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Woelk M, Hagenaars MA, Raes F, Vervliet B, Krans J. Imagery rescripting and extinction: Effects on US expectancy, US revaluation, and the generalization of fear reduction. Behav Res Ther 2024; 178:104544. [PMID: 38704975 DOI: 10.1016/j.brat.2024.104544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/25/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
Exposure therapy consists of exposing patients to their fears and thereby diminishing their harm expectancies (i.e., extinction or expectancy learning). Although effective for many anxiety patients, its long-term success depends on the generalization of these harm expectancies to other stimuli. However, research shows that this generalization of extinction is limited. Besides decreasing harm expectancies, fear reduction may also be achieved by changing the meaning of an aversive memory representation (US revaluation). Imagery rescripting (ImRs) may be more successful in generalizing fear reduction because it allegedly works through US revaluation. The current experiment aimed to test working mechanisms for ImRs and extinction (revaluation and expectancy learning, respectively), and to examine generalization of fear reduction. In a fear conditioning paradigm, 113 healthy participants watched an aversive film clip that was used as the US. The manipulation consisted of imagining a script with a positive ending to the film clip (ImRs-only), extinction (extinction-only), or both (ImRs + extinction). Results showed enhanced US revaluation in ImRs + extinction. US expectancy decreased more strongly in the extinction conditions. Generalization of fear reduction was found in all conditions. Our results suggest different working mechanisms for ImRs and exposure. Future research should replicate this in (sub)clinical samples.
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Affiliation(s)
- M Woelk
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Tiensestraat 102 box 3712, 3000, Leuven, Belgium; Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584, CS Utrecht, the Netherlands.
| | - M A Hagenaars
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584, CS Utrecht, the Netherlands
| | - F Raes
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Tiensestraat 102 box 3712, 3000, Leuven, Belgium
| | - B Vervliet
- Research Unit Brain and Cognition, KU Leuven, Tiensestraat 102 box 3717, 3000, Leuven, Belgium
| | - J Krans
- Research Unit Behaviour, Health, and Psychopathology, KU Leuven, Tiensestraat 102 box 3712, 3000, Leuven, Belgium; Pro Persona Overwaal Centre for Anxiety, OCD, and PTSD, Pastoor van Laakstraat 48, 6663, CB Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525, GD Nijmegen, the Netherlands
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Gatzounis R, Gelissen A, Theuerzeit D, Meulders A. Rewarding Approach Behaviour Attenuates the Return of Pain-Related Avoidance After Successful Extinction with Response Prevention. THE JOURNAL OF PAIN 2024; 25:104453. [PMID: 38145858 DOI: 10.1016/j.jpain.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
After successful exposure treatment for chronic pain, pain-related fear and avoidance may return, i.e., relapse may occur. This return of fear and avoidance may be modulated by various post-treatment factors. In this study, we aimed to investigate two potential factors that may affect return of fear and avoidance, i.e. cognitive load and rewarding approach behaviour. In an operant pain-related avoidance conditioning paradigm, healthy pain-free volunteers first learned to fear and avoid an arm-reaching movement that was often paired with painful electrocutaneous stimulation (T1), by performing alternative movements that were less often (T2) or never (T3) paired with pain. During extinction with response prevention, participants were only allowed to perform T1, and pain was omitted. To model relapse, two unexpected painful stimuli were presented (i.e., reinstatement manipulation), after which participants could freely choose among the three arm-reaching movements again. During test, the Low Load group performed an additional easy digit task, whereas the High Load group performed a more cognitively demanding digit task. The Reward group performed the demanding digit task, whilst being rewarded to perform T1. Results showed that pain-related fear and avoidance returned, irrespective of cognitive load imposed. When participants were rewarded to approach T1, however, the return of avoidance, but not fear, was attenuated. Our findings suggest that engaging in rewarding activities may facilitate the maintenance of treatment outcomes, and provide additional support to the growing body of literature indicating a divergent relationship between fear and avoidance. PERSPECTIVE: Results of this experiment suggest that engaging in rewarding activities may optimize exposure treatment for chronic pain, by dampening the return of pain-related avoidance - though not of pain-related fear - after extinction.
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Affiliation(s)
- Rena Gatzounis
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anouk Gelissen
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Daniëlla Theuerzeit
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, the Netherlands; Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Belgium.
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Luyten L, Chalkia A, Schnell AE, Özcan B, Leng L, Schroyens N, Van Oudenhove L, Vanpaemel W, Beckers T. No harmful effect of propranolol administered prior to fear memory extinction in rats and humans. J Anxiety Disord 2024; 104:102870. [PMID: 38733644 PMCID: PMC7615999 DOI: 10.1016/j.janxdis.2024.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Exposure therapy is an evidence-based treatment option for anxiety-related disorders. Many patients also take medication that could, in principle, affect exposure therapy efficacy. Clinical and laboratory evidence indeed suggests that benzodiazepines may have detrimental effects. Large clinical trials with propranolol, a common beta-blocker, are currently lacking, but several preclinical studies do indicate impaired establishment of safety memories. Here, we investigated the effects of propranolol given prior to extinction training in 9 rat studies (N = 215) and one human study (N = 72). A Bayesian meta-analysis of our rat studies provided strong evidence against propranolol-induced extinction memory impairment during a drug-free test, and the human study found no significant difference with placebo. Two of the rat studies actually suggested a small beneficial effect of propranolol. Lastly, two rat studies with a benzodiazepine (midazolam) group provided some evidence for a harmful effect on extinction memory, i.e., impaired extinction retention. In conclusion, our midazolam findings are in line with prior literature (i.e., an extinction retention impairment), but this is not the case for the 10 studies with propranolol. Our data thus support caution regarding the use of benzodiazepines during exposure therapy, but argue against a harmful effect of propranolol on extinction learning.
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Affiliation(s)
- Laura Luyten
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| | - Anastasia Chalkia
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Anna Elisabeth Schnell
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Burcu Özcan
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lu Leng
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Natalie Schroyens
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Translational Research in Gastro-Intestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Wolf Vanpaemel
- Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Tom Beckers
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
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Lommen MJJ, Hoekstra S, van den Brink RHS, Lenaert B. Fear generalization predicts post-traumatic stress symptoms: A two-year follow-up study in Dutch fire fighters. J Anxiety Disord 2024; 103:102855. [PMID: 38484507 DOI: 10.1016/j.janxdis.2024.102855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 01/20/2024] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Abstract
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.
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Affiliation(s)
- Miriam J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
| | | | - Rob H S van den Brink
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert Lenaert
- Department of Life Span Psychology, Faculty of Psychology, Open University, Heerlen, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Klein Z, Shner-Livne G, Danon-Kraun S, Ginat-Frolich R, Pine DS, Shechner T. Enhanced late positive potential to conditioned threat cue during delayed extinction in anxious youth. J Child Psychol Psychiatry 2024; 65:215-228. [PMID: 37157184 DOI: 10.1111/jcpp.13814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Deficits in threat learning relate to anxiety symptoms. Since several anxiety disorders arise in adolescence, impaired adolescent threat learning could contribute to adolescent changes in risk for anxiety. This study compared threat learning among anxious and non-anxious youth using self-reports, peripheral psychophysiology measures, and event-related potentials. Because exposure therapy, the first-line treatment for anxiety disorders, is largely based on principles of extinction learning, the study also examined the link between extinction learning and treatment outcomes among anxious youth. METHODS Clinically anxious (n = 28) and non-anxious (n = 33) youth completed differential threat acquisition and immediate extinction. They returned to the lab a week later to complete a threat generalization test and a delayed extinction task. Following these two experimental visits, anxious youth received exposure therapy for 12 weeks. RESULTS Anxious as compared to non-anxious youth demonstrated elevated cognitive and physiological responses across acquisition and immediate extinction learning, as well as greater threat generalization. In addition, anxious youth showed enhanced late positive potential response to the conditioned threat cue compared to the safety cue during delayed extinction. Finally, aberrant neural response during delayed extinction was associated with poorer treatment outcomes. CONCLUSIONS The study emphasizes differences between anxious and non-anxious youth in threat learning processes and provides preliminary support for a link between neural processing during delayed extinction and exposure-based treatment outcome in pediatric anxiety.
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Affiliation(s)
- Zohar Klein
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Gil Shner-Livne
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Shani Danon-Kraun
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Rivkah Ginat-Frolich
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Daniel S Pine
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Tomer Shechner
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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Roesmann K, Leehr EJ, Böhnlein J, Gathmann B, Herrmann MJ, Junghöfer M, Schwarzmeier H, Seeger FR, Siminski N, Straube T, Dannlowski U, Lueken U. Mechanisms of action underlying virtual reality exposure treatment in spider phobia: Pivotal role of within-session fear reduction. J Anxiety Disord 2023; 100:102790. [PMID: 37879242 DOI: 10.1016/j.janxdis.2023.102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
Although virtual-reality exposure treatment (VRET) for anxiety disorders is an efficient treatment option for specific phobia, mechanisms of action for immediate and sustained treatment response need to be elucidated. Towards this aim, core therapy process variables were assessed as predictors for short- and long-term VR treatment outcomes. In a bi-centric study, n = 186 patients with spider phobia completed a baseline-assessment, a one-session VRET, a post-therapy assessment, and a 6-month-follow-up assessment (ClinicalTrials.gov, ID: NCT03208400). Short- and long-term outcomes regarding self-reported symptoms in the spider phobia questionnaire (SPQ) and final patient-spider distance in the behavioral avoidance test (BAT) were predicted via logistic regression models with the corresponding baseline score, age, initial fear activation, within-session fear reduction and fear expectancy violation as predictors. To predict long-term remission status at 6-month-follow-up, dimensional short-term changes in the SPQ and BAT were additionally included. Higher within-session fear reductions predicted better treatment outcomes (long-term SPQ; short- and long-term BAT). Lower initial fear activation tended to be associated with better long-term outcomes (SPQ), while fear expectancy violation was not associated with any outcome measure. Short-term change in the SPQ predicted remission status. Findings highlight that in VRET for spider phobia, the experience of fear reduction is central for short- and long-term treatment success and should be focused by therapists.
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Affiliation(s)
- Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany; Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Psychology, Unit for Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany.
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Brouillard A, Davignon LM, Turcotte AM, Marin MF. Morphologic alterations of the fear circuitry: the role of sex hormones and oral contraceptives. Front Endocrinol (Lausanne) 2023; 14:1228504. [PMID: 38027091 PMCID: PMC10661904 DOI: 10.3389/fendo.2023.1228504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background Endogenous sex hormones and oral contraceptives (OCs) have been shown to influence key regions implicated in fear processing. While OC use has been found to impact brain morphology, methodological challenges remain to be addressed, such as avoiding selection bias between OC users and non-users, as well as examining potential lasting effects of OC intake. Objective We investigated the current and lasting effects of OC use, as well as the interplay between the current hormonal milieu and history of hormonal contraception use on structural correlates of the fear circuitry. We also examined the role of endogenous and exogenous sex hormones within this network. Methods We recruited healthy adults aged 23-35 who identified as women currently using (n = 62) or having used (n = 37) solely combined OCs, women who never used any hormonal contraceptives (n = 40), or men (n = 41). Salivary endogenous sex hormones and current users' salivary ethinyl estradiol (EE) were assessed using liquid chromatography - tandem mass spectrometry. Using structural magnetic resonance imaging, we extracted surface-based gray matter volumes (GMVs) and cortical thickness (CT) for regions of interest of the fear circuitry. Exploratory whole-brain analyses were conducted with surface-based and voxel-based morphometry methods. Results Compared to men, all three groups of women exhibited a larger GMV of the dorsal anterior cingulate cortex, while only current users showed a thinner ventromedial prefrontal cortex. Irrespective of the menstrual cycle phase, never users exhibited a thicker right anterior insular cortex than past users. While associations with endogenous sex hormones remain unclear, we showed that EE dosage in current users had a greater influence on brain anatomy compared to salivary EE levels and progestin androgenicity, with lower doses being associated with smaller cortical GMVs. Discussion Our results highlight a sex difference for the dorsal anterior cingulate cortex GMV (a fear-promoting region), as well as a reduced CT of the ventromedial prefrontal cortex (a fear-inhibiting region) specific to current OC use. Precisely, this finding was driven by lower EE doses. These findings may represent structural vulnerabilities to anxiety and stress-related disorders. We showed little evidence of durable anatomical effects, suggesting that OC intake can (reversibly) affect fear-related brain morphology.
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Affiliation(s)
- Alexandra Brouillard
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | - Lisa-Marie Davignon
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | | | - Marie-France Marin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
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Boddez Y, Scheveneels S, Van Dessel P. Let's play pretend: Towards effective modelling in experimental psycho(patho)logy. J Behav Ther Exp Psychiatry 2023; 80:101809. [PMID: 37247975 DOI: 10.1016/j.jbtep.2022.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/12/2022] [Accepted: 11/12/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Models are omnipresent in science. We introduce a novel framework to achieve more effective modelling practices in general psychology and experimental psychopathology. METHOD We analyze three types of models that are common in psychology: laboratory models, computational models, and cognitive models. We then evaluate two common ways to assess the translational value of models (phenomenological similarity and deep similarity) as well as an arguably underappreciated way (functional similarity). Functional similarity is based on an assessment of whether variables (e.g., the administration of a pharmacological substance) have a similar effect (a) in the model (e.g., in a fear conditioning procedure) and (b) on the real-life target phenomenon (e.g., on real-life anxiety complaints). CONCLUSIONS We argue that the assessment of functional similarity is a powerful tool to assess the translational value of models in the field of experimental psychopathology and beyond.
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Affiliation(s)
- Yannick Boddez
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.
| | - Sara Scheveneels
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands; Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | - Pieter Van Dessel
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
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Waters AM, Ryan KM, Luck CC, Craske MG, Lipp OV. Approximating exposure therapy in the lab: Replacing the CS+ with a similar versus a different stimulus and including additional stimuli resembling the CS+ during extinction. Behav Res Ther 2023; 167:104357. [PMID: 37364363 DOI: 10.1016/j.brat.2023.104357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
Recent studies have shown that extinction training including the conditional stimulus (CS+) and stimuli that are similar to the CS + enhances extinction retention and generalisation to novel stimuli. However, in a clinical setting, the CS+ is rarely available for use during exposure therapy. The aim of the present study was to determine if replacing the CS+ with a similar versus different stimulus, and including other similar stimuli during extinction, could reduce fear at test on par with extinction using the original CS+ with and without other similar stimuli. In an experiment conducted in a single session, participants completed a habituation phase followed by an acquisition phase using two dog images presented with (CS+) and without (CS-) an acoustic unconditional stimulus (US). Participants were randomly allocated to four extinction conditions: similar CS + dog with novel dog images (Similar replacement extinction condition); different CS + dog with novel dog images (Different replacement extinction condition); original CS + dog with novel dog images (Multiple extinction control condition); and original CS + without novel dog images (Standard extinction control condition). All participants completed a test phase with the original CSs followed by a generalisation test with another two novel dog images. All groups acquired, and then extinguished differential skin conductance responses (SCRs) with no differences observed between groups. Whereas the Similar replacement extinction group and the Multiple and Standard extinction control groups did not exhibit significant differential SCRs when re-exposed to the original CS + relative to the CS- at test, differential responding to the CSs was significant at test in the Different replacement extinction group. There were no significant differences between groups in SCRs to the two novel dog images during the generalisation phase and in between-phase subjective ratings. Findings suggest that replacement stimuli used during extinction should be as similar as possible to the CS + to reduce physiological arousal to the original CS+.
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Affiliation(s)
| | | | | | - Michelle G Craske
- Department of Psychology & Department of Psychiatry & Biobehavioral Sciences, UCLA, United States
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Australia
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10
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Modecki KL, Ryan KM, Waters AM. Fear learning and extinction predicts anxiety in daily life: a study of Pavlovian conditioning and ecological momentary assessment. Psychol Med 2023; 53:5301-5311. [PMID: 36093766 PMCID: PMC10476067 DOI: 10.1017/s0033291722002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/07/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The association between anxious mood and aberrant fear learning mechanisms has not been fully elucidated. Studying how fear conditioning and extinction constructs relate to anxiety symptoms and reactivity to stressful and benign moments in everyday life provides a powerful addition to experimental paradigms. METHOD Fifty-one young adults completed laboratory-based differential conditioning and extinction tasks with (CS + ) and without (CS-) an aversive unconditional stimulus (US). Electrodermal skin conductance responses were measured during each phase, followed by ecological momentary assessment (EMA) tapping anxiety and stressors six times daily for seven days (2, 142 moments). RESULTS Conditioned electrodermal reactivity to the CS + and overgeneralisation to the CS- were associated with greater change in anxiety (measured via EMA), across non-stressful situations, remaining the same across stressful situations. Likewise, during extinction when the CS + is now safe, more electrodermal reactivity to the CS + was associated with more anxiety change across non-stressful situations and remained the same across stressful situations. Also, during extinction when threat is absent, more electrodermal reactivity at the late stage of the CS- was associated with less momentary anxiety change in response to stressful situations; more electrodermal activity at the late stage of the CS + was associated with more anxiety change across non-stressful situations and remained the same across stressful situations. CONCLUSIONS Sampling 'in vivo' emotion and stress experiences, study findings revealed links between conditioned electrodermal reactivity and overgeneralisation to safe stimuli and heightened anxious reactivity during non-stressful (i.e. safe) moments in daily life, coupled with less change in response to actual stressors.
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Affiliation(s)
- Kathryn L. Modecki
- Menzies Health Institute Queensland; Centre for Mental Health, School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Katherine M. Ryan
- School of Applied Psychology Griffith University Mt Gravatt, Queensland, Australia
| | - Allison M. Waters
- Centre for Mental Health; School of Applied Psychology Griffith University Mt Gravatt, Queensland, Australia
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Ney LJ, Akosile W, Davey C, Pitcher L, Felmingham KL, Mayo LM, Hill MN, Strodl E. Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician's perspective. Expert Rev Clin Pharmacol 2023; 16:1093-1108. [PMID: 37885234 DOI: 10.1080/17512433.2023.2276309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward. AREAS COVERED In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy. EXPERT OPINION Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes.
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Affiliation(s)
- Luke J Ney
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Wole Akosile
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Davey
- Department of Psychiatry, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | | | - Kim L Felmingham
- School of Psychological Sciences, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Leah M Mayo
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Matthew N Hill
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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12
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Dewitte M, Meulders A. Fear Learning in Genital Pain: Toward a Biopsychosocial, Ecologically Valid Research and Treatment Model. JOURNAL OF SEX RESEARCH 2023; 60:768-785. [PMID: 36648251 DOI: 10.1080/00224499.2022.2164242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Although fear learning mechanisms are implicated in the development, maintenance, exacerbation, and reduction of genital pain, systematic research on how fear of genital pain emerges, spreads, persists, and reemerges after treatment is lacking. This paper provides an overview of the literature on pain-related fear, integrates the ideas on learning and sexual arousal responding, and specifies the pathways through which compromised learning may contribute to the development and persistence of genital pain. In order to refine theories of genital pain and optimize treatments, we need to adopt a biopsychosocial framework to pain-related fear learning and uncover potential moderators that shape individual trajectories. This involves examining the role of physiological processes, subjective experiences, as well as partner and relational cues in fear acquisition, excessive generalization and impaired safety learning, extinction of fear, counterconditioning, and return of fear. Recent methodological advances in fear conditioning and sex research are promising to enable more symptom-specific and ecologically valid experimental paradigms.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University
| | - Ann Meulders
- Department of Clinical Psychological Science, Maastricht University
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13
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Bach DR, Sporrer J, Abend R, Beckers T, Dunsmoor JE, Fullana MA, Gamer M, Gee DG, Hamm A, Hartley CA, Herringa RJ, Jovanovic T, Kalisch R, Knight DC, Lissek S, Lonsdorf TB, Merz CJ, Milad M, Morriss J, Phelps EA, Pine DS, Olsson A, van Reekum CM, Schiller D. Consensus design of a calibration experiment for human fear conditioning. Neurosci Biobehav Rev 2023; 148:105146. [PMID: 36990370 PMCID: PMC10618407 DOI: 10.1016/j.neubiorev.2023.105146] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Fear conditioning is a widely used laboratory model to investigate learning, memory, and psychopathology across species. The quantification of learning in this paradigm is heterogeneous in humans and psychometric properties of different quantification methods can be difficult to establish. To overcome this obstacle, calibration is a standard metrological procedure in which well-defined values of a latent variable are generated in an established experimental paradigm. These intended values then serve as validity criterion to rank methods. Here, we develop a calibration protocol for human fear conditioning. Based on a literature review, series of workshops, and survey of N = 96 experts, we propose a calibration experiment and settings for 25 design variables to calibrate the measurement of fear conditioning. Design variables were chosen to be as theory-free as possible and allow wide applicability in different experimental contexts. Besides establishing a specific calibration procedure, the general calibration process we outline may serve as a blueprint for calibration efforts in other subfields of behavioral neuroscience that need measurement refinement.
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Affiliation(s)
- Dominik R Bach
- Wellcome Centre for Human Neuroimaging and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, United Kingdom; Hertz Chair for Artificial Intelligence and Neuroscience, Transdisciplinary Research Area "Life & Health", University of Bonn, Germany.
| | - Juliana Sporrer
- Wellcome Centre for Human Neuroimaging and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, United Kingdom
| | - Rany Abend
- National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA
| | - Tom Beckers
- KU Leuven, Faculty of Psychology and Educational Sciences/Leuven Brain Institute, Leuven, Belgium
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, USA
| | - Miquel A Fullana
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, & Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona, Spain
| | - Matthias Gamer
- Julius-Maximilians-University of Würzburg, Department of Psychology, Würzburg, Germany
| | - Dylan G Gee
- Yale University, Department of Psychology, New Haven, CT, USA
| | - Alfons Hamm
- Department of Psychology, University of Greifswald, Germany
| | | | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine & Public Health, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Raffael Kalisch
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany; and Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - David C Knight
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA
| | - Shmuel Lissek
- Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Tina B Lonsdorf
- University Medical Center Hamburg-Eppendorf, Institute of Systems Neuroscience, Hamburg, Germany
| | - Christian J Merz
- Ruhr University Bochum, Faculty of Psychology, Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Bochum, Germany
| | - Mohammed Milad
- Department of Psychiatry and Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA; The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Jayne Morriss
- School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom
| | - Elizabeth A Phelps
- Department of Psychology, Harvard University, 52 Oxford St., Cambridge, MA, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA
| | - Andreas Olsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom
| | - Daniela Schiller
- Friedman Brain Institute, Department of Neuroscience, Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
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14
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Ginat-Frolich R, Kara-Ivanov A, Strauss AY, Myers A, Huppert JD. Mechanisms underlying interoceptive exposure: belief disconfirmation or extinction? A preliminary study. Cogn Behav Ther 2023; 52:132-145. [PMID: 36217830 DOI: 10.1080/16506073.2022.2109511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Interoceptive exposure, or exposure to one's feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in a lab-based, analog study with individuals high in AS. Participants (n = 59) were randomized into three groups: a cognitive-behavioral intervention emphasizing belief disconfirmation (CbI), a behavioral intervention emphasizing exposure (BI), and a control condition. Self-report measures assessing AS, catastrophizing of bodily sensations, and subjective units of distress (SUDS) were collected before, during and after the intervention. Participants also completed online questionnaires at a one-month follow-up. Following the CbI but not BI, a decrease was observed in both AS and catastrophizing interpretations. Furthermore, only the CbI group exhibited a decrease in SUDS ratings, whereas the BI group exhibited a significant increase. Notably, these effects were not maintained at a one-month follow-up. Findings suggest that cognitive interventions without repeated behavioral exposure may be sufficient in reducing self-reported anxiety-related symptoms and catastrophic misinterpretations, though not at maintaining them. This raises questions regarding the role of pure behavioral mechanisms in exposure.
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Affiliation(s)
| | - Anna Kara-Ivanov
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayelet Myers
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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15
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Beckers T, Hermans D, Lange I, Luyten L, Scheveneels S, Vervliet B. Understanding clinical fear and anxiety through the lens of human fear conditioning. NATURE REVIEWS PSYCHOLOGY 2023; 2:233-245. [PMID: 36811021 PMCID: PMC9933844 DOI: 10.1038/s44159-023-00156-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
Fear is an adaptive emotion that mobilizes defensive resources upon confrontation with danger. However, fear becomes maladaptive and can give rise to the development of clinical anxiety when it exceeds the degree of threat, generalizes broadly across stimuli and contexts, persists after the danger is gone or promotes excessive avoidance behaviour. Pavlovian fear conditioning has been the prime research instrument that has led to substantial progress in understanding the multi-faceted psychological and neurobiological mechanisms of fear in past decades. In this Perspective, we suggest that fruitful use of Pavlovian fear conditioning as a laboratory model of clinical anxiety requires moving beyond the study of fear acquisition to associated fear conditioning phenomena: fear extinction, generalization of conditioned fear and fearful avoidance. Understanding individual differences in each of these phenomena, not only in isolation but also in how they interact, will further strengthen the external validity of the fear conditioning model as a tool with which to study maladaptive fear as it manifests in clinical anxiety.
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Affiliation(s)
- Tom Beckers
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Dirk Hermans
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Iris Lange
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Laura Luyten
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Sara Scheveneels
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Bram Vervliet
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
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16
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Purves KL, Krebs G, McGregor T, Constantinou E, Lester KJ, Barry TJ, Craske MG, Young KS, Breen G, Eley TC. Evidence for distinct genetic and environmental influences on fear acquisition and extinction. Psychol Med 2023; 53:1106-1114. [PMID: 34474701 PMCID: PMC9975999 DOI: 10.1017/s0033291721002580] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent with an early age of onset. Understanding the aetiology of disorder emergence and recovery is important for establishing preventative measures and optimising treatment. Experimental approaches can serve as a useful model for disorder and recovery relevant processes. One such model is fear conditioning. We conducted a remote fear conditioning paradigm in monozygotic and dizygotic twins to determine the degree and extent of overlap between genetic and environmental influences on fear acquisition and extinction. METHODS In total, 1937 twins aged 22-25 years, including 538 complete pairs from the Twins Early Development Study took part in a fear conditioning experiment delivered remotely via the Fear Learning and Anxiety Response (FLARe) smartphone app. In the fear acquisition phase, participants were exposed to two neutral shape stimuli, one of which was repeatedly paired with a loud aversive noise, while the other was never paired with anything aversive. In the extinction phase, the shapes were repeatedly presented again, this time without the aversive noise. Outcomes were participant ratings of how much they expected the aversive noise to occur when they saw either shape, throughout each phase. RESULTS Twin analyses indicated a significant contribution of genetic effects to the initial acquisition and consolidation of fear, and the extinction of fear (15, 30 and 15%, respectively) with the remainder of variance due to the non-shared environment. Multivariate analyses revealed that the development of fear and fear extinction show moderate genetic overlap (genetic correlations 0.4-0.5). CONCLUSIONS Fear acquisition and extinction are heritable, and share some, but not all of the same genetic influences.
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Affiliation(s)
- K. L. Purves
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
| | - G. Krebs
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley, London, UK
| | - T. McGregor
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - E. Constantinou
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - K. J. Lester
- School of Psychology, University of Sussex, Brighton, Sussex, UK
| | - T. J. Barry
- Experimental Psychopathology Lab, Department of Psychology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - M. G. Craske
- Department of Psychology, University of California, Los Angeles, California, USA
| | - K. S. Young
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - G. Breen
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK
| | - T. C. Eley
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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17
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Fear conditioning and extinction learning in the mood and anxiety disorders spectrum - Associations with the outcome of cognitive behavior therapy. Behav Res Ther 2023; 160:104229. [PMID: 36463833 DOI: 10.1016/j.brat.2022.104229] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
In the current study, we test for the specificity of deficits in fear acquisition and extinction for the anxiety disorders spectrum. We compared fear acquisition and fear extinction learning between a group of patients with either an anxiety disorder (n = 93) or depression (n = 103) attending for treatment in our outpatient center and a sample of healthy control participants (n = 60). To assess the specificity of the predictive validity of extinction learning and safety learning for the outcome of exposure-based treatments, patients additionally underwent disorder-specific cognitive behavior therapy (CBT). We found only very little evidence for differences in safety or extinction learning between healthy controls and patients with anxiety-disorders or depression using both a group-based categorical analytic approach, as well as a trans-diagnostic, dimensional analytic approach. On the contrary, for anxiety patients only, more favorable extinction learning and more favorable safety learning was associated with more favorable treatment outcome. In sum, this specific prediction of treatment outcome in anxiety patients confirms and extends current theoretical models of exposure-based treatments for anxiety disorders, but does not support the notion of general extinction learning deficits in the anxiety disorders spectrum.
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18
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Russman Block S, Norman LJ, Zhang X, Mannella KA, Yang H, Angstadt M, Abelson JL, Himle JA, Taylor SF, Fitzgerald KD. Resting-State Connectivity and Response to Psychotherapy Treatment in Adolescents and Adults With OCD: A Randomized Clinical Trial. Am J Psychiatry 2023; 180:89-99. [PMID: 36475374 PMCID: PMC10956516 DOI: 10.1176/appi.ajp.21111173] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cortical-subcortical hyperconnectivity related to affective-behavioral integration and cortical network hypoconnectivity related to cognitive control have been demonstrated in obsessive-compulsive disorder (OCD); the study objective was to examine whether these connectivity patterns predict treatment response. METHODS Adolescents (ages 12-17) and adults (ages 24-45) were randomly assigned to 12 sessions of exposure and response prevention (ERP) or stress management therapy (SMT), an active control. Before treatment, resting-state connectivity of ventromedial prefrontal cortical (vmPFC), cingulo-opercular, frontoparietal, and subcortical regions was assessed with functional MRI. OCD severity was assessed with the Yale-Brown Obsessive Compulsive Scale before, during, and after treatment. Usable fMRI and longitudinal symptom data were obtained from 116 patients (68 female; 54 adolescents; 60 medicated). RESULTS ERP produced greater decreases in symptom scores than SMT. ERP was selectively associated with less vmPFC-subcortical (caudate and thalamus) connectivity in both age groups and primarily in unmedicated participants. Greater symptom improvement with both ERP and SMT was associated with greater cognitive-control (cingulo-opercular and frontoparietal) and subcortical (putamen) connectivity across age groups. Developmental specificity was observed across ERP and SMT treatments, such that greater improvements with ERP than SMT were associated with greater frontoparietal-subcortical (nucleus accumbens) connectivity in adolescents but greater connectivity between frontoparietal regions in adults. Comparison of response-predictive connections revealed no significant differences compared with a matched healthy control group. CONCLUSIONS The results suggest that less vmPFC-subcortical connectivity related to affect-influenced behavior may be important for ERP engagement, whereas greater cognitive-control and motor circuit connectivity may generally facilitate response to psychotherapy. Finally, neural predictors of treatment response may differ by age.
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Affiliation(s)
- Stefanie Russman Block
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Luke J Norman
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Xiaoxi Zhang
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Kristin A Mannella
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Huan Yang
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Mike Angstadt
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - James L Abelson
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Joseph A Himle
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Stephan F Taylor
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
| | - Kate D Fitzgerald
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald)
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19
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Reduction of costly safety behaviors after extinction with a generalization stimulus is determined by individual differences in generalization rules. Behav Res Ther 2023; 160:104233. [PMID: 36450199 DOI: 10.1016/j.brat.2022.104233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
Exposure-based treatment involves repeated presentation of feared stimuli or situations in the absence of perceived threat (i.e., extinction learning). However, the stimulus or situation of fear acquisition (CS+) is highly unlikely to be replicated and presented during treatment. Thereby, stimuli that resemble the CS+ (generalization stimuli; GSs) are typically presented. Preliminary evidence suggests that depending on how one generalizes fear (i.e., different generalization rules), presenting the same GS in extinction leads to differential effectiveness of extinction learning. The current study aimed to extend this finding to safety behaviors. After differential fear and avoidance conditioning, participants exhibited discrete generalization gradients that were consistent with their reported generalization rules (Similarity vs Linear). The Linear group showed stronger safety behaviors to a selected GS compared to the Similarity group, presumably due to higher threat expectancy. After extinction learning to this GS, the Linear group exhibited stronger reduction in safety behaviors generalization compared to the Similarity group. The results show that identifying distinct generalization rules allows one to predict expectancy violation to the extinction stimulus, in addition to corroborating the idea that strongly violating threat expectancy leads to better extinction learning and its generalization. With regard to clinical implications, identifying one's generalization rule (e.g., threat beliefs) help designing exposure sessions that evoke strong expectancy violation, enhancing the reduction in the generalization of maladaptive safety behaviors.
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20
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Vervliet B. Fear Extinction as a Psychologist Views It. Curr Top Behav Neurosci 2023; 64:3-18. [PMID: 37498494 DOI: 10.1007/7854_2023_433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Fear extinction is a topic of central importance in translational neuroscience. It integrates knowledge from various disciplines, including clinical psychology, experimental psychology, psychiatry, cellular and systems neuroscience, and pharmacology. The experimental phenomenon of extinction was first discovered by Ivan P. Pavlov more than 100 years ago and still forms the basis for investigating the psychological and physiological mechanisms that drive extinction of fear. Here, I present old and new ways to think about fear conditioning and extinction from a psychologist's point of view. Extinction is a simple phenomenon with a complex machinery. Enhancing the behavioral analysis of extinction is necessary to advance research in neighboring disciplines as well and to increase our chances to develop extinction enhancers that might further improve efficacy of extinction-based therapies to treat dysfunctional fears. For that purpose, I address a number of fundamental questions in this chapter to clarify psychological viewpoints on the process of fear extinction. What is extinction? What is an association? What is fear? What can we learn from fear extinction? My goal is to reinforce critical thinking about basic assumptions underlying fear extinction and to open up new avenues for further research.
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Affiliation(s)
- Bram Vervliet
- Brain and Cognition, KU Leuven, Leuven, Belgium.
- Leuven Brain Institute, Leuven, Belgium.
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21
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Winkler CD, Koval P, Phillips LJ, Felmingham KL. Does prediction error during exposure relate to clinical outcomes in cognitive behavior therapy for social anxiety disorder? A study protocol. Front Psychiatry 2022; 13:1000686. [PMID: 37082515 PMCID: PMC10111196 DOI: 10.3389/fpsyt.2022.1000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven't been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.
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Affiliation(s)
- Christopher D. Winkler
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Kredlow MA, de Voogd LD, Phelps EA. A Case for Translation From the Clinic to the Laboratory. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1120-1149. [PMID: 35245166 PMCID: PMC9271534 DOI: 10.1177/17456916211039852] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments for emotional disorders and identifying strategies to make treatments more effective. This research has often focused on translation from the laboratory to the clinic. Although this approach has notable successes, it has not been seamless. There are many examples of strategies that work in the laboratory that fail to lead to improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is a failure to focus on translation from the clinic to the laboratory. Here, we discuss potential benefits of translation from the clinic to the laboratory and provide examples of how this might be implemented. We first consider two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that are missing from these analogues, and propose variations to better capture the clinical process. Second, we discuss two clinical procedures that have more recently been brought into the laboratory (eye-movement desensitization and reprocessing and imagery rescripting). We conclude by highlighting potential implications of this proposed shift in focus for translational research.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychology, Tufts University
- Department of Psychology, Harvard University
| | - Lycia D de Voogd
- Donders Institute for Brain, Cognition, and Behavior, Radboud University and Radboud University Medical Center
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23
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Ney LJ, Laing PAF, Steward T, Zuj DV, Dymond S, Harrison B, Graham B, Felmingham KL. Methodological implications of sample size and extinction gradient on the robustness of fear conditioning across different analytic strategies. PLoS One 2022; 17:e0268814. [PMID: 35609058 PMCID: PMC9128987 DOI: 10.1371/journal.pone.0268814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Fear conditioning paradigms are critical to understanding anxiety-related disorders, but studies use an inconsistent array of methods to quantify the same underlying learning process. We previously demonstrated that selection of trials from different stages of experimental phases and inconsistent use of average compared to trial-by-trial analysis can deliver significantly divergent outcomes, regardless of whether the data is analysed with extinction as a single effect, as a learning process over the course of the experiment, or in relation to acquisition learning. Since small sample sizes are attributed as sources of poor replicability in psychological science, in this study we aimed to investigate if changes in sample size influences the divergences that occur when different kinds of fear conditioning analyses are used. We analysed a large data set of fear acquisition and extinction learning (N = 379), measured via skin conductance responses (SCRs), which was resampled with replacement to create a wide range of bootstrapped databases (N = 30, N = 60, N = 120, N = 180, N = 240, N = 360, N = 480, N = 600, N = 720, N = 840, N = 960, N = 1080, N = 1200, N = 1500, N = 1750, N = 2000) and tested whether use of different analyses continued to produce deviating outcomes. We found that sample size did not significantly influence the effects of inconsistent analytic strategy when no group-level effect was included but found strategy-dependent effects when group-level effects were simulated. These findings suggest that confounds incurred by inconsistent analyses remain stable in the face of sample size variation, but only under specific circumstances with overall robustness strongly hinging on the relationship between experimental design and choice of analyses. This supports the view that such variations reflect a more fundamental confound in psychological science-the measurement of a single process by multiple methods.
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Affiliation(s)
- Luke J. Ney
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Patrick A. F. Laing
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Trevor Steward
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Daniel V. Zuj
- School of Psychology, Swansea University, Wales, United Kingdom
| | - Simon Dymond
- School of Psychology, Swansea University, Wales, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Ben Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Bronwyn Graham
- School of Psychology, University of New South Wales, New South Wales, Australia
| | - Kim L. Felmingham
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
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Ehring T, Limburg K, Kunze AE, Wittekind CE, Werner GG, Wolkenstein L, Guzey M, Cludius B. (When and how) does basic research in clinical psychology lead to more effective psychological treatment for mental disorders? Clin Psychol Rev 2022; 95:102163. [DOI: 10.1016/j.cpr.2022.102163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
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25
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The effect of partial and continuous reinforcement on the generalization of conditioned fear in humans. LEARNING AND MOTIVATION 2022. [DOI: 10.1016/j.lmot.2022.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Combining the trauma film and fear conditioning paradigms: A theoretical review and meta-analysis with relevance to PTSD. Behav Res Ther 2022; 152:104081. [DOI: 10.1016/j.brat.2022.104081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 01/01/2023]
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27
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Gatzounis R, Meulders A. Pain and avoidance: The potential benefits of imagining your best possible self. Behav Res Ther 2022; 153:104080. [DOI: 10.1016/j.brat.2022.104080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/02/2022]
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Measuring Extinction Learning across the Lifespan – Adaptation of an optimized paradigm to closely match exposure treatment procedures. Biol Psychol 2022; 170:108311. [DOI: 10.1016/j.biopsycho.2022.108311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
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29
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Miller DB, Rassaby MM, Collins KA, Milad MR. Behavioral and neural mechanisms of latent inhibition. Learn Mem 2022; 29:38-47. [PMID: 35042827 PMCID: PMC8774194 DOI: 10.1101/lm.053439.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Fear is an adaptive emotion that serves to protect an organism against potential dangers. It is often studied using classical conditioning paradigms where a conditioned stimulus is paired with an aversive unconditioned stimulus to induce a threat response. Less commonly studied is a phenomenon that is related to this form of conditioning, known as latent inhibition. Latent inhibition (LI) is a paradigm in which a neutral cue is repeatedly presented in the absence of any aversive associations. Subsequent pairing of this pre-exposed cue with an aversive stimulus typically leads to reduced expression of a conditioned fear/threat response. In this article, we review some of the theoretical basis for LI and its behavioral and neural mechanisms. We compare and contrast LI and fear/threat extinction-a process in which a previously conditioned cue is repeatedly presented in the absence of aversive outcomes. We end with highlighting the potential clinical utility of LI. Particularly, we focus on how LI application could be useful for enhancing resilience, especially for individuals who are more prone to continuous exposure to trauma and stressful environments, such as healthcare workers and first responders. The knowledge to be gained from advancing our understanding of neural mechanisms in latent inhibition could be applicable across psychiatric disorders characterized by exaggerated fear responses and impaired emotion regulation.
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Affiliation(s)
- Dylan B Miller
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York 10016, USA
| | - Madeleine M Rassaby
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York 10016, USA
| | - Katherine A Collins
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA
| | - Mohammad R Milad
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York 10016, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA
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30
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Labrenz F, Woud ML, Elsenbruch S, Icenhour A. The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine. Front Psychiatry 2022; 13:841734. [PMID: 35250678 PMCID: PMC8894646 DOI: 10.3389/fpsyt.2022.841734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/28/2022] [Indexed: 12/12/2022] Open
Abstract
Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.
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Affiliation(s)
- Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany.,Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Adriane Icenhour
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
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Adams TG, Cisler JM, Kelmendi B, George JR, Kichuk SA, Averill CL, Anticevic A, Abdallah CG, Pittenger C. Transcranial direct current stimulation targeting the medial prefrontal cortex modulates functional connectivity and enhances safety learning in obsessive-compulsive disorder: Results from two pilot studies. Depress Anxiety 2022; 39:37-48. [PMID: 34464485 PMCID: PMC8732293 DOI: 10.1002/da.23212] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Exposed-based psychotherapy is a mainstay of treatment for obsessive-compulsive disorder (OCD) and anxious psychopathology. The medial prefrontal cortex (mPFC) and the default mode network (DMN), which is anchored by the mPFC, promote safety learning. Neuromodulation targeting the mPFC might augment therapeutic safety learning and enhance response to exposure-based therapies. METHODS To characterize the effects of mPFC neuromodulation on functional connectivity, 17 community volunteers completed resting-state functional magnetic resonance imaging scans before and after 20 min of frontopolar anodal multifocal transcranial direct current stimulation (tDCS). To examine the effects of tDCS on therapeutic safety learning, 24 patients with OCD completed a pilot randomized clinical trial; they were randomly assigned (double-blind, 50:50) to receive active or sham frontopolar tDCS before completing an in vivo exposure and response prevention (ERP) challenge. Changes in subjective emotional distress during the ERP challenge were used to index therapeutic safety learning. RESULTS In community volunteers, frontal pole functional connectivity with the middle and superior frontal gyri increased, while connectivity with the anterior insula and basal ganglia decreased (ps < .001, corrected) after tDCS; functional connectivity between DMN and salience network also decreased after tDCS (ps < .001, corrected). OCD patients who received active tDCS exhibited more rapid therapeutic safety learning (ps < .05) during the ERP challenge than patients who received sham tDCS. CONCLUSIONS Frontopolar tDCS may modulate mPFC and DMN functional connectivity and can accelerate therapeutic safety learning. Though limited by small samples, these findings motivate further exploration of the effects of frontopolar tDCS on neural and behavioral targets associated with exposure-based psychotherapies.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
| | - Josh M Cisler
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Benjamin Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
| | - Jamilah R George
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Department of Psychological Sciences, University of Connecticut, Mansfield, Connecticut, USA
| | - Stephen A Kichuk
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Christopher L Averill
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Alan Anticevic
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Chadi G Abdallah
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher Pittenger
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Child Study Center, Yale University, New Haven, Connecticut, USA
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32
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Rosenberg BM, Taschereau-Dumouchel V, Lau H, Young KS, Nusslock R, Zinbarg RE, Craske MG. A Multivoxel Pattern Analysis of Anhedonia During Fear Extinction: Implications for Safety Learning. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 8:417-425. [PMID: 34954395 DOI: 10.1016/j.bpsc.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pavlovian learning processes are central to the etiology and treatment of anxiety disorders. Anhedonia and related perturbations in reward processes have been implicated in Pavlovian learning. Associations between anhedonia symptoms and neural indices of Pavlovian learning can inform transdiagnostic associations among depressive and anxiety disorders. METHODS Participants ages 18 to 19 years (67% female) completed a fear extinction (n = 254) and recall (n = 249) paradigm during functional magnetic resonance imaging. Symptom dimensions of general distress (common to anxiety and depression), fears (more specific to anxiety), and anhedonia-apprehension (more specific to depression) were evaluated. We trained whole-brain multivoxel pattern decoders for anhedonia-apprehension during extinction and extinction recall and tested the decoders' ability to predict anhedonia-apprehension in an external validation sample. Specificity analyses examined effects covarying for general distress and fears. Decoding was repeated within canonical brain networks to highlight candidate neurocircuitry underlying whole-brain effects. RESULTS Whole-brain decoder training succeeded during both tasks. Prediction of anhedonia-apprehension in the external validation sample was successful for extinction (R2 = 0.047; r = 0.276, p = .002) but not extinction recall (R2 < 0.001, r = -0.063, p = .492). The extinction decoder remained significantly associated with anhedonia-apprehension covarying for fears and general distress (t121 = 3.209, p = .002). Exploratory results highlighted activity in the cognitive control, default mode, limbic, salience, and visual networks related to these effects. CONCLUSIONS Results suggest that patterns of brain activity during extinction, particularly in the cognitive control, default mode, limbic, salience, and visual networks, can be predictive of anhedonia symptoms. Future research should examine associations between anhedonia and extinction, including studies of exposure therapy or positive affect treatments among anhedonic individuals.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, Los Angeles, California.
| | - Vincent Taschereau-Dumouchel
- Department of Psychiatry and Addictology, University of Montréal, Montreal, Quebec, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Hakwan Lau
- RIKEN Center for Brain Science, Saitama, Japan
| | - Katherine S Young
- Social, Genetic and Development Psychiatry Centre, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Maudsley Biomedical Research Centre, King's College London, London, United Kingdom
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, Illinois; Family Institute at Northwestern University, Northwestern University, Evanston, Illinois
| | - Michelle G Craske
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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Abstract
BACKGROUND Fear acquisition of certain stimuli, such as snakes, is thought to be rapid, resistant to extinction, and easily transferable onto other similar objects. It has been hypothesized that due to increased survival chances, preparedness to instantly acquire fear towards evolutionary threats has been hardwired into neural pathways of the primate brain. Here, we compare participants' fear of snakes according to experience; from those who often deal with snakes and even suffer snakebites to those unfamiliar with snakes. METHODS The Snake Questionnaire-12 (SNAQ-12) and Specific Phobia Questionnaire (SPQ) were administered to three groups of participants with a different level of experience with snakes and snakebites: 1) snake experts, 2) firefighters, and 3) college students. RESULTS This study shows that individuals more experienced with snakes demonstrate lower fear. Moreover, participants who have suffered a snakebite (either venomous or not) score lower on fear of snakes (SNAQ-12), but not of all other potentially phobic stimuli (SPQ). CONCLUSIONS Our results suggest that a harmless benign exposure might immunize people to highly biologically prepared fears of evolutionary threats, such as snakes.
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Affiliation(s)
- Carlos M Coelho
- Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
- University Institute of Maia, Maia, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Jakub Polák
- Applied Neuroscience and Neuroimaging Research Programme, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Panrapee Suttiwan
- Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
- Life Di Center, Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
| | - Andras N Zsido
- Institute of Psychology, University of Pécs, Pécs, Hungary.
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Berg H, Hunt C, Cooper SE, Olatunji BO, Lissek S. Generalization of conditioned disgust and the attendant maladaptive avoidance: Validation of a novel paradigm and effects of trait disgust-proneness. Behav Res Ther 2021; 146:103966. [PMID: 34560412 DOI: 10.1016/j.brat.2021.103966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
Overgeneralization of conditioned fear to safe stimuli that resemble a previously-learned threat-cue is a well-studied correlate of clinical anxiety, yet whether conditioned disgust generalizes remains unknown, as does the extent to which such generalization is associated with disgust-related traits and maladaptive outcomes. The present study addresses this gap by adapting a validated fear-generalization paradigm to assess conditioned disgust and behavioral avoidance to a disgust-cue (CS+) paired with a disgusting video clip, and safe generalization stimuli parametrically varying in perceptual similarity to CS+. For comparison, levels of fear generalization were also assessed using the original fear-generalization paradigm. In both paradigms, costly and unnecessary avoidance to safe threat-cue approximations analogues maladaptive outcomes of generalization. In the disgust paradigm only, disgust-proneness was associated with elevated perceived risk to safe stimuli and increases in the extent to which such elevations were accompanied by maladaptive avoidance. Comparable levels of generalization, and positive associations between generalization and maladaptive avoidance, were found across disgust and fear paradigms. Results confirm that conditioned disgust is subject to generalization, implicate generalized disgust as a source of maladaptive avoidance particularly among those prone to disgust, and suggest a potential role for these processes in the etiology and maintenance of disgust-related disorders.
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Affiliation(s)
- Hannah Berg
- Department of Psychology, University of Minnesota - Twin Cities, 75 E River Rd, Minneapolis, MN, 55455, USA.
| | - Christopher Hunt
- Department of Psychology, University of Minnesota - Twin Cities, 75 E River Rd, Minneapolis, MN, 55455, USA.
| | - Samuel E Cooper
- Department of Psychology, University of Minnesota - Twin Cities, 75 E River Rd, Minneapolis, MN, 55455, USA.
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, PMB 407817, 2301 Vanderbilt Place, Nashville, TN, 37240, USA.
| | - Shmuel Lissek
- Department of Psychology, University of Minnesota - Twin Cities, 75 E River Rd, Minneapolis, MN, 55455, USA.
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van Dis EAM, Landkroon E, Hagenaars MA, van der Does FHS, Engelhard IM. Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure. Behav Ther 2021; 52:1188-1197. [PMID: 34452672 DOI: 10.1016/j.beth.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 01/04/2023]
Abstract
Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.
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Mobbs D, Wise T, Suthana N, Guzmán N, Kriegeskorte N, Leibo JZ. Promises and challenges of human computational ethology. Neuron 2021; 109:2224-2238. [PMID: 34143951 PMCID: PMC8769712 DOI: 10.1016/j.neuron.2021.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 12/22/2022]
Abstract
The movements an organism makes provide insights into its internal states and motives. This principle is the foundation of the new field of computational ethology, which links rich automatic measurements of natural behaviors to motivational states and neural activity. Computational ethology has proven transformative for animal behavioral neuroscience. This success raises the question of whether rich automatic measurements of behavior can similarly drive progress in human neuroscience and psychology. New technologies for capturing and analyzing complex behaviors in real and virtual environments enable us to probe the human brain during naturalistic dynamic interactions with the environment that so far were beyond experimental investigation. Inspired by nonhuman computational ethology, we explore how these new tools can be used to test important questions in human neuroscience. We argue that application of this methodology will help human neuroscience and psychology extend limited behavioral measurements such as reaction time and accuracy, permit novel insights into how the human brain produces behavior, and ultimately reduce the growing measurement gap between human and animal neuroscience.
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Affiliation(s)
- Dean Mobbs
- Department of Humanities and Social Sciences, 1200 E. California Blvd., HSS 228-77, Pasadena, CA 91125, USA; Computation and Neural Systems Program at the California Institute of Technology, 1200 E. California Blvd., HSS 228-77, Pasadena, CA 91125, USA.
| | - Toby Wise
- Department of Humanities and Social Sciences, 1200 E. California Blvd., HSS 228-77, Pasadena, CA 91125, USA; Wellcome Centre for Human Neuroimaging, University College London, London, UK; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA; Departments of Neurosurgery, Psychology, and Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Noah Guzmán
- Computation and Neural Systems Program at the California Institute of Technology, 1200 E. California Blvd., HSS 228-77, Pasadena, CA 91125, USA
| | - Nikolaus Kriegeskorte
- Department of Psychology, Columbia University, New York, NY, USA; Department of Neuroscience, Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, USA
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Lange I, Papalini S, Vervliet B. Experimental models in psychopathology research: The relation between Research Domain Criteria and Experimental Psychopathology. Curr Opin Psychol 2021; 41:118-123. [PMID: 34418641 DOI: 10.1016/j.copsyc.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
Experimental Psychopathology (EPP) and the Research Domain Criteria (RDoC) are research approaches that have developed in parallel, providing inter-related yet different scientific frameworks to investigate psychopathology at the intersection of fundamental and applied research. Here we address the overlap and differences between RDoC and EPP, and the challenges that both approaches face. Although overlap between EPP and RDoC can be clearly observed, each approach has its own unique strengths and weaknesses. These aspects will be illustrated by examples with respect to fear conditioning, an experimental procedure that has played a central role in both EPP and RDoC. We see much potential in boosting psychopathology research by combining the strengths of these two approaches.
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Affiliation(s)
- Iris Lange
- Laboratory of Biological Psychology, Department of Brain and Cognition, KU Leuven, Belgium; Leuven Brain Institute, KU Leuven, Belgium.
| | - Silvia Papalini
- Laboratory of Biological Psychology, Department of Brain and Cognition, KU Leuven, Belgium; Leuven Brain Institute, KU Leuven, Belgium
| | - Bram Vervliet
- Laboratory of Biological Psychology, Department of Brain and Cognition, KU Leuven, Belgium; Leuven Brain Institute, KU Leuven, Belgium
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Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory. THE JOURNAL OF PAIN 2021; 22:1315-1327. [PMID: 34029684 DOI: 10.1016/j.jpain.2021.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/04/2023]
Abstract
Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them. We propose several adaptations that are expected to strengthen inhibitory learning and/or retrieval of the extinction memory, thus likely decreasing relapse. We summarize the limited, but emerging experimental data in the pain domain, and draw parallels with experimental evidence in the anxiety literature. Our reflections and suggestions pertain to the use of the fear hierarchy, reassurance, positive psychology interventions, exposure with a range of stimuli and within different contexts, and the use of safety behaviors during treatment, as well as associating the fear-inducing stimuli with novel outcomes. In addition, we reflect on the importance of specifically tackling (the return of) pain-related avoidance behavior with techniques such as disentangling fear from avoidance and reinforcing approach behaviors. Finally, we discuss challenges in the clinical application of exposure to improve functioning in chronic primary pain and possible avenues for future research. Perspectives: Inspired by recent advances in learning theory and its applications on the treatment of anxiety disorders, we reflect on the delivery of exposure treatment for chronic primary pain and propose strategies to improve its long-term outcomes.
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Laing PAF, Harrison BJ. Safety learning and the Pavlovian conditioned inhibition of fear in humans: Current state and future directions. Neurosci Biobehav Rev 2021; 127:659-674. [PMID: 34023357 DOI: 10.1016/j.neubiorev.2021.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 01/02/2023]
Abstract
Safety learning occurs when an otherwise neutral stimulus comes to signal the absence of threat, allowing organisms to use safety information to inhibit fear and anxiety in nonthreatening environments. Although it continues to emerge as a topic of relevance in biological and clinical psychology, safety learning remains inconsistently defined and under-researched. Here, we analyse the Pavlovian conditioned inhibition paradigm and its application to the study of safety learning in humans. We discuss existing studies; address outstanding theoretical considerations; and identify prospects for its further application. Though Pavlovian conditioned inhibition presents a theoretically sound model of safety learning, it has been investigated infrequently, with decade-long interims between some studies, and notable methodological variability. Consequently, we argue that the full potential of conditioned inhibition as a model for human safety learning remains untapped, and propose that it could be revisited as a framework for addressing timely questions in the behavioural and clinical sciences.
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Affiliation(s)
- Patrick A F Laing
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Victoria, Australia.
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Victoria, Australia.
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Scheveneels S, Boddez Y, Hermans D. Predicting clinical outcomes via human fear conditioning: A narrative review. Behav Res Ther 2021; 142:103870. [PMID: 34000680 DOI: 10.1016/j.brat.2021.103870] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
A common assumption in human fear conditioning research is that findings are informative for the etiology and treatment of clinical anxiety. One way to empirically evaluate the external validity of fear conditioning is by prospective studies. We review available prospective research investigating whether individual performance in fear conditioning predicts individual differences in anxiety levels and exposure-based treatment outcome. We focus on fear extinction, generalization, acquisition, and avoidance. Results suggest that reduced extinction and broader generalization predict higher anxiety levels. Results with respect to the predictive value of acquisition for anxiety levels are mixed. With regard to predicting exposure-based treatment outcome, some studies do find an association with extinction whereas others do not. The majority of studies does not find an association with acquisition. Evidence on extinction recall is limited and not consistent. The interpretation of these results requires caution. The number of available studies is limited. It is possible that not all work, in particular studies with only null effects, has found its way to publication. Future research on this topic will benefit from large sample sizes, preregistered hypotheses, full transparency about the conducted analyses and the publication of high-quality studies with null effects.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.
| | - Yannick Boddez
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Dirk Hermans
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
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Hagedorn B, Wolf OT, Merz CJ. Stimulus-Based Extinction Generalization: Neural Correlates and Modulation by Cortisol. Int J Neuropsychopharmacol 2021; 24:354-365. [PMID: 33196833 PMCID: PMC8059492 DOI: 10.1093/ijnp/pyaa085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/07/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND While healthy individuals and patients with anxiety disorders easily generalize fear responses, extinction learning is more stimulus specific. Treatments aiming to generalize extinction learning are urgently needed, since they comprise the potential to overcome stimulus specificity and reduce relapses, particularly in the face of stressful events. METHODS In the current 3-day functional magnetic resonance imaging fear conditioning paradigm, we aimed to create a generalized extinction memory trace in 60 healthy men and women by presenting multiple sizes of 1 conditioned stimulus during extinction training (CS+G; generalized), whereas the other conditioned stimulus was solely presented in its original size (CS+N; nongeneralized). Recall was tested on the third day after pharmacological administration of either the stress hormone cortisol or placebo. RESULTS After successful fear acquisition, prolonged activation of the amygdala and insula and deactivation of the ventromedial prefrontal cortex for CS+G compared with CS+N during extinction learning indicated sustained fear to the generalization stimuli. In line with our hypotheses, reduced amygdala activation was observed after extinction generalization on the third day in the contrast CS+G minus CS+N, possibly reflecting an attenuated return of fear. Cortisol administration before recall, however, blocked this effect. CONCLUSIONS Taken together, the findings show that extinction generalization was associated with decreased activation of the fear network during recall after prolonged activation of the fear network during extinction learning. However, the generalization of the extinction memory did not counteract the detrimental effects of stress hormones on recall. Thus, stimulus-based extinction generalization may not be sufficient to reduce relapses after stressful experiences.
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Affiliation(s)
- Bianca Hagedorn
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University, Bochum, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University, Bochum, Germany
| | - Christian J Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University, Bochum, Germany
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Hendrikx LJ, Krypotos AM, Engelhard IM. Enhancing extinction with response prevention via imagery-based counterconditioning: Results on conditioned avoidance and distress. J Behav Ther Exp Psychiatry 2021; 70:101601. [PMID: 32835958 DOI: 10.1016/j.jbtep.2020.101601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Maladaptive avoidance is a core characteristic of anxiety-related disorders. Its reduction is often promoted using extinction with response prevention (ExRP) procedures, but these effects are often short-lived. Research has shown that pairing a feared stimulus with a stimulus of an incompatible valence (i.e., counterconditioning) may be effective in reducing fear. This laboratory study tested whether positive imagery during ExRP (i.e., imagery counterconditioning protocol) can also reduce avoidance. METHODS In the counterconditioning procedure, participants imagined a positive sound. There were four phases. First, participants were presented with squares on a computer screen of which one (CS+) was paired with an aversive sound and another (CS-) was not. Second, they learned to avoid the negative sound in the presence of the CS+, via a key press. Third, they were assigned to either the Counterconditioning (that was asked to imagine a positive sound during ExRP) or No Counterconditioning group (standard ExRP). Finally, they performed a test phase that consisted of two parts: in the first part, avoidance responses were available for each CS and in the second part, these responses were prevented. RESULTS The Counterconditioning intervention resulted in a short-lived reduction of distress associated with the CS+. However, groups did not differ in avoidance or distress during the test phases. LIMITATIONS US-expectancy ratings were collected only at the end of the experiment. CONCLUSIONS The results indicate that positive imagery during ExRP may be effective in reducing distress during the intervention. Explanations for the persistence of avoidance and fear are discussed.
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Affiliation(s)
- Laura J Hendrikx
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Angelos-Miltiadis Krypotos
- Department of Clinical Psychology, Utrecht University, the Netherlands; Department of Healthy Psychology, KU Leuven, Belgium.
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, the Netherlands
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Cloutier RM, Bilsky SA, Baxley C, Anderson KG, Blumenthal H. Development of the A-DISS rejection task to demonstrate the unique and overlapping affective features of social anxiety and depression. COGNITIVE THERAPY AND RESEARCH 2021; 45:74-89. [PMID: 33776170 PMCID: PMC7992050 DOI: 10.1007/s10608-020-10152-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social anxiety (SA) and depression are prevalent, often comorbid disorders, associated with poor psychosocial functioning. Experimental psychopathology approaches can clarify the transdiagnostic mechanisms underlying these disorders, but most laboratory tasks are limited. We developed and validated the Audio-Dialogue Inductions of Social Stress (A-DISS) experimental task to model real-time rejection sensitivity in a realistic and developmentally relevant context. Participants are asked to imagine overhearing peers at a party talking badly about them (Rejection) or a teacher at their school (Neutral). METHODS Study 1 focused on identifying and refining stimuli that elicited relevant emotional responses for Rejection (e.g., increased anxiety) and Neutral (e.g., no emotional changes) conditions (N=48). Study 2 examined whether participants' SA and depression symptoms moderated the effects of A-DISS condition (N=52). RESULTS The Rejection condition elicited higher negative affect/lower positive affect while the Neutral condition sustained stable affect. Findings were consistent across gender and race/ethnicity. Moderation analyses were statistically significant; participants with elevated SA or depression reported feeling more rejected, insecure, and anxious after Rejection than those with below average symptoms. CONCLUSIONS Findings provide preliminary validation of a novel peer rejection task for research on understanding the affective experience of real-time rejection overall, especially for those with elevated SA and depression. SA and depression symptoms each uniquely moderating the effects of Rejection exposure on similar affective states, suggests individuals with SA or depression may benefit from interventions targeting specific reactions to rejection/stress and transdiagnostic risk factors.
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Affiliation(s)
- Renee M Cloutier
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States of America
- The Methodology Center, The Pennsylvania State University, 423 Health and Human Development Building, University Park, PA 16802, United States of America (Present Address)
| | - Sarah A Bilsky
- Department of Psychology, The University of Mississippi, 302D Peabody Hall, University Park, MS, 38677
| | - Catherine Baxley
- Department of Psychology, Saint Louis University, 3700 Lindell Blvd, St. Louis, MO 63108, United States of America
| | - Kristen G Anderson
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd. Portland, OR 97202
| | - Heidemarie Blumenthal
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States of America
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Anderson LM, Berg H, Brown TA, Menzel J, Reilly EE. The Role of Disgust in Eating Disorders. Curr Psychiatry Rep 2021; 23:4. [PMID: 33404776 PMCID: PMC7895454 DOI: 10.1007/s11920-020-01217-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and treatment of disgust-based symptoms in EDs. RECENT FINDINGS Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited. Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.
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Affiliation(s)
- Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Avenue South, F229, Minneapolis, MN 55454, USA
| | - Hannah Berg
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Road, Minneapolis, MN 55455, USA
| | - Tiffany A. Brown
- Department of Psychiatry, University of California - San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Jessie Menzel
- Department of Psychiatry, University of California - San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Erin E. Reilly
- Department of Psychology, Hofstra University, 210 Hauser Hall, Hempstead, NY 11549, USA
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Wong AHK, Glück VM, Boschet JM, Engelke P. Generalization of extinction with a generalization stimulus is determined by learnt threat beliefs. Behav Res Ther 2020; 135:103755. [PMID: 33152614 PMCID: PMC7581402 DOI: 10.1016/j.brat.2020.103755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022]
Abstract
Expectancy violation refers to the mismatch between an expected and the actual outcome. Maximizing expectancy violation is crucial for exposure-based treatment. Since the original stimulus of fear acquisition (CS+) is rarely available, stimuli that resemble the CS+ (generalization stimuli; GSs) are presented during treatment. A given GS may evoke either strong or weak generalized fear depending on an individual's threat beliefs. Presenting this GS in extinction would then evoke different levels of expectancy violation, which determines the strength of the subsequent generalization of extinction to other stimuli, including the CS+. After differential fear conditioning, participants exhibited discrete generalization gradients depending on their inferred relational rules (Linear vs Similarity). Crucially, the Linear group showed strong generalized fear to the GS used in extinction. This strong expectancy violation led to enhanced extinction learning and subsequently to strong generalization of extinction as characterized by a flat generalization gradient, and reduced conditioned fear to the CS+. In contrast, the Similarity group showed weak generalized fear to the same GS in extinction, and limited generalization of extinction. These results corroborate the importance of expectancy violation in exposure-based treatment, and suggest that exposure sessions designed to evoke strong threat beliefs may lead to better treatment outcome.
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Affiliation(s)
- Alex H K Wong
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Valentina M Glück
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Juliane M Boschet
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Paula Engelke
- Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Würzburg, Germany
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Gazendam FJ, Krypotos AM, Kamphuis JH, van der Leij AR, Huizenga HM, Eigenhuis A, Kindt M. From adaptive to maladaptive fear: Heterogeneity in threat and safety learning across response systems in a representative sample. Int J Psychophysiol 2020; 158:271-287. [DOI: 10.1016/j.ijpsycho.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/29/2020] [Accepted: 09/05/2020] [Indexed: 12/17/2022]
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47
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Memories of 100 years of human fear conditioning research and expectations for its future. Behav Res Ther 2020; 135:103732. [DOI: 10.1016/j.brat.2020.103732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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48
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Gatzounis R, Meulders A. Once an Avoider Always an Avoider? Return of Pain-Related Avoidance After Extinction With Response Prevention. THE JOURNAL OF PAIN 2020; 21:1224-1235. [DOI: 10.1016/j.jpain.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 12/28/2022]
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van den Akker K, Schyns G, Jansen A. Individual differences in extinction learning predict weight loss after treatment: A pilot study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:782-788. [PMID: 33463853 PMCID: PMC7689699 DOI: 10.1002/erv.2778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/03/2020] [Accepted: 07/19/2020] [Indexed: 01/01/2023]
Abstract
Learning theorists suggest extinction learning to be a central mechanism in weight loss success; however, empirical studies are scarce. In this pilot study, it was examined whether individual differences in extinction learning predict outcome after weight loss treatment. Overweight and obese individuals first completed a laboratory conditioning task in which individual differences in extinction learning were assessed. Next, they were randomised to one of two weight loss interventions: cue exposure therapy (CET), which is considered the clinical analogue of laboratory extinction, or a control lifestyle intervention. In line with expectations, better extinction learning in the laboratory task was associated with more weight loss at both post-treatment (CET only) and follow-up (both interventions) measurements. In contrast, two other indices of treatment success (reduction in overeating expectancies and ad libitum food intake during a laboratory taste test) showed no associations with pre-treatment extinction learning. It is suggested that extinction learning may be a core mechanism underlying weight loss success, and hence, an important target for new obesity interventions.
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Affiliation(s)
- Karolien van den Akker
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological ScienceMaastricht UniversityMaastrichtThe Netherlands
| | - Ghislaine Schyns
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological ScienceMaastricht UniversityMaastrichtThe Netherlands
| | - Anita Jansen
- Faculty of Psychology and Neuroscience, Department of Clinical Psychological ScienceMaastricht UniversityMaastrichtThe Netherlands
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50
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Sjouwerman R, Scharfenort R, Lonsdorf TB. Individual differences in fear acquisition: multivariate analyses of different emotional negativity scales, physiological responding, subjective measures, and neural activation. Sci Rep 2020; 10:15283. [PMID: 32943701 PMCID: PMC7498611 DOI: 10.1038/s41598-020-72007-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/20/2020] [Indexed: 01/13/2023] Open
Abstract
Negative emotionality is a well-established and stable risk factor for affective disorders. Individual differences in negative emotionality have been linked to associative learning processes which can be captured experimentally by computing CS-discrimination values in fear conditioning paradigms. Literature suffers from underpowered samples, suboptimal methods, and an isolated focus on single questionnaires and single outcome measures. First, the specific and shared variance across three commonly employed questionnaires [STAI-T, NEO-FFI-Neuroticism, Intolerance of Uncertainty (IU) Scale] in relation to CS-discrimination during fear-acquisition in multiple analysis units (ratings, skin conductance, startle) is addressed (NStudy1 = 356). A specific significant negative association between STAI-T and CS-discrimination in SCRs and between IU and CS-discrimination in startle responding was identified in multimodal and dimensional analyses, but also between latent factors negative emotionality and fear learning, which capture shared variance across questionnaires/scales and across outcome measures. Second, STAI-T was positively associated with CS-discrimination in a number of brain areas linked to conditioned fear (amygdala, putamen, thalamus), but not to SCRs or ratings (NStudy2 = 113). Importantly, we replicate potential sampling biases between fMRI and behavioral studies regarding anxiety levels. Future studies are needed to target wide sampling distributions for STAI-T and verify whether current findings are generalizable to other samples.
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Affiliation(s)
- Rachel Sjouwerman
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Robert Scharfenort
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Tina B Lonsdorf
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
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