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Mitra S, Asthana MK. Investigating the effect of continuous and partial reinforcement in conceptual fear generalization. Sci Rep 2024; 14:26305. [PMID: 39487156 PMCID: PMC11530634 DOI: 10.1038/s41598-024-71575-0] [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: 05/07/2024] [Accepted: 08/29/2024] [Indexed: 11/04/2024] Open
Abstract
Fear generalization plays a major role in the acquisition and maintenance of anxiety disorders. In fear generalization, conditioned fear responses are observed for novel stimuli sharing perceptually or conceptually similar properties with the conditioned stimulus (CS). The reinforcement rates of the unconditioned stimulus (UCS) impact fear acquisition and generalization. Fear generalization can be studied using the category-based conditioning paradigm, where individuals are conditioned to members of a category rather than a single stimulus. The current study explored the effect of UCS reinforcement (i.e., continuous and partial) on conceptual fear generalization due to category-based similarity using a visual aversive UCS. The CSs were exemplars from four categories, i.e., animals, insects, household appliances, and tools. Thirty healthy participants underwent fear acquisition with exemplars from the four stimulus categories, presented with varying levels of UCS reinforcement (100%, 62.5%, and 37.5%). Subsequently, fear generalization was tested with novel unreinforced exemplars from each category. A significant effect of reinforcement on the UCS expectancy and CS-UCS contingency ratings was observed. UCS expectancy ratings increased with increasing certainty of UCS occurrence in the generalization phase. Our results may help to understand how fear generalizes to conceptually related stimuli based on the certainty of the UCS occurrence.
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Affiliation(s)
- Sharmili Mitra
- Department of Humanities & Social Sciences, Indian Institute of Technology Roorkee, Roorkee, 247667, India
| | - Manish Kumar Asthana
- Department of Humanities & Social Sciences, Indian Institute of Technology Roorkee, Roorkee, 247667, India.
- Department of Design, Indian Institute of Technology Roorkee, Roorkee, 247667, India.
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2
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Ram H, Grinfeld G, Liberman N. Anticipated variability increases generalization of predictive learning. NPJ SCIENCE OF LEARNING 2024; 9:55. [PMID: 39244561 PMCID: PMC11380665 DOI: 10.1038/s41539-024-00269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 08/23/2024] [Indexed: 09/09/2024]
Abstract
We show that learners generalized more broadly around the learned stimulus when they expected more variability between the learning set and the generalization set, as well as within the generalization set. Experiments 1 and 3 used a predictive learning task and demonstrated border perceptual generalization both when expected variability was manipulated explicitly via instructions (Experiment 1), and implicitly by increasing temporal distance to the anticipated application of learning (Experiment 3). Experiment 2 showed that expecting to apply learning in the more distant future increases expected variability in the generalization set. We explain the relation between expected variability and generalization as an accuracy-applicability trade-off: when learners anticipate more variable generalization targets, they "cast a wider net" during learning, by attributing the outcome to a broader range of stimuli. The use of more abstract, broader categories when anticipating a more distant future application aligns with Construal Level Theory of psychological distance.
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Affiliation(s)
- Hadar Ram
- Bar-Ilan University, Tel Aviv, Israel.
| | | | - Nira Liberman
- Tel Aviv University, Tel Aviv, Israel
- International Faculty, Key Profile Area II: Behavioral Economic Engineering and Social Cognition, University of Cologne, Cologne, Germany
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Kesim IE, Pittig A, Wong AHK. The effect of typicality training on costly safety behavior generalization. PSYCHOLOGICAL RESEARCH 2024; 88:1771-1782. [PMID: 38822864 PMCID: PMC11281986 DOI: 10.1007/s00426-024-01979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Typicality asymmetry in generalization refers to enhanced fear generalization when trained with typical compared to atypical exemplars. Typical exemplars are highly representative of their category, whereas atypical exemplars are less representative. Individual risk factors, such as trait anxiety, attenuate this effect, due to the high level of threat ambiguity of atypical exemplars. Although recent research provided evidence for generalization of safety behavior, it is unclear whether this generalization also follows typicality asymmetry. This study examined (1) whether participants exhibited typicality asymmetry in the generalization of safety behavior and (2) whether this effect would be attenuated by individual risk factors, such as intolerance of uncertainty and trait anxiety. METHODS Participants were trained with either typical (Typical group, n = 53) or atypical (Atypical group, n = 55) exemplars in a fear and avoidance conditioning procedure. Participants acquired differential conditioned fear and costly safety behavior to the threat- and safety-related exemplars. In a following Generalization Test, the degree of safety behavior to novel exemplars of the same categories was tested. RESULTS The Atypical group showed greater differential safety behavior responses compared to the Typical group. Higher trait anxiety was associated with lower differential safety behavior generalization, driven by an increase in generalized responding to novel safety-related exemplars. LIMITATIONS This study used hypothetical cost instead of real cost. CONCLUSIONS Training with atypical exemplars led to greater safety behavior generalization. Moreover, individuals with high trait anxiety show impaired safety behavior generalization.
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Affiliation(s)
- Işık E Kesim
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus School of Social and Behavioural Sciences, 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, 37073, Göttingen, Germany
| | - Alex H K Wong
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands.
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Patterson RR, Lipp OV, Luck CC. The influence of instructions on reversing the generalization of valence, US expectancy, and electrodermal responding in fear conditioning. Psychophysiology 2024; 61:e14429. [PMID: 37661638 DOI: 10.1111/psyp.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023]
Abstract
Pairing a conditional stimulus (CS) with an aversive unconditional stimulus (US) causes negative valence and US expectancy to generalize to stimuli that are perceptually and/or conceptually similar to the CS. Past research has shown that instructing participants that the US is more likely to follow stimuli that are dissimilar to the CS reversed the generalization of US expectancy but left generalized valence unchanged. Here, we examined whether instructions about the relationship between stimuli that are perceptually similar would affect the generalization of valence. A picture of an alien (CS+) was paired with an electric stimulus, while a perceptually different alien stimulus (CS-) was presented alone. After conditioning, valence, US expectancy, and electrodermal responses generalized to different aliens that were perceptually similar (by color and shape) to the CS+ and CS-. Participants were then instructed that aliens perceptually similar to the CS+ belonged to the same group as the CS- and that aliens perceptually similar to the CS- belonged to the same group as the CS+. The instructions caused an elimination (but not a reversal) of generalized expectancy and valence but did not affect generalized electrodermal responses. This suggests that evaluations of generalization stimuli are sensitive to instructions about their relationship to the CS and that dissociations reported in the literature between valence and expectancy after instructions may occur due to the type of instruction used.
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Affiliation(s)
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Camilla C Luck
- School of Population Health, Curtin University, Perth, Australia
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Ren LY, Cicvaric A, Zhang H, Meyer MA, Guedea AL, Gao P, Petrovic Z, Sun X, Lin Y, Radulovic J. Stress-induced changes of the cholinergic circuitry promote retrieval-based generalization of aversive memories. Mol Psychiatry 2022; 27:3795-3805. [PMID: 35551246 PMCID: PMC9846583 DOI: 10.1038/s41380-022-01610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/13/2022] [Accepted: 04/28/2022] [Indexed: 02/08/2023]
Abstract
Generalization, the process of applying knowledge acquired in one context to other contexts, often drives the expression of similar behaviors in related situations. At the cellular level, generalization is thought to depend on the activity of overlapping neurons that represent shared features between contexts (general representations). Using contextual fear conditioning in mice, we demonstrate that generalization can also occur in response to stress and result from reactivation of specific, rather than general context representations. We found that generalization emerges during memory retrieval, along with stress-induced abnormalities of septohippocampal oscillatory activity and acetylcholine release, which are typically found in negative affective states. In hippocampal neurons that represent aversive memories and drive generalization, cholinergic septohippocampal afferents contributed to a unique reactivation pattern of cFos, Npas4, and repressor element-1 silencing transcription factor (REST). Together, these findings suggest that generalization can be triggered by perceptually dissimilar but valence-congruent memories of specific aversive experiences. Through promoting the reactivation of such memories and their interference with ongoing behavior, abnormal cholinergic signaling could underlie maladaptive cognitive and behavioral generalization linked to negative affective states.
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Affiliation(s)
- Lynn Y Ren
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
| | - Ana Cicvaric
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Hui Zhang
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Mariah Aa Meyer
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
| | - Anita L Guedea
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
| | - Pan Gao
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA
| | - Zorica Petrovic
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Xiaochen Sun
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yingxi Lin
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Psychiatry, State University of New York Upstate Medical University, New York, NY, USA
| | - Jelena Radulovic
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA.
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
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6
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Kenwood MM, Kalin NH, Barbas H. The prefrontal cortex, pathological anxiety, and anxiety disorders. Neuropsychopharmacology 2022; 47:260-275. [PMID: 34400783 PMCID: PMC8617307 DOI: 10.1038/s41386-021-01109-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
Abstract
Anxiety is experienced in response to threats that are distal or uncertain, involving changes in one's subjective state, autonomic responses, and behavior. Defensive and physiologic responses to threats that involve the amygdala and brainstem are conserved across species. While anxiety responses typically serve an adaptive purpose, when excessive, unregulated, and generalized, they can become maladaptive, leading to distress and avoidance of potentially threatening situations. In primates, anxiety can be regulated by the prefrontal cortex (PFC), which has expanded in evolution. This prefrontal expansion is thought to underlie primates' increased capacity to engage high-level regulatory strategies aimed at coping with and modifying the experience of anxiety. The specialized primate lateral, medial, and orbital PFC sectors are connected with association and limbic cortices, the latter of which are connected with the amygdala and brainstem autonomic structures that underlie emotional and physiological arousal. PFC pathways that interface with distinct inhibitory systems within the cortex, the amygdala, or the thalamus can regulate responses by modulating neuronal output. Within the PFC, pathways connecting cortical regions are poised to reduce noise and enhance signals for cognitive operations that regulate anxiety processing and autonomic drive. Specialized PFC pathways to the inhibitory thalamic reticular nucleus suggest a mechanism to allow passage of relevant signals from thalamus to cortex, and in the amygdala to modulate the output to autonomic structures. Disruption of specific nodes within the PFC that interface with inhibitory systems can affect the negative bias, failure to regulate autonomic arousal, and avoidance that characterize anxiety disorders.
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Affiliation(s)
- Margaux M Kenwood
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Neuroscience Training Program at University of Wisconsin-Madison, Madison, USA
| | - Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Neuroscience Training Program at University of Wisconsin-Madison, Madison, USA
- Wisconsin National Primate Center, Madison, WI, USA
| | - Helen Barbas
- Neural Systems Laboratory, Department of Health Sciences, Boston University, Boston, MA, USA.
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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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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8
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Wang J, Wang Y, Liao M, Zou Y, Lei Y, Zhu Y. Conditioned generalisation in generalised anxiety disorder: the role of concurrent perceptual and conceptual cues. Cogn Emot 2021; 35:1516-1526. [PMID: 34602017 DOI: 10.1080/02699931.2021.1982677] [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: 10/20/2022]
Abstract
Previous research in extinction indicates no difference in US expectancies for aversive and non-aversive unconditioned stimuli (USs). In this study, we bridged these topics by examining how concurrent perceptual and conceptual cues influence conditioned generalisation of generalised anxiety disorder (GAD) patients by using non-aversive USs. The study included two consecutive phases: acquisition and generalisation. In the acquisition phase, we used blue and purple images as the perceptually conditioned stimuli, images of animals and household items as the conceptually conditioned stimuli, and non-aversive images as unconditioned stimuli (US). In the generalisation phase, we used images containing both conceptual and perceptual cues (e.g. blue animals) as the generalisation stimuli. Participants rated the US expectancy for all images. We found that compared with the control group, the patients exhibited generalisation in response to stimuli that included conditional conceptual cues. These results reveal novel evidence of generalisation in GAD and may have implications for considering the concept-based information in extinction treatment.
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Affiliation(s)
- Jinxia Wang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, People's Republic of China.,School of Psychology, Shenzhen University, Shenzhen, People's Republic of China.,Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Yizhen Wang
- School of Psychology, Shenzhen University, Shenzhen, People's Republic of China
| | - Meiling Liao
- Department of Applied Psychology, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yefeng Zou
- Fuzhou Neuropsychiatric Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yi Lei
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, People's Republic of China
| | - Yuxi Zhu
- School of Management, Shenzhen Polytechnic, Shenzhen, People's Republic of China
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Morriss J, Zuj DV, Mertens G. The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research. Int J Psychophysiol 2021; 166:116-126. [PMID: 34097936 DOI: 10.1016/j.ijpsycho.2021.05.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Daniel V Zuj
- Experimental Psychopathology Lab, Department of Psychology, Swansea University, Swansea, UK
| | - Gaëtan Mertens
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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Influence of Perceptual and Conceptual Information on Fear Generalization: A Behavioral and Event-Related Potential Study. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 21:1054-1065. [PMID: 34021495 DOI: 10.3758/s13415-021-00912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/08/2022]
Abstract
Learned fear can be generalized through both perceptual and conceptual information. This study investigated how perceptual and conceptual similarities influence this generalization process. Twenty-three healthy volunteers completed a fear-generalization test as brain activity was recorded in the form of event-related potentials (ERPs). Participants were exposed to a de novo fear acquisition paradigm with four categories of conditioned stimuli (CS): two conceptual cues (animals and furniture); and two perceptual cues (blue and purple shapes). Animals (C+) and purple shapes (P+) were paired with the unconditioned stimulus (US), whereas furniture (C-) and blue shapes (P-) never were. The generalized stimuli were thus blue animals (C+P+, determined danger), blue furniture (C-P+, perceptual danger), purple animals (C+P-, conceptual danger), and purple furniture (C-P-, determined safe). We found that perceptual cues elicited larger fear responses and shorter reaction times than did conceptual cues during fear acquisition. This suggests that a perceptually related pathway might evoke greater fear than a conceptually based route. During generalization, participants were more afraid of C+ exemplars than of C- exemplars. Furthermore, C+ trials elicited greater N400 amplitudes. Thus, participants appear able to use conceptually based cues to infer the value of the current stimuli. Additionally, compared with C+ exemplars, we found an enhanced late positive potential effect in response to C- exemplars, which seems to reflect a late inhibitory process and might index safety learning. These findings may offer new insights into the pathological mechanism of anxiety disorders.
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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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12
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Acute stress leaves fear generalization in healthy individuals intact. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 21:372-389. [PMID: 33629258 PMCID: PMC8121734 DOI: 10.3758/s13415-021-00874-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
Because threatening situations often occur in a similar manner, the generalization of fear to similar situations is adaptive and can avoid harm to the organism. However, the overgeneralization of fear to harmless stimuli is maladaptive and assumed to contribute to anxiety disorders. Thus, elucidating factors that may modulate fear (over)generalization is important. Based on the known effects of acute stress on learning, which are at least partly due to noradrenergic arousal, we investigated whether stress may promote fear overgeneralization and whether we could counteract this effect by reducing noradrenergic arousal. In a placebo-controlled, double-blind, between-subjects design, 120 healthy participants underwent a fear-conditioning procedure on Day 1. Approximately 24 hours later, participants received orally either a placebo or the beta-adrenergic receptor antagonist propranolol and were exposed to a stress or control manipulation before they completed a test of fear generalization. Skin conductance responses as well as explicit rating data showed a successful acquisition of conditioned fear on Day 1 and a pronounced fear generalization 24 hours later. Although physiological data confirmed the successful stress manipulation and reduction of noradrenergic arousal, the extent of fear generalization remained unaffected by stress and propranolol. The absence of a stress effect on fear generalization was confirmed by a second study and a Bayesian analysis across both data sets. Our findings suggest that acute stress leaves fear generalization processes intact, at least in a sample of healthy, young individuals.
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Wong AHK, Beckers T. Trait anxiety is associated with reduced typicality asymmetry in fear generalization. Behav Res Ther 2021; 138:103802. [PMID: 33482583 DOI: 10.1016/j.brat.2021.103802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
In fear conditioning, training with typical category exemplars has been shown to promote fear generalization to novel exemplars of the same category, whereas training with atypical category exemplars supports limited if any generalization to other category members, amounting to a typicality asymmetry in fear generalization. The present study sought to examine how trait anxiety bears on typicality asymmetry in fear generalization. Participants in one condition were presented with typical exemplars during fear acquisition and atypical exemplars of the same category in the subsequent generalization test (typical condition), whereas in the other group, atypical and typical exemplars were presented during fear acquisition and generalization test, respectively (atypical condition). We observed a typicality asymmetry in fear generalization in self-reported expectancy ratings in low trait anxious individuals only. High trait anxious individuals showed a similar degree of fear generalization in both conditions. The current results help illuminate why some individuals are at risk for exhibiting broad fear generalization after exposure to an aversive event.
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Affiliation(s)
- Alex H K Wong
- University of New South Wales Sydney, Sydney, NSW, Australia; Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Tom Beckers
- Centre for the 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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14
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Jacobsen HB, Klungsøyr O, Landrø NI, Stiles TC, Roche BT. MINDflex Training for Cognitive Flexibility in Chronic Pain: A Randomized, Controlled Cross-Over Trial. Front Psychol 2020; 11:604832. [PMID: 33408670 PMCID: PMC7779603 DOI: 10.3389/fpsyg.2020.604832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
Impairments in executive functioning are prevalent in chronic pain conditions, with cognitive inflexibility being the most frequently reported. The current randomized, cross-over trial, piloted a computerized cognitive training (CCT) program based on Relational Frame Theory, targeting improvement in cognitive flexibility. At baseline, 73 chronic pain patients completed testing on pre-selected outcomes of executive functioning, alongside IQ measures. When tested three times over the course of 5 months, there was a drop-out rate of 40% at the third time point, leaving 44 patients who had data at all time points. The results showed that there was a substantial learning effect from the MINDFLEX training and a substantial time-dependent improvement on the primary outcomes of increased flexibility, but that this could not be tied to active training. In conclusion, this small study indicated a learning effect as well as improvement on primary outcomes. Based on the current results, a larger trial with improved feasibility of training is warranted.
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Affiliation(s)
- Henrik B. Jacobsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Ole Klungsøyr
- Oslo Centre for Biostatistics and Epidemiology, Section for Treatment Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Nils I. Landrø
- Clinical Neuroscience Research Group, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Tore C. Stiles
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bryan T. Roche
- Department of Psychology, Maynooth University, Maynooth, Ireland
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15
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Bennett MP, Roche B, Dymond S, Baeyens F, Vervliet B, Hermans D. Transitions from avoidance: Reinforcing competing behaviours reduces generalised avoidance in new contexts. Q J Exp Psychol (Hove) 2020; 73:2119-2131. [PMID: 32686989 PMCID: PMC7672781 DOI: 10.1177/1747021820943148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Generalised avoidance behaviours are a common diagnostic feature of anxiety-related disorders and a barrier to affecting changes in anxiety during therapy. However, strategies to mitigate generalised avoidance are under-investigated. Even less attention is given to reducing the category-based generalisation of avoidance. We therefore investigated the potential of an operant-based approach. Specifically, it was examined whether reinforcing competing (non-avoidance) behaviours to threat-predictive cues would interfere with the expression of generalised avoidance. Using a matching-to-sample task, artificial stimulus categories were established using physically dissimilar nonsense shapes. A member of one category (conditioned stimulus; CS1) was then associated with an aversive outcome in an Acquisition context, unless an avoidance response was made. Next, competing behaviours were reinforced in response to the CS1 in new contexts. Finally, we tested for the generalisation of avoidance to another member of the stimulus category (generalisation stimulus; GS1) in both a Novel context and the Acquisition context. The selective generalisation of avoidance to GS1 was observed, but only in the Acquisition context. In the Novel context, the generalisation of avoidance to GSs was significantly reduced. A comparison group (Experiment 2), which did not learn any competing behaviours, avoided GS1 in both contexts. These findings suggest that reinforcing competing behavioural responses to threat-predictive cues can lead to reductions in generalised avoidance. This study is among the first study to demonstrate sustained reductions in generalised avoidance resulting from operant-based protocols, and the clinical and research implications are discussed.
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Affiliation(s)
- Marc P Bennett
- Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK
| | - Bryan Roche
- National University of Ireland, Maynooth, Ireland
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16
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Costly avoidance triggered by categorical fear generalization. Behav Res Ther 2020; 129:103606. [PMID: 32224325 DOI: 10.1016/j.brat.2020.103606] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 02/18/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
Fear generalization refers to the spread of acquired fear to novel stimuli that resemble the original fear-related stimulus. Preliminary evidence suggests that excessive fear generalization is a pathogenic feature of anxiety disorders, however, it remains unclear how fear generalization affects pathological avoidance. The current study thus aimed to examine the link between categorical fear generalization and costly avoidance. By combining a fear acquisition training phase and an avoidance test, the current findings showed that acquired fear spreads to novel stimuli that belonged to the same category of the original fear-related stimuli, but not to those that belonged to the fear-irrelevant categories. Importantly, participants avoided these fear-related novel stimuli despite costs. The current findings indicate that categorical fear generalization triggers costly avoidance. In terms of clinical implication, a decrease in costly avoidance aligned with a decrease in US expectancies. This emphasizes that behavioral approach may initiate extinction learning.
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17
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18
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Pittig A, Wong AH, Glück VM, Boschet JM. Avoidance and its bi-directional relationship with conditioned fear: Mechanisms, moderators, and clinical implications. Behav Res Ther 2020; 126:103550. [DOI: 10.1016/j.brat.2020.103550] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/16/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
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19
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Taxonomic relations evoke more fear than thematic relations after fear conditioning: An EEG study. Neurobiol Learn Mem 2020; 167:107099. [DOI: 10.1016/j.nlm.2019.107099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 08/14/2019] [Accepted: 10/09/2019] [Indexed: 01/31/2023]
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20
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Carpenter JK, Pinaire M, Hofmann SG. From Extinction Learning to Anxiety Treatment: Mind the Gap. Brain Sci 2019; 9:brainsci9070164. [PMID: 31336700 PMCID: PMC6680899 DOI: 10.3390/brainsci9070164] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022] Open
Abstract
Laboratory models of extinction learning in animals and humans have the potential to illuminate methods for improving clinical treatment of fear-based clinical disorders. However, such translational research often neglects important differences between threat responses in animals and fear learning in humans, particularly as it relates to the treatment of clinical disorders. Specifically, the conscious experience of fear and anxiety, along with the capacity to deliberately engage top-down cognitive processes to modulate that experience, involves distinct brain circuitry and is measured and manipulated using different methods than typically used in laboratory research. This paper will identify how translational research that investigates methods of enhancing extinction learning can more effectively model such elements of human fear learning, and how doing so will enhance the relevance of this research to the treatment of fear-based psychological disorders.
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Affiliation(s)
- Joseph K Carpenter
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Megan Pinaire
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA.
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21
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Lei Y, Wang J, Dou H, Qiu Y, Li H. Influence of typicality in category-based fear generalization: Diverging evidence from the P2 and N400 effect. Int J Psychophysiol 2019; 135:12-20. [DOI: 10.1016/j.ijpsycho.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 01/22/2023]
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22
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Hayes SC, Hofmann SG. Survival circuits and therapy: from automaticity to the conscious experience of fear and anxiety. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Mertens G, Boddez Y, Sevenster D, Engelhard IM, De Houwer J. A review on the effects of verbal instructions in human fear conditioning: Empirical findings, theoretical considerations, and future directions. Biol Psychol 2018; 137:49-64. [DOI: 10.1016/j.biopsycho.2018.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/14/2022]
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24
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Quaddles: A multidimensional 3-D object set with parametrically controlled and customizable features. Behav Res Methods 2018; 51:2522-2532. [PMID: 30088255 DOI: 10.3758/s13428-018-1097-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many studies of vision and cognition require novel three-dimensional object sets defined by a parametric feature space. Creating such sets and verifying that they are suitable for a given task, however, can be time-consuming and effortful. Here we present a new set of multidimensional objects, Quaddles, designed for studies of feature-based learning and attention, but adaptable for many research purposes. Quaddles have features that are all equally visible from any angle around the vertical axis and can be designed to be equally discriminable along feature dimensions; these objects do not show strong or consistent response biases, with a small number of quantified exceptions. They are available as two-dimensional images, rotating videos, and FBX object files suitable for use with any modern video game engine. We also provide scripts that can be used to generate hundreds of thousands of further Quaddles, as well as examples and tutorials for modifying Quaddles or creating completely new object sets from scratch, with the aim to speed up the development time of future novel-object studies.
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25
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Boddez Y. The presence of your absence: A conditioning theory of grief. Behav Res Ther 2018; 106:18-27. [DOI: 10.1016/j.brat.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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26
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Dymond S, Bennett M, Boyle S, Roche B, Schlund M. Related to Anxiety: Arbitrarily Applicable Relational Responding and Experimental Psychopathology Research on Fear and Avoidance. Perspect Behav Sci 2018; 41:189-213. [PMID: 32004365 PMCID: PMC6701705 DOI: 10.1007/s40614-017-0133-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Humans have an unparalleled ability to engage in arbitrarily applicable relational responding (AARR). One of the consequences of this ability to spontaneously combine and relate events from the past, present, and future may, in fact, be a propensity to suffer. For instance, maladaptive fear and avoidance of remote or derived threats may actually perpetuate anxiety. In this narrative review, we consider contemporary AARR research on fear and avoidance as it relates to anxiety. We first describe laboratory-based research on the emergent spread of fear- and avoidance-eliciting functions in humans. Next, we consider the validity of AARR research on fear and avoidance and address the therapeutic implications of the work. Finally, we outline challenges and opportunities for a greater synthesis between behavior analysis research on AARR and experimental psychopathology.
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Affiliation(s)
- Simon Dymond
- Experimental Psychopathology Lab, Department of Psychology, Swansea University, Singleton Campus, Swansea, SA2 8PP UK
- Department of Psychology, Reykjavík University, Menntavegur 1, Nauthólsvík, 101 Reykjavík, Iceland
| | - Marc Bennett
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Sean Boyle
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Bryan Roche
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare Ireland
| | - Michael Schlund
- Department of Psychiatry, University of Pittsburgh, Loeffler Building, Room 316, 121 Meyran Avenue, Pittsburgh, PA 15213 USA
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Pittig A, Treanor M, LeBeau RT, Craske MG. The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research. Neurosci Biobehav Rev 2018; 88:117-140. [DOI: 10.1016/j.neubiorev.2018.03.015] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 12/25/2022]
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28
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Koban L, Kusko D, Wager TD. Generalization of learned pain modulation depends on explicit learning. Acta Psychol (Amst) 2018; 184:75-84. [PMID: 29025685 DOI: 10.1016/j.actpsy.2017.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 08/28/2017] [Accepted: 09/19/2017] [Indexed: 11/30/2022] Open
Abstract
The experience of pain is strongly influenced by contextual and socio-affective factors, including learning from previous experiences. Pain is typically perceived as more intense when preceded by a conditioned cue (CSHIGH) that has previously been associated with higher pain intensities, compared to cues associated with lower intensities (CSLOW). In three studies (total N=134), we tested whether this learned pain modulation generalizes to perceptually similar cues (Studies 1 and 2) and conceptually similar cues (Study 3). The results showed that participants report higher pain when heat stimulation was preceded by novel stimuli that were either perceptually (Studies 1 and 2) or conceptually (Study 3) similar to the previously conditioned CSHIGH. In all three studies, the strength of this generalization effect was strongly correlated with individual differences in explicitly learned expectations. Together, these findings suggest an important role of conscious expectations and higher-order conceptual inference during generalization of learned pain modulation. We discuss implications for the understanding of placebo and nocebo effects as well as for chronic pain and anxiety.
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Affiliation(s)
- Leonie Koban
- Department of Psychology and Neuroscience, University of Colorado Boulder, United States; Institute of Cognitive Science, University of Colorado Boulder, United States.
| | - Daniel Kusko
- Department of Psychology and Neuroscience, University of Colorado Boulder, United States; Institute of Cognitive Science, University of Colorado Boulder, United States
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado Boulder, United States; Institute of Cognitive Science, University of Colorado Boulder, United States
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The Concept of Contexts in Pain: Generalization of Contextual Pain-Related Fear Within a de Novo Category of Unique Contexts. THE JOURNAL OF PAIN 2018; 19:76-87. [DOI: 10.1016/j.jpain.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
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30
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Vahey NA, Bennett M, Whelan R. Conceptual advances in the cognitive neuroscience of learning: Implications for relational frame theory. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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31
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Bennett MP, Meulders A, Baeyens F, Vlaeyen JWS. Words putting pain in motion: the generalization of pain-related fear within an artificial stimulus category. Front Psychol 2015; 6:520. [PMID: 25983704 PMCID: PMC4415322 DOI: 10.3389/fpsyg.2015.00520] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/13/2015] [Indexed: 12/03/2022] Open
Abstract
Patients with chronic pain are often fearful of movements that never featured in painful episodes. This study examined whether a neutral movement's conceptual relationship with pain-relevant stimuli could precipitate pain-related fear; a process known as symbolic generalization. As a secondary objective, we also compared experiential and verbal fear learning in the generalization of pain-related fear. We conducted an experimental study with 80 healthy participants who were recruited through an online experimental management system (M age = 23.04 years, SD = 6.80 years). First, two artificial categories were established wherein nonsense words and joystick arm movements were equivalent. Using a between-groups design, nonsense words from one category were paired with either an electrocutaneous stimulus (pain-US) or threatening information, while nonsense words from the other category were paired with no pain-US or safety information. During a final testing phase, participants were prompted to perform specific joystick arm movements that were never followed by a pain-US, although they were informed that it could occur. The results showed that movements equivalent to the pain-relevant nonsense words evoked heightened pain-related fear as measured by pain-US expectancy, fear of pain, and unpleasantness ratings. Also, experience with the pain-US evinced stronger acquisition and generalization compared to experience with threatening information. The clinical importance and theoretical implications of these findings are discussed.
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Affiliation(s)
- Marc P. Bennett
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of LeuvenLeuven, Belgium
- Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of LeuvenLeuven, Belgium
| | - Ann Meulders
- Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of LeuvenLeuven, Belgium
- Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of LeuvenLeuven, Belgium
| | - Frank Baeyens
- Centre for Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of LeuvenLeuven, Belgium
- Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of LeuvenLeuven, Belgium
| | - Johan W. S. Vlaeyen
- Center for Excellence on Generalization Research in Health and Psychopathology, Faculty of Psychology and Educational Science, University of LeuvenLeuven, Belgium
- Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, University of LeuvenLeuven, Belgium
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht UniversityMaastricht, Netherlands
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