation(s) in RCA: 406] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Successful goal-directed behavior requires not only correct action selection, planning, and execution but also the ability to flexibly adapt behavior when performance problems occur or the environment changes. A prerequisite for determining the necessity, type, and magnitude of adjustments is to continuously monitor the course and outcome of one's actions. Feedback-control loops correcting deviations from intended states constitute a basic functional principle of adaptation at all levels of the nervous system. Here, we review the neurophysiology of evaluating action course and outcome with respect to their valence, i.e., reward and punishment, and initiating short- and long-term adaptations, learning, and decisions. Based on studies in humans and other mammals, we outline the physiological principles of performance monitoring and subsequent cognitive, motivational, autonomic, and behavioral adaptation and link them to the underlying neuroanatomy, neurochemistry, psychological theories, and computational models. We provide an overview of invasive and noninvasive systemic measures, such as electrophysiological, neuroimaging, and lesion data. We describe how a wide network of brain areas encompassing frontal cortices, basal ganglia, thalamus, and monoaminergic brain stem nuclei detects and evaluates deviations of actual from predicted states indicating changed action costs or outcomes. This information is used to learn and update stimulus and action values, guide action selection, and recruit adaptive mechanisms that compensate errors and optimize goal achievement.
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Abstract
Anxiety disorders are highly prevalent and debilitating psychiatric disorders. Owing to the complex aetiology of anxiety disorders, translational studies involving multiple approaches, including human and animal genetics, molecular, endocrinological and imaging studies, are needed to get a converging picture of function or dysfunction of anxiety-related circuits. An advantage of anxiety disorders is that the neural circuitry of fear is comparatively well understood, with striking analogies between animal and human models, and this article aims to provide a brief overview of current translational approaches to anxiety. Experimental models that involve similar tasks in animals and humans, such as fear conditioning and extinction, seem particularly promising and can be readily integrated with imaging, behavioural and physiological readouts. The cross-validation between animal and human genetics models is essential to examine the relevance of candidate genes, as well as their neural pathways, for anxiety disorders; a recent example of such cross-validation work is provided by preclinical and clinical work on TMEM132D, which has been identified as a candidate gene for panic disorder. Further integration of epigenetic data and gene × environment interaction are promising approaches, as highlighted by FKPB5 and PACAP, early life trauma and stress-related anxiety disorders. Finally, connecting genetic and epigenetic data with functionally relevant imaging readouts will allow a comparison of overlap and differences across species in mechanistic pathways from genes to brain functioning and behaviour.
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Andersson E, Rück C, Lavebratt C, Hedman E, Schalling M, Lindefors N, Eriksson E, Carlbring P, Andersson G, Furmark T. Genetic polymorphisms in monoamine systems and outcome of cognitive behavior therapy for social anxiety disorder. PLoS One 2013; 8:e79015. [PMID: 24260145 PMCID: PMC3829855 DOI: 10.1371/journal.pone.0079015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 09/18/2013] [Indexed: 11/29/2022] Open
Abstract
Objective The role of genetics for predicting the response to cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has only been studied in one previous investigation. The serotonin transporter (5-HTTLPR), the catechol-o-methyltransferase (COMT) val158met, and the tryptophan hydroxylase-2 (TPH2) G-703Tpolymorphisms are implicated in the regulation of amygdala reactivity and fear extinction and therefore might be of relevance for CBT outcome. The aim of the present study was to investigate if these three gene variants predicted response to CBT in a large sample of SAD patients. Method Participants were recruited from two separate randomized controlled CBT trials (trial 1: n = 112, trial 2: n = 202). Genotyping were performed on DNA extracted from blood or saliva samples. Effects were analyzed at follow-up (6 or 12 months after treatment) for both groups and for each group separately at post-treatment. The main outcome measure was the Liebowitz Social Anxiety Scale Self-Report. Results At long-term follow-up, there was no effect of any genotype, or gene × gene interactions, on treatment response. In the subsamples, there was time by genotype interaction effects indicating an influence of the TPH2 G-703T-polymorphism on CBT short-term response, however the direction of the effect was not consistent across trials. Conclusions None of the three gene variants, 5-HTTLPR, COMTval158met and TPH2 G-703T, was associated with long-term response to CBT for SAD. Trial Registration ClinicalTrials.gov (ID-NCT0056496)
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Affiliation(s)
- Evelyn Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Catharina Lavebratt
- Department of Molecular Medicine, Center for Molecular Medicine Neurogenetics Unit, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine & Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine, Center for Molecular Medicine Neurogenetics Unit, Karolinska Institutet, Stockholm, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Elias Eriksson
- Department of Pharmacology, Institute of Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Behavior Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Hartley CA, Casey BJ. Risk for anxiety and implications for treatment: developmental, environmental, and genetic factors governing fear regulation. Ann N Y Acad Sci 2013; 1304:1-13. [PMID: 24147742 DOI: 10.1111/nyas.12287] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anxiety disorders are the most common psychiatric disorders, affecting as many as 10% of youth, with diagnoses peaking during adolescence. A core component of these disorders is an unremitting fear in the absence of present threat. One of the most commonly used therapies to treat these disorders is exposure-based cognitive behavioral therapy that identifies the source of the fear and anxiety and then desensitizes the individual to it. This treatment builds on basic principles of fear-extinction learning. A number of patients improve with this therapy, but 40-50% do not. This paper provides an overview of recent empirical studies employing both human imaging and cross-species behavioral genetics to examine how fear regulation varies across individuals and across development, especially during adolescence. These studies have important implications for understanding who may be at risk for anxiety disorders and for whom and when during development exposure-based therapies may be most effective.
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Affiliation(s)
- Catherine A Hartley
- Department of Psychiatry, Sackler Institute for Developmental Psychobiology, Weill Cornell Medical College, New York, New York
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Lester KJ, Eley TC. Therapygenetics: Using genetic markers to predict response to psychological treatment for mood and anxiety disorders. BIOLOGY OF MOOD & ANXIETY DISORDERS 2013; 3:4. [PMID: 23388219 PMCID: PMC3575379 DOI: 10.1186/2045-5380-3-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/07/2012] [Indexed: 02/08/2023]
Abstract
Considerable variation is evident in response to psychological therapies for mood and anxiety disorders. Genetic factors alongside environmental variables and gene-environment interactions are implicated in the etiology of these disorders and it is plausible that these same factors may also be important in predicting individual differences in response to psychological treatment. In this article, we review the evidence that genetic variation influences psychological treatment outcomes with a primary focus on mood and anxiety disorders. Unlike most past work, which has considered prediction of response to pharmacotherapy, this article reviews recent work in the field of therapygenetics, namely the role of genes in predicting psychological treatment response. As this is a field in its infancy, methodological recommendations are made and opportunities for future research are identified.
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Affiliation(s)
- Kathryn J Lester
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Thalia C Eley
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
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Abstract
Fear memory persistence, central for the development and maintenance of anxiety disorders, is partially genetically controlled. Recently, consolidation and reconsolidation processes have been reported to affect fear memory stability and integrity. This study explored the impact of reconsolidation processes and genetic make-up on fear reacquisition by manipulating reconsolidation, using extinction performed outside or inside a reconsolidation interval. Reacquisition measured by skin conductance responses was stronger in individuals that extinguished outside (6 h) than inside (10 min) the reconsolidation interval. However, the effect was predominantly present in val/val homozygotes of the functional val158met polymorphism of the catechol O-methyltransferase (COMT) enzyme and in short-allele carriers of the serotonin-transporter length 5-HTTLPR polymorphism. These results demonstrate that reconsolidation of human fear memory is influenced by dopamine and serotonin-related genes.
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Sakaki M, Mather M. How reward and emotional stimuli induce different reactions across the menstrual cycle. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2012; 6:1-17. [PMID: 22737180 DOI: 10.1111/j.1751-9004.2011.00415.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite widespread belief that moods are affected by the menstrual cycle, researchers on emotion and reward have not paid much attention to the menstrual cycle until recently. However, recent research has revealed different reactions to emotional stimuli and to rewarding stimuli across the different phases of the menstrual cycle. The current paper reviews the emerging literature on how ovarian hormone fluctuation during the menstrual cycle modulates reactions to emotional stimuli and to reward. Behavioral and neuroimaging studies in humans suggest that estrogen and progesterone have opposing influences. That is, it appears that estrogen enhances reactions to reward, but progesterone counters the facilitative effects of estrogen and decreases reactions to rewards. In contrast, reactions to emotionally arousing stimuli (particularly negative stimuli) appear to be decreased by estrogen but enhanced by progesterone. Potential factors that can modulate the effects of the ovarian hormones (e.g., an inverse quadratic function of hormones' effects; the structural changes of the hippocampus across the menstrual cycle) are also discussed.
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A review on experimental and clinical genetic associations studies on fear conditioning, extinction and cognitive-behavioral treatment. Transl Psychiatry 2011; 1:e41. [PMID: 22832657 PMCID: PMC3309482 DOI: 10.1038/tp.2011.36] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Fear conditioning and extinction represent basic forms of associative learning with considerable clinical relevance and have been implicated in the pathogenesis of anxiety disorders. There is considerable inter-individual variation in the ability to acquire and extinguish conditioned fear reactions and the study of genetic variants has recently become a focus of research. In this review, we give an overview of the existing genetic association studies on human fear conditioning and extinction in healthy individuals and of related studies on cognitive-behavioral treatment (CBT) and exposure, as well as pathology development after trauma. Variation in the serotonin transporter (5HTT) and the catechol-o-methyltransferase (COMT) genes has consistently been associated with effects in pre-clinical and clinical studies. Interesting new findings, which however require further replication, have been reported for genetic variation in the dopamine transporter (DAT1) and the pituitary adenylate cyclase 1 receptor (ADCYAP1R1) genes, whereas the current picture is inconsistent for variation in the brain-derived neurotrophic factor (BDNF) gene. We end with a discussion of the findings and their limitations, as well as future directions that we hope will aid the field to develop further.
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