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Wong AHK, Pittig A, Engelhard IM. The generalization of threat beliefs to novel safety stimuli induced by safety behaviors. Behav Brain Res 2024; 470:115078. [PMID: 38825020 DOI: 10.1016/j.bbr.2024.115078] [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: 01/29/2024] [Revised: 04/08/2024] [Accepted: 05/30/2024] [Indexed: 06/04/2024]
Abstract
Safety behaviors are responses that can reduce or even prevent an expected threat. Moreover, empirical studies have shown that using safety behaviors to a learnt safety stimulus can induce threat beliefs to it. No research so far has examined whether threat beliefs induced this way generalize to other novel stimuli related to the safety stimulus. Using a fear and avoidance conditioning model, the current study (n=116) examined whether threat beliefs induced by safety behaviors generalize to other novel generalization stimuli (GSs). Participants first acquired safety behaviors to a threat predicting conditioned stimulus (CSthreat). Safety behaviors could then be performed in response to one safe stimulus (CSsafeShift) but not to another (CSsafe). In a following generalization test, participants showed a significant but small increase in threat expectancies to GSs related to CSsafeShift compared to GSs related to CSsafe. Interestingly, the degree of safety behaviors used to the CSsafeShift predicted the subsequent increase in generalized threat expectancies, and this link was elevated in trait anxious individuals. The findings suggest that threat beliefs induced by unnecessary safety behaviors generalize to other related stimuli. This study provides a potential explanation for the root of threat belief acquisition to a wide range of stimuli or situations.
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Affiliation(s)
- Alex H K Wong
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam 3062 PA, the Netherlands.
| | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, Georg-August-Universität Göttingen, Kurze-Geismar-Straße 1, Göttingen 37073, Germany
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, P.O. Box 80140, Utrecht 3508 TC, the Netherlands
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2
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Buzzanca-Fried KE, Snyder AR, Bauer RM, Morgan-Daniel J, de Corcho CP, Addeo R, Lahey SM, Houck Z, Beneciuk JM. Psychological Constructs From the Fear Avoidance Model and Beyond as Predictors for Persisting Symptoms After Concussion: An Integrative Review. Arch Phys Med Rehabil 2024:S0003-9993(24)00949-3. [PMID: 38663576 DOI: 10.1016/j.apmr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES To identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and contribute to the theoretical framework of the FAM for PSaC. DATA SOURCES Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications and experimental and quasi-experimental study designs. The literature search was not limited by publication date restrictions. Gray literature, with the exception of doctoral dissertations, was excluded. STUDY SELECTION We included studies in the English language consisting of human participants aged ≥18 years. Articles must have included both outcomes pertaining to PSaC (≥3mo after injury) and psychological constructs. DATA EXTRACTION One reviewer extracted data from the resulting studies using a standardized data extraction form designed for this review. Two reviewers independently assessed risk of bias using the Quality in Prognosis Studies tool. DATA SYNTHESIS This review found numerous psychological constructs, some directly linked to the FAM, that have potential prognostic relationships with PSaC. However, research remains limited and some psychological factors central to FAM were only identified in a small number of studies (catastrophizing, cogniphobia, and avoidance), whereas other psychological factors were studied more extensively (anxiety and depression). CONCLUSIONS There is the need for additional evidence, and this integrative review provides an adaptation of the FAM for PSaC to be used as a guiding preliminary framework for future research. Future research should aim to include psychological factors proposed in this modified FAM to fully understand PSaC.
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Affiliation(s)
- Katherine E Buzzanca-Fried
- Department of Rehabilitation Science, University of Florida, Gainesville, FL; Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL.
| | - Aliyah R Snyder
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Christopher Perez de Corcho
- Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL
| | - Russell Addeo
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Sarah M Lahey
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Zachary Houck
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Jason M Beneciuk
- Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL; Department of Physical Therapy, University of Florida, Gainesville, FL, United States
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Glück VM, Boschet-Lange JM, Pittig R, Pittig A. Persistence of extensively trained avoidance is not elevated in anxiety disorders in an outcome devaluation paradigm. Behav Res Ther 2023; 170:104417. [PMID: 37879245 DOI: 10.1016/j.brat.2023.104417] [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: 03/15/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND A habitual avoidance component may enforce the persistence of maladaptive avoidance behavior in anxiety disorders. Whether habitual avoidance is acquired more strongly in anxiety disorders is unclear. METHODS Individuals with current social anxiety disorder, panic disorder and/or agoraphobia (n = 62) and healthy individuals (n = 62) completed a devaluation paradigm with extensive avoidance training, followed by the devaluation of the aversive outcome. In the subsequent test phase, habitual response tendencies were inferred from compatibility effects. Neutral control trials were added to assess general approach learning in the absence of previous extensive avoidance training. RESULTS The compatibility effects indicating habitual control did not differ between patients with anxiety disorders and healthy controls. Patients showed lower overall approach accuracy, but this effect was unrelated to the compatibility effects. CONCLUSIONS In this study, anxiety disorders were characterized by reduced approach but not stronger habitual avoidance. These results do not indicate a direct association between anxiety disorders and the acquisition of pervasive habitual avoidance in this devaluation paradigm.
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Affiliation(s)
- Valentina M Glück
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Juliane M Boschet-Lange
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Roxana Pittig
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Göttingen, Germany.
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Spix M, Melles H, Jansen A. From Bad to Worse: Safety Behaviors Exacerbate Eating Disorder Fears. Behav Sci (Basel) 2023; 13:574. [PMID: 37504021 PMCID: PMC10376478 DOI: 10.3390/bs13070574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
When evaluating ambiguous situations, humans sometimes use their behavior as a source of information (behavior-as-information effect) and interpret safety behaviors as evidence for danger. Accordingly, we hypothesized that eating disorder safety behaviors (restrictive eating, body checking, etc.) might aggravate fear and anxiety in individuals with an eating disorder. The present study tested to what extent eating disorder safety behaviors increase threat perception in individuals with and without an eating disorder. For this, 108 individuals with a self-reported eating disorder diagnosis and 82 healthy controls rated the dangerousness of several short situations. The situations systematically varied in the presence of eating disorder safety behaviors and danger information. As expected, all participants perceived situations in which the protagonist executed an eating disorder safety behavior as more threatening than situations without a safety behavior. This 'behavior-as-information' effect was equally strong in individuals with and without an eating disorder. Additionally, safety behaviors strengthened threat perception more in safe situations than in dangerous situations. To conclude, the presence of eating disorder safety behavior can increase threat perception regardless of whether individuals have an eating disorder or not. This makes eating disorder safety behaviors a potential risk factor for the development and maintenance of eating disorder fears.
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Affiliation(s)
- Michelle Spix
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Hanna Melles
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
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Spix M, Schutzeichel F, Jansen A. Can you learn to starve yourself? Inducing food avoidance in the laboratory. Behav Res Ther 2023; 166:104340. [PMID: 37267783 DOI: 10.1016/j.brat.2023.104340] [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: 08/01/2022] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
The restriction of energy intake is a central and persistent symptom of anorexia nervosa. Recent models of the disorder suggest that food restrictions are learned avoidance behaviours, which are acquired and maintained by classical and operant conditioning. The present study aims to test this learning model of food restriction. It investigates whether introducing negative consequences for the intake of tasty high-calorie food and introducing positive consequences for its avoidance can create food avoidance, increase fear of food, and decrease eating desires in healthy individuals. 104 women were randomly assigned to an experimental or control condition and completed an appetitive conditioning and avoidance learning task. While the experimental condition received money after avoiding the tasty high-calorie food item and heard an aversive sound after not avoiding food intake, the control condition never received these consequences. In the extinction phase, reward and punishment discontinued for both conditions. We measured avoidance frequency, mouse movements, fear, eating desires and stimulus liking. Participants in the experimental condition avoided the food more often than controls and showed increased fear, reduced eating desires and less liking for cues associated with food intake. These results support the notion that food avoidance behaviours, reduced eating desires and fear of food can be learned via classical and operant conditioning. Conditioning paradigms might be a useful tool to study the development and maintenance of food restriction in anorexia nervosa.
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Affiliation(s)
- Michelle Spix
- Department of Clinical Psychological Science, Maastricht University, the Netherlands.
| | - Franziska Schutzeichel
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
| | - Anita Jansen
- Department of Clinical Psychological Science, Maastricht University, the Netherlands.
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Buzzanca‐Fried K, Morgan‐Daniel J, Snyder A, Bauer R, Lahey S, Addeo R, Houck Z, Perez C, Beneciuk J. PROTOCOL: Fear avoidance model psychological factors as predictors for persistent post-concussion clinical outcomes: An integrative review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1311. [PMID: 37131460 PMCID: PMC10052450 DOI: 10.1002/cl2.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Persisting symptoms after concussion (PSaC) include physical, cognitive, and psychological symptoms which contribute to rehabilitation challenges. Previous research has not thoroughly investigated the association between PSaC and pain-related psychological factors. Therefore, there is an opportunity to use current pain models, such as the Fear Avoidance Model (FAM), as a framework to explore these relationships. The goals of this integrative review are to (1) identify and describe range of evidence that explores relationships between psychological factors and clinical outcomes in patients with PSaC, and (2) develop a comprehensive understanding of FAM-specific psychological factors that have been identified as potential predictors of clinical outcomes in patients with PSaC. Methods This review will be based on principles and stages of an integrative review which will allow for inclusion of diverse methodologies: (1) problem formulation, (2) literature search, (3) data evaluation, (4) data analysis, and (5) presentation. Methods for reporting this review will be informed by the 2020 PRISMA guidelines for systematic reviews. Discussion The findings from this integrative review will inform healthcare professionals working in post-concussion rehabilitation settings regarding relationships between FAM psychological factors and PSaC-an area that until recently has not been thoroughly explored. Additionally, this review will inform the development of other reviews and clinical studies to further investigate relationships between FAM psychological factors and PSaC. Integrative Review Registration OSF DOI 10.17605/OSF.IO/CNGPW.
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Affiliation(s)
| | - Jane Morgan‐Daniel
- University of Florida Health Science Center LibrariesGainesvilleFloridaUSA
| | - Aliyah Snyder
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Russell Bauer
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Sarah Lahey
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Russell Addeo
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Zachary Houck
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Christopher Perez
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Jason Beneciuk
- Department of Rehabilitation ScienceUniversity of FloridaGainesvilleFloridaUSA
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Observational extinction reduces fear and its retention among adolescents and adults. Behav Res Ther 2022; 159:104207. [PMID: 36279765 DOI: 10.1016/j.brat.2022.104207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/22/2022] [Accepted: 10/05/2022] [Indexed: 12/14/2022]
Abstract
Observational fear learning has been notably understudied in fear learning research, especially the potential benefits of observational extinction. Additionally, no studies have investigated observational extinction during adolescence, a key developmental stage for the emergence of anxiety disorders. This study compared observational and direct fear extinction following observational fear acquisition among adolescents and adults. Participants underwent differential observational fear acquisition. Next, participants underwent one of three fear extinctions: (1) observational extinction, (2) direct extinction, (3) no-extinction. Thereafter, participants underwent a US reminder and finally, a direct exposure test. Skin conductance response (SCR), self-reported fear, and risk assessment were measured. Differential observational fear acquisition was demonstrated by both age groups across all measures. During extinction, the observational and direct extinction groups did not differ in differential extinction, however, during the US reminder the observational group exhibited higher SCR compared to the direct group, but not the no-extinction group. Finally, during the direct exposure test, the no-extinction group showed greater differential risk assessment and higher SCR compared to the observational and direct groups. Additionally, adolescents showed poorer discrimination between the CSs compared to adults. Observational extinction successfully reduced fear and its retention amongst youth and adults pointing to the potential benefit of vicarious exposure therapy.
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Wong AH, Pittig A. Threat belief determines the degree of costly safety behavior: Assessing rule-based generalization of safety behavior with a dimensional measure of avoidance. Behav Res Ther 2022; 156:104158. [DOI: 10.1016/j.brat.2022.104158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
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Wong AH, Wirth FM, Pittig A. Avoidance of learnt fear: Models, potential mechanisms, and future directions. Behav Res Ther 2022; 151:104056. [DOI: 10.1016/j.brat.2022.104056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/21/2022]
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Wong AHK, Pittig A. Avoiding a feared stimulus: Modelling costly avoidance of learnt fear in a sensory preconditioning paradigm. Biol Psychol 2021; 168:108249. [PMID: 34973369 DOI: 10.1016/j.biopsycho.2021.108249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/27/2022]
Abstract
Avoidance of learnt fear prevents the onset of a feared stimulus and the threat that follows. In anxiety-related disorders, it turns pathological given its cost and persistence in the absence of realistic threat. The current study examined the acquisition of costly avoidance of learnt fear in healthy individuals (n = 45), via a sensory preconditioning paradigm. Two neutral preconditioning stimuli (PSs) were paired with two neutral conditioned stimuli (CSs). One CS then came to predict an aversive outcome whereas the other CS came to predict safety. In test, participants engaged in stronger avoidance to the PS associated with the fear-related CS than the PS associated with the safety-related CS. Of note, executing behavioral avoidance led to missing out a competing reward, thus rendering avoidance costly. The results also provide preliminary evidence that threat anticipation and a negative change in valence play a role in driving costly avoidance of learnt fear. Future studies should examine how avoidance of learnt fear maintains pathological anxiety.
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Affiliation(s)
- Alex H K Wong
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Andre Pittig
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany; Translational Psychotherapy, Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Klein Z, Berger S, Vervliet B, Shechner T. Fear learning, avoidance, and generalization are more context-dependent for adults than adolescents. Behav Res Ther 2021; 147:103993. [PMID: 34740098 DOI: 10.1016/j.brat.2021.103993] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 01/02/2023]
Abstract
This study examined developmental differences in contextual and perceptual generalization of fear and avoidance learning. Adults (N = 39) and adolescents (N = 44) completed differential fear acquisition wherein each conditional stimulus (CS) appeared in a background context. In the dangerous context, one stimulus (CS+) predicted an aversive sound, and the other stimulus (CS-) did not. In the safe context, the aversive sound was never administered with either CS. During fear generalization, participants were presented with three generalization stimuli (GSs), ranging on a perceptual continuum from threat to safety stimuli, in both contexts. Participants then completed avoidance conditioning and avoidance generalization phases, allowing them to actively avoid the upcoming aversive sound by pressing an avoidance button. Developmental differences emerged in threat perception, physiological arousal, avoidance behavior, and eye movements during contextual fear learning and generalization. Adolescents showed less discrimination between stimuli and contexts than adults, resulting primarily from their elevated fear responses to safety and generalized stimuli. Developmental differences in fear learning should be further explored in future research, as they could explain why adolescence is a sensitive developmental period for anxiety.
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Affiliation(s)
- Zohar Klein
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Israel
| | - Smadar Berger
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Israel
| | - Bram Vervliet
- Laboratory for Biological Psychology, KU Leuven, Belgium; Leuven Brain Institute, KU Leuven, Belgium
| | - Tomer Shechner
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Israel.
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Skversky-Blocq Y, Haaker J, Shechner T. Watch and Learn: Vicarious Threat Learning across Human Development. Brain Sci 2021; 11:brainsci11101345. [PMID: 34679409 PMCID: PMC8533719 DOI: 10.3390/brainsci11101345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 12/21/2022] Open
Abstract
Vicarious threat learning is an important pathway in learning about safety and danger in the environment and is therefore critical for survival. It involves learning by observing another person's (the demonstrator) fearful responses to threat and begins as early as infancy. The review discusses the literature on vicarious threat learning and infers how this learning pathway may evolve over human development. We begin by discussing the methods currently being used to study observational threat learning in the laboratory. Next, we focus on the social factors influencing vicarious threat learning; this is followed by a review of vicarious threat learning among children and adolescents. Finally, we examine the neural mechanisms underpinning vicarious threat learning across human development. To conclude, we encourage future research directions that will help elucidate how vicarious threat learning emerges and how it relates to the development of normative fear and pathological anxiety.
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Affiliation(s)
- Yael Skversky-Blocq
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel;
| | - Jan Haaker
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Tomer Shechner
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel;
- Correspondence:
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