Reducing avoidance in adults with high spider fear using perceptual discrimination training

Fear generalization predicts post-traumatic stress symptoms: A two-year follow-up study in Dutch fire fighters

INTRODUCTION

Excessive fear generalization has been associated with pathological anxiety, including posttraumatic stress disorder (PTSD). However, studies investigating the longitudinal relationship between generalization and the development of anxiety symptomatology are scarce. This study aims to test the predictive value of fear generalization for PTSD symptoms in a high-risk profession sample and to explore the relationship between generalization and neuroticism, which are both linked to PTSD.

METHOD

Longitudinal data from a multi-wave study in 529 Dutch fire-fighters were used. Fear generalization, PTSD symptoms and neuroticism were assessed at baseline. PTSD symptoms were reevaluated at six, 12, 18, and 24 months. Generalization was assessed in a differential conditioning paradigm by measuring expectancies of an aversive outcome when presented with stimuli similar to previously conditioned stimuli.

RESULTS

Higher expectancy ratings towards stimuli most similar to safety signals predicted PTSD symptoms at follow-up after controlling for baseline PTSD symptoms, whereas higher expectancy ratings towards stimuli most similar to danger signals was associated with neuroticism. Neuroticism weakened the predictive power of fear generalization when considered simultaneously.

DISCUSSION

These findings suggest that heightened fear generalization is associated with the development of anxiety and trauma-related symptoms. Targeting problematic fear generalization may be a promising intervention approach.

Spider vs. guns: expectancy and attention biases to phylogenetic threat do not extend to ontogenetic threat

Introduction

Attention bias plays an important role in specific fears and phobias. Previous studies revealed that a-priori expectancies affect attention toward neutral stimuli but not threatening stimuli. The aim of the current study was to test whether this selective influence of expectancies on attention is specific to phylogenetic threat (i.e., spiders) or whether it can be generalized to ontogenetic threat (i.e., guns). Correspondingly, we directly compared expectancy effects on attentional allocation to phylogenetically vs. ontogenetically threatening stimuli.

Method

Expectancies were manipulated by presenting a cue indicating the likelihood of the appearance of a deviant picture in a visual search array. The array included eight distractors and one neutral (phone/bird) or threatening (gun/spider) deviant picture. In a comprehensive design, we examined the effects of stimulus type (phylogenetic/ontogenetic) and visual background (white and sterile/complex and ecological). Individual differences such as intolerance of uncertainty and spider fear were also measured.

Results

Results showed that attention bias toward spiders does not extend to threatening ontogenetic stimuli (i.e., guns). Our previous findings on attention bias toward spiders were replicated and a small to medium positive correlation was found between reaction time to bird targets and pre-existing fear of spider levels. Cues were used to detect threatening as well as neutral targets on both background types, except for spider targets on a complex background, replicating previous results. A small to medium positive correlation was also found between fear of spiders and intolerance of uncertainty.

Discussion

Together, these results suggest that expectancy and attentional processes may differ between ontogenetic and phylogenetic threat. Importantly, the effects of expectancy on attentional allocation depend on an interaction between the type of threat (ontogenetic/phylogenetic), visual factors, and individual differences.

Know Your Movements: Poorer Proprioceptive Accuracy is Associated With Overprotective Avoidance Behavior

Pain-related avoidance of movements that are actually safe (ie, overprotective behavior) plays a key role in chronic pain disability. Avoidance is reinforced through operant learning: after learning that a certain movement elicits pain, movements that prevent pain are more likely to be performed. Proprioceptive accuracy importantly contributes to motor learning and memory. Interestingly, reduced accuracy has been documented in various chronic pain conditions, prompting the question whether this relates to avoidance becoming excessive. Using robotic arm-reaching movements, we tested the hypothesis that poor proprioceptive accuracy is associated with excessive pain-related avoidance in pain-free participants. Participants first performed a task to assess proprioceptive accuracy, followed by an operant avoidance training during which a pain stimulus was presented when they performed one movement trajectory, but not when they performed another trajectory. During a test phase, movements were no longer restricted to 2 trajectories, but participants were instructed to avoid pain. Unbeknownst to the participants, the pain stimulus was never presented during this phase. Results supported our hypothesis. Furthermore, exploratory analyses indicated a reduction in proprioceptive accuracy after avoidance learning, which was associated with excessive avoidance and higher trait fear of pain. PERSPECTIVE: This study is the first to show that poorer proprioceptive accuracy is associated with excessive pain-related avoidance. This finding is especially relevant for chronic pain conditions, as reduced accuracy has been documented in these populations, and points toward the need for research on training accuracy to tackle excessive avoidance.

Reducing attention bias in spider fear by manipulating expectancies

The present series of studies examines the causal interaction between expectancy and attention biases in spider fear. Previous studies found that a-priori expectancy does not affect attention bias toward spiders, as measured by detection of spider targets in a subsequent visual search array compared to detection of bird targets (i.e. neutral targets) that appeared equally often. In the present series of studies, target frequency was manipulated. Targets were preceded by a verbal cue stating the likelihood that a certain target would appear. The aim was to examine whether manipulation of expectancies toward either target affects attention bias. In Experiment 1, birds appeared more frequently than spiders. Among a representative sample of the student population, attention bias toward spiders was significantly reduced. Experiment 2 replicated these results with both low- and high-fearful participants. In Experiment 3, spiders appeared more frequently than birds. Attention bias was reduced among low- and high-fearful groups, but not as strongly as the reduction in Experiments 1 and 2. These results suggest that target salience plays a role in attention bias, in competition with expectancy. To our knowledge, this is the first study to show that varying expectancy can reduce attention bias, most importantly in high fear.