1
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Strigo IA, Craig ADB, Simmons AN. Expectation of pain and relief: A dynamical model of the neural basis for pain-trauma co-morbidity. Neurosci Biobehav Rev 2024; 163:105750. [PMID: 38849067 DOI: 10.1016/j.neubiorev.2024.105750] [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: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
Posttraumatic Stress Disorder (PTSD) is highly co-morbid with chronic pain conditions. When present, PTSD significantly worsens chronic pain outcomes. Likewise, pain contributes to a more severe PTSD as evidenced by greater disability, more frequent use of harmful opioid analgesics and increased pain severity. The biomechanism behind this comorbidity is incompletely understood, however recent work strongly supports the widely-accepted role of expectation, in the entanglement of chronic pain and trauma symptoms. This work has shown that those with trauma have a maladaptive brain response while expecting stress and pain, whereas those with chronic pain may have a notable impairment in brain response while expecting pain relief. This dynamical expectation model of the interaction between neural systems underlying expectation of pain onset (traumatic stress) and pain offset (chronic pain) is biologically viable and may provide a biomechanistic insight into pain-trauma comorbidity. These predictive mechanisms work through interoceptive pathways in the brain critically the insula cortex. Here we highlight how the neural expectation-related mechanisms augment the existing models of pain and trauma to better understand the dynamics of pain and trauma comorbidity. These ideas will point to targeted complementary clinical approaches, based on mechanistically separable neural biophenotypes for the entanglement of chronic pain and trauma symptoms.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | | | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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2
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Robinson MD, Irvin RL, Asad MR. Threat sensitivity in emotion dynamics: Negativity effects and sex differences. Behav Res Ther 2024; 178:104542. [PMID: 38648683 DOI: 10.1016/j.brat.2024.104542] [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: 12/13/2023] [Revised: 03/03/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
Evolutionary theorizing has given rise to the idea that responding to any particular threat may be more mandatory than responding to any particular reward. The present three experiments (total N = 375) sought to provide support for this perspective in an emotion dynamics task in which participants continuously rated their affective state in response to appetitive (reward-related) versus aversive (threat-related) images. Even when equating images for arousal and extremity, several negativity effects (e.g., steeper reactivity slopes in response to aversive images) were found. These negativity effects can serve as an experimental model of threat sensitivity, which should predispose some individuals, more than others, to symptoms related to fear and anxiety. This point was made with respect to sex differences, given that women (relative to men) are diagnosed with anxiety disorders at higher rates. Sex differences were pronounced and extensions of this work, both basic and applied, are proposed.
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3
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Cichocki AC, Zinbarg RE, Craske MG, Chat IKY, Young KS, Bookheimer SY, Nusslock R. Transdiagnostic symptom of depression and anxiety associated with reduced gray matter volume in prefrontal cortex. Psychiatry Res Neuroimaging 2024; 339:111791. [PMID: 38359709 PMCID: PMC10938645 DOI: 10.1016/j.pscychresns.2024.111791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/25/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
Dimensional models of psychopathology may provide insight into mechanisms underlying comorbid depression and anxiety and improve specificity and sensitivity of neuroanatomical findings. The present study is the first to examine neural structure alterations using the empirically derived Tri-level Model. Depression and anxiety symptoms of 269 young adults were assessed using the Tri-level Model dimensions: General Distress (transdiagnostic depression and anxiety symptoms), Anhedonia-Apprehension (relatively specific depression symptoms), and Fears (specific anxiety symptoms). Using structural MRI, gray matter volumes were extracted for emotion generation (amygdala, nucleus accumbens) and regulation (orbitofrontal, ventrolateral, and dorsolateral prefrontal cortex) regions, often implicated in depression and anxiety. Each Tri-level symptom was regressed onto each region of interest, separately, adjusting for relevant covariates. General Distress was significantly associated with smaller gray matter volumes in bilateral orbitofrontal cortex and ventrolateral prefrontal cortex, independent of Anhedonia-Apprehension and Fears symptom dimensions. These results suggests that prefrontal alterations are associated with transdiagnostic dysphoric mood common across depression and anxiety, rather than unique symptoms of these disorders. Additionally, no regions of interest were associated with Anhedonia-Apprehension or Fears, highlighting the importance of studying transdiagnostic features of depression and anxiety. This has implications for understanding mechanisms of and interventions for depression and anxiety.
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Affiliation(s)
- Anna C Cichocki
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States.
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States; The Family Institute at Northwestern University, Evanston, IL, United States
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Iris K-Y Chat
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States
| | - Katherine S Young
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Susan Y Bookheimer
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Swift Hall, 2029 Sheridan Road, Evanston IL 60208, United States
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4
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Qiao Z, Poppelaars ES, Li X. In the anticipation of threat: Neural regulatory activity indicated by delta-beta correlation and its relation to anxiety. Biol Psychol 2024; 187:108769. [PMID: 38447860 DOI: 10.1016/j.biopsycho.2024.108769] [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: 07/06/2023] [Revised: 11/16/2023] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
The anticipation of oncoming threats is emotionally challenging and related to anxiety. The current study aimed to investigate the neural regulatory processes during the anticipatory preparations in stressful situations in relation to trait anxiety, especially in an uncertainty-related stressful situation. To this end, we measured within-subjects delta-beta amplitude-amplitude correlation (AAC) and phase-amplitude coupling (PAC) with electroencephalography using a well-defined stress-inducing paradigm in 28 high-trait-anxiety (HTA) and 29 low-trait-anxiety (LTA) college students. Specifically, a threat probability task was conducted, where participants anticipated the future stimuli under the uncertain (i.e., an average of 50% electric shocks), certain (i.e., 100% electric shocks) and no threat conditions, as well as a resting state task. Results showed a generally larger delta-beta AAC in the LTA group relative to the HTA group across conditions, supporting the hypothesis that delta-beta AAC reflects the efficiency of stress regulation and trait anxiety could compromise this adaptive regulatory activity. Furthermore, a larger delta-beta PAC was found under the uncertain threat condition relative to the no threat condition, indicating the sensitivity of delta-beta PAC in reflecting state anxiety. These findings indicate that while delta-beta AAC is more related to trait anxiety and could distinguish between high and low trait anxiety irrespective of conditions, delta-beta PAC is more related to state anxiety and is sensitive enough to detect the uncertainty-related anxious state.
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Affiliation(s)
- Zhiling Qiao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China; Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven 3000, Belgium
| | | | - Xuebing Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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5
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Carpenter JK. Normalizing Uncertain Threat: What Change in Anxiety-Potentiated Startle Can Tell Us About Anxiety Treatment. Biol Psychiatry 2024; 95:e1-e3. [PMID: 38030310 DOI: 10.1016/j.biopsych.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Joseph K Carpenter
- National Center for PTSD, Women's Health Sciences Division, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
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6
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Hoge EA, Armstrong CH, Mete M, Oliva I, Lazar SW, Lago TR, Grillon C. Attenuation of Anxiety-Potentiated Startle After Treatment With Escitalopram or Mindfulness Meditation in Anxiety Disorders. Biol Psychiatry 2024; 95:85-92. [PMID: 37331547 DOI: 10.1016/j.biopsych.2023.06.003] [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: 10/28/2022] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Biological markers for anxiety disorders may further understanding of disorder pathophysiology and suggest potential targeted treatments. The fear-potentiated startle (FPS) (a measure of startle to predictable threat) and anxiety-potentiated startle (APS) (startle to unpredictable threat) laboratory paradigm has been used to detect physiological differences in individuals with anxiety disorders compared with nonanxious control individuals, and in pharmacological challenge studies in healthy adults. However, little is known about how startle may change with treatment for anxiety disorders, and no data are available regarding alterations due to mindfulness meditation training. METHODS Ninety-three individuals with anxiety disorders and 66 healthy individuals completed 2 sessions of the neutral, predictable, and unpredictable threat task, which employs a startle probe and the threat of shock to assess moment-by-moment fear and anxiety. Between the two testing sessions, patients received randomized 8-week treatment with either escitalopram or mindfulness-based stress reduction. RESULTS APS, but not FPS, was higher in participants with anxiety disorders compared with healthy control individuals at baseline. Further, there was a significantly greater decrease in APS for both treatment groups compared with the control group, with the patient groups showing reductions bringing them into the range of control individuals at the end of the treatment. CONCLUSIONS Both anxiety treatments (escitalopram and mindfulness-based stress reduction) reduced startle potentiation during unpredictable (APS) but not predictable (FPS) threat. These findings further validate APS as a biological correlate of pathological anxiety and provide physiological evidence for the impact of mindfulness-based stress reduction on anxiety disorders, suggesting that there may be comparable effects of the two treatments on anxiety neurocircuitry.
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Affiliation(s)
- Elizabeth A Hoge
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC.
| | | | - Mihriye Mete
- Center of Biostatistics, Informatics and Data Science, Medstar Health Research Institute, Hyattsville, Maryland
| | - Isabelle Oliva
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tiffany R Lago
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Christian Grillon
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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7
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Wilson KA, MacNamara A. Transdiagnostic Fear and Anxiety: Prospective Prediction Using the No-Threat, Predictable Threat, and Unpredictable Threat Task. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:930-938. [PMID: 37881540 PMCID: PMC10593901 DOI: 10.1016/j.bpsgos.2022.10.004] [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: 07/25/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Fear and anxiety are distinct dimensions of psychopathology that may be characterized by differences in dimensional threat reactivity. Heightened response to predictable threat is hypothesized to underlie fear symptomatology, whereas increased response to unpredictable threat may underlie anxiety. Despite widespread acceptance of this model, these purported associations have rarely been tested, and the prognostic value of predictable and unpredictable threat responding is unclear. Here we examined multilevel indicators of predictable and unpredictable threat response as cross-sectional correlates and prospective predictors of transdiagnostic fear and anxiety. Methods Fifty-two individuals with varying levels of internalizing psychopathology (31 female) performed the no-threat, predictable threat, and unpredictable threat task. Transdiagnostic fear and anxiety were assessed at baseline (time 1) and approximately 1.5 years later (time 2). We used event-related potential, the stimulus-preceding negativity, as a measure of threat anticipation and startle eyeblink as a measure of defensive reactivity during the no-threat, predictable threat, and unpredictable threat task. These probes were assessed as cross-sectional correlates and prospective predictors of fear and anxiety. Results Participants with larger time 1 stimulus-preceding negativities to predictable threat were characterized by greater time 1 fear. Larger time 1 stimulus-preceding negativities to unpredictable threat were associated with greater increases in time 2 anxiety. Heightened time 1 startle to predictable threat predicted larger increases in time 2 fear. Conclusions Results validate predictable and unpredictable threat responding as dimensional correlates of transdiagnostic fear versus anxiety and suggest that psychophysiological measures of predictable and unpredictable threat response hold promise as prospective predictors of trajectories of fear and anxiety.
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Affiliation(s)
- Kayla A. Wilson
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
- Institute for Neuroscience, Texas A&M University, College Station, Texas
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8
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Verona E, McDonald JB, Bozzay ML. Threat effects on cognitive systems: Testing links to aggression proneness. Emotion 2023; 23:1633-1647. [PMID: 36355676 PMCID: PMC10169539 DOI: 10.1037/emo0001178] [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] [Indexed: 11/12/2022]
Abstract
The biobehavioral study of aggression has implications for expanding our understanding of transdiagnostic processes that increase risk for disinhibited behaviors. Toward this end, our study tested tenets from the process model of aggression (Verona & Bresin, 2015). First, we expected that the predictability of threat would differentially alter cognitive networks, including attentional alerting and executive control. Second, we examined the moderating effects of self- and informant reports of aggression on threat-related changes in cognitive functioning. Using event-related potential (ERP) measures of cognitive-attentional processes, 143 community individuals participated in a well-validated and translational threat manipulation (NPU) task (Schmitz & Grillon, 2012) while completing the Attention Network Test (Fan et al., 2002). Analyses revealed that relatively unpredictable threat quickened alerting-related reaction time, whereas predictable threat interfered with processing of flanker task stimuli. The results, however, failed to show reliable relationships between aggression proneness and threat-related cognitive alterations. The findings fit with a broader literature on cognitive and behavioral outputs of threat activation and provide fruitful avenues for better understanding threat-related aggression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Edelyn Verona
- Department of Psychology, University of South Florida
- Center for Justice Research & Policy, University of South Florida
| | | | - Melanie L. Bozzay
- Alpert Medical School of Brown University
- Providence VA Medical Center
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9
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Ferry RA, Beatty CC, Klein DN, Nelson BD. Family study of the startle reflex and event-related potentials in anticipation of predictable and unpredictable threat in adolescents and their parents. Psychophysiology 2023; 60:e14311. [PMID: 37076982 PMCID: PMC10524960 DOI: 10.1111/psyp.14311] [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: 07/01/2021] [Revised: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
A heightened sensitivity to unpredictable threat has been identified as a potential transdiagnostic mechanism of psychopathology. The majority of supporting research has been conducted in adults, and it is unclear whether psychophysiological indicators of sensitivity to unpredictable threat are comparable in youth during developmental periods associated with increased risk for psychopathology. In addition, no studies have examined whether sensitivity to unpredictable threat is correlated between parents and their offspring. The present study examined defensive motivation (startle reflex) and attentional engagement (probe N100, P300) in anticipation of predictable and unpredictable threat in a sample of 15-year-old adolescents (N = 395) and a biological parent (N = 379). Adolescents, compared to their parents, demonstrated greater startle potentiation and probe N100 enhancement in anticipation of unpredictable threat. In addition, overall startle potentiation in anticipation of threat was correlated between the adolescents and their parents. Adolescence is a key developmental period characterized by heightened defensive motivation and attentional engagement in anticipation of both predictable and unpredictable threat. Sensitivity to threat might index is one mechanism of vulnerability that is at least partially shared between parents and their offspring.
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Affiliation(s)
- Rachel A Ferry
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Clare C Beatty
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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10
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Beatty CC, Ferry RA, Eaton NR, Klein DN, Nelson BD. Neurobiological sensitivity to unpredictable threat and familial risk for the internalizing and externalizing spectra in adolescents. Psychol Med 2023; 53:5395-5404. [PMID: 35982518 DOI: 10.1017/s0033291722002434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adolescence is a key developmental period for the emergence of psychiatric disorders. However, there is still no consensus on the core mechanisms of dysfunction in youth. Neurobiological sensitivity to unpredictable threat has been associated with several psychiatric disorders in adults. The present study examined adolescent defensive motivation (startle reflex) and attention (event-related potentials) in anticipation of unpredictable threat in relation to both adolescent and maternal (i.e. familial risk) internalizing and externalizing spectra. METHODS The sample included 395 15-year-old adolescents and their biological mothers. Adolescent startle potentiation and probe P300 suppression (indicating increased attention to threat) were measured in anticipation of predictable and unpredictable threat. Adolescent and maternal lifetime history of psychiatric disorders were assessed via semi-structured diagnostic interviews, and confirmatory factor analysis was used to model internalizing and externalizing spectra. RESULTS The adolescent internalizing spectrum was positively associated with adolescent startle potentiation and probe P300 suppression to unpredictable threat. Conversely, the adolescent externalizing spectrum was negatively associated with adolescent P300 suppression to unpredictable threat. The maternal internalizing spectrum was positively associated with adolescent startle potentiation to unpredictable threat and P300 suppression to both predictable and unpredictable threat. The maternal externalizing spectrum was negatively associated with adolescent startle potentiation to unpredictable threat and P300 suppression to both predictable and unpredictable threat. Adolescent and maternal internalizing and externalizing spectra were independently related to adolescent startle potentiation and P300 suppression. CONCLUSIONS Adolescent neurobiological sensitivity to unpredictable threat is associated with both personal history and familial risk for the internalizing and externalizing spectra.
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Affiliation(s)
- Clare C Beatty
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Rachel A Ferry
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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11
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Abend R. Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum. Neurosci Biobehav Rev 2023; 152:105305. [PMID: 37414377 PMCID: PMC10528507 DOI: 10.1016/j.neubiorev.2023.105305] [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: 07/09/2022] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.
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Affiliation(s)
- Rany Abend
- School of Psychology, Reichman University, P.O. Box 167, Herzliya 4610101, Israel; Section on Development and Affective Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
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12
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Difede J, McAleavey AA, Emrich M, Jick A, Ovalles A, Wyka K, Spielman L, Olden M, Peskin M, Becket-Davenport C, Rubenstein A, Brownstein MJ, Damiano E, Itzkowitz D, Lu SF, Needell NJ, Kocsis JH, Gordon-Elliott JS, Simon NG. A proof-of-concept randomized crossover clinical trial of a first-in-class vasopressin 1a receptor antagonist for PTSD: Design, methods, and recruitment. Contemp Clin Trials Commun 2023; 33:101116. [PMID: 37008794 PMCID: PMC10060168 DOI: 10.1016/j.conctc.2023.101116] [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: 10/19/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
Background Almost eight million Americans suffer from Posttraumatic Stress Disorder (PTSD). Current PTSD drug therapies rely on repurposed antidepressants and anxiolytics, which produce undesirable side effects and have recognized compliance issues. Vasopressin represents a promising and novel target for pharmacological intervention. Logistical issues implementing a clinical trial for a novel PTSD pharmaceutical are relatively uncharted territory as trials concerning a new agent have not been published in the past several decades. All published trials have repurposed FDA-approved psychoactive medications with known risk profiles. Our recruitment challenges are discussed in this context. Methods An 18-week proof-of-concept randomized crossover clinical trial of a first-in-class vasopressin 1a receptor antagonist (SRX246) for PTSD was conducted. All participants received SRX246 for 8 weeks, the placebo for 8 weeks, and the drug vs. placebo arms were compared. Participants were assessed every 2 weeks for PTSD symptoms as well as other medication effects. Results were expected to provide an initial demonstration of safety and tolerability in this clinical population and potentially clinical efficacy in SRX246-treated patients measured by Clinician Administered PTSD Scale (CAPS) score changes, clinical impression, and other indices compared to placebo. The primary hypothesis was that SRX246 would result in a clinically meaningful 10-point reduction in mean CAPS score compared to placebo. Discussion This study is the first to investigate an oral vasopressin 1a receptor antagonist for PTSD. As a wave of PTSD clinical trials with new pharmaceutical compounds are beginning now, lessons learned from our recruitment challenges may be invaluable to these endeavors.
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Affiliation(s)
- JoAnn Difede
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | | | - Mariel Emrich
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Adina Jick
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Annell Ovalles
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Lisa Spielman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan Olden
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Melissa Peskin
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | | | - Amy Rubenstein
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | | | - Eve Damiano
- Azevan Pharmaceuticals, Inc. Bethlehem, PA, USA
| | | | - Shi-fang Lu
- Azevan Pharmaceuticals, Inc. Bethlehem, PA, USA
- Department of Biological Sciences, Lehigh University, Bethlehem, PA, USA
| | - Nancy J. Needell
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - James H. Kocsis
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | | | - Neal G. Simon
- Azevan Pharmaceuticals, Inc. Bethlehem, PA, USA
- Department of Biological Sciences, Lehigh University, Bethlehem, PA, USA
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13
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Brown VM, Price R, Dombrovski AY. Anxiety as a disorder of uncertainty: implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:844-868. [PMID: 36869259 PMCID: PMC10475148 DOI: 10.3758/s13415-023-01080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
In cognitive-behavioral conceptualizations of anxiety, exaggerated threat expectancies underlie maladaptive anxiety. This view has led to successful treatments, notably exposure therapy, but is not consistent with the empirical literature on learning and choice alterations in anxiety. Empirically, anxiety is better described as a disorder of uncertainty learning. How disruptions in uncertainty lead to impairing avoidance and are treated with exposure-based methods, however, is unclear. Here, we integrate concepts from neurocomputational learning models with clinical literature on exposure therapy to propose a new framework for understanding maladaptive uncertainty functioning in anxiety. Specifically, we propose that anxiety disorders are fundamentally disorders of uncertainty learning and that successful treatments, particularly exposure therapy, work by remediating maladaptive avoidance from dysfunctional explore/exploit decisions in uncertain, potentially aversive situations. This framework reconciles several inconsistencies in the literature and provides a path forward to better understand and treat anxiety.
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Affiliation(s)
- Vanessa M Brown
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Rebecca Price
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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14
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Carsten HP, Härpfer K, Nelson BD, Kathmann N, Riesel A. Don't worry, it won't be fine. Contributions of worry and anxious arousal to startle responses and event-related potentials in threat anticipation. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023:10.3758/s13415-023-01094-4. [PMID: 37106311 PMCID: PMC10400686 DOI: 10.3758/s13415-023-01094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/29/2023]
Abstract
A widely shared framework suggests that anxiety maps onto two dimensions: anxious apprehension and anxious arousal. Previous research linked individual differences in these dimensions to differential neural response patterns in neuropsychological, imaging, and physiological studies. Differential effects of the anxiety dimensions might contribute to inconsistencies in prior studies that examined neural processes underlying anxiety, such as hypersensitivity to unpredictable threat. We investigated the association between trait worry (as a key component of anxious apprehension), anxious arousal, and the neural processing of anticipated threat. From a large online community sample (N = 1,603), we invited 136 participants with converging and diverging worry and anxious arousal profiles into the laboratory. Participants underwent the NPU-threat test with alternating phases of unpredictable threat, predictable threat, and safety, while physiological responses (startle reflex and startle probe locked event-related potential components N1 and P3) were recorded. Worry was associated with increased startle responses to unpredictable threat and increased attentional allocation (P3) to startle probes in predictable threat anticipation. Anxious arousal was associated with increased startle and N1 in unpredictable threat anticipation. These results suggest that trait variations in the anxiety dimensions shape the dynamics of neural processing of threat. Specifically, trait worry seems to simultaneously increase automatic defensive preparation during unpredictable threat and increase attentional responding to threat-irrelevant stimuli during predictable threat anticipation. The current study highlights the utility of anxiety dimensions to understand how physiological responses during threat anticipation are altered in anxiety and supports that worry is associated with hypersensitivity to unpredictable, aversive contexts.
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Affiliation(s)
- Hannes Per Carsten
- Department of Psychology, University of Hamburg, Von-Melle-Park 11, 20146, Hamburg, Germany.
| | - Kai Härpfer
- Department of Psychology, University of Hamburg, Von-Melle-Park 11, 20146, Hamburg, Germany
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Norbert Kathmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Anja Riesel
- Department of Psychology, University of Hamburg, Von-Melle-Park 11, 20146, Hamburg, Germany
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15
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Stegmann Y, Andreatta M, Wieser MJ. The effect of inherently threatening contexts on visuocortical engagement to conditioned threat. Psychophysiology 2023; 60:e14208. [PMID: 36325884 DOI: 10.1111/psyp.14208] [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: 03/22/2022] [Revised: 09/06/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
Fear and anxiety are crucial for adaptive responding in life-threatening situations. Whereas fear is a phasic response to an acute threat accompanied by selective attention, anxiety is characterized by a sustained feeling of apprehension and hypervigilance during situations of potential threat. In the current literature, fear and anxiety are usually considered mutually exclusive, with partially separated neural underpinnings. However, there is accumulating evidence that challenges this distinction between fear and anxiety, and simultaneous activation of fear and anxiety networks has been reported. Therefore, the current study experimentally tested potential interactions between fear and anxiety. Fifty-two healthy participants completed a differential fear conditioning paradigm followed by a test phase in which the conditioned stimuli were presented in front of threatening or neutral contextual images. To capture defense system activation, we recorded subjective (threat, US-expectancy), physiological (skin conductance, heart rate) and visuocortical (steady-state visual evoked potentials) responses to the conditioned stimuli as a function of contextual threat. Results demonstrated successful fear conditioning in all measures. In addition, threat and US-expectancy ratings, cardiac deceleration, and visuocortical activity were enhanced for fear cues presented in threatening compared with neutral contexts. These results are in line with an additive or interactive rather than an exclusive model of fear and anxiety, indicating facilitated defensive behavior to imminent danger in situations of potential threat.
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Affiliation(s)
- Yannik Stegmann
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Marta Andreatta
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthias J Wieser
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
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16
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Shi B, Xu K, Zhao J. The long-term impacts of air quality on fine-grained online emotional responses to haze pollution in 160 Chinese cities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 864:161160. [PMID: 36572304 DOI: 10.1016/j.scitotenv.2022.161160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Air pollution poses a great threat to public health and social stability by influencing multiple emotions. In particular, the air quality in developing countries is deteriorating along with rapid industrialization and urbanization, and multiple emotions may change along with regulation updates and air quality trending. Monitoring changes in public emotion is crucial for environmental governance. However, limited evidence exists for long-term effects of air quality on fine-grained emotions. Traditional surveys have the drawbacks of spatial limitations and high costs of time and money. Here, we use deep learning models to identify multiple emotions of over 10 million haze-related tweets and evaluate the effect of air quality on emotional predispositions for 160 cities from 2014 to 2019 in China. We find that sadness and joy are persistently associated with air quality, while anger and disgust are not. Surprisingly, the effects on fear vanished in the last three years. Moreover, air pollution initially had a greater impact on expressed fear in cities with higher income, poorer air quality and a greater percentage of women. Through popularity ranking and dynamic topic model, we interpretively revealed that people are no longer overly panicked and their attention is shifting toward policies and sources of haze. Our findings highlight the temporal evolution in the public's emotional response and provide significant implications for equitable public policies.
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Affiliation(s)
- Bowen Shi
- State Key Laboratory of Software Development Environment, Beihang University, Beijing 10091, China
| | - Ke Xu
- State Key Laboratory of Software Development Environment, Beihang University, Beijing 10091, China
| | - Jichang Zhao
- School of Economics and Management, Beihang University, Beijing 10091, China.
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17
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Barber KE, Zainal NH, Newman MG. The mediating effect of stress reactivity in the 18-year bidirectional relationship between generalized anxiety and depression severity. J Affect Disord 2023; 325:502-512. [PMID: 36642311 PMCID: PMC9930685 DOI: 10.1016/j.jad.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and major depressive disorder (MDD) often precede and predict one another. Heightened stress reactivity may be a mediation mechanism underlying the long-term connections between GAD and MDD. However, cross-sectional studies on this topic have hindered directional inferences. METHOD The present study examined stress reactivity as a potential mediator of the sequential associations between GAD and MDD symptoms in a sample of 3,294 community-dwelling adults (M age = 45.6, range = 20-74). Participants completed three waves of measurement (T1, T2, and T3) spaced nine years apart. GAD and MDD symptom severity were assessed at T1, T2, and T3 (Composite International Diagnostic Interview-Short Form). Stress reactivity (Multidimensional Personality Questionnaire) was measured at T2. RESULTS Structural equation mediation modeling demonstrated that higher T1 GAD symptoms positively predicted more severe T3 MDD symptoms via T2 stress reactivity, controlling for T1 MDD (d = 0.45-0.50). However, T2 stress reactivity was not a significant mediator in the relationship between T1 MDD severity and T3 GAD symptoms after controlling for T1 GAD. Direct effects indicated that T1 GAD positively predicted T3 MDD 18 years later and vice versa (d = 1.29-1.65). LIMITATIONS Stress reactivity was assessed using a self-report measure, limiting conclusions to perceived (vs. physiologically indexed) stress reactivity. CONCLUSIONS These findings indicate that stress reactivity may be one mechanism through which GAD leads to later MDD over prolonged durations. Overall, results suggest that targeting stress reactivity in treatments for GAD may reduce the risk of developing subsequent MDD.
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Affiliation(s)
- Kathryn E Barber
- Department of Psychology, Marquette University, United States of America; Department of Psychology and Psychiatry, The Pennsylvania State University, United States of America.
| | - Nur Hani Zainal
- Department of Public Health, Harvard Medical School, United States of America
| | - Michelle G Newman
- Department of Psychology and Psychiatry, The Pennsylvania State University, United States of America
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18
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Maresh K, Papageorgiou A, Ridout D, Harrison NA, Mandy W, Skuse D, Muntoni F. Startle responses in Duchenne muscular dystrophy: a novel biomarker of brain dystrophin deficiency. Brain 2023; 146:252-265. [PMID: 35136951 PMCID: PMC9825594 DOI: 10.1093/brain/awac048] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 01/12/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is characterized by loss of dystrophin in muscle, however patients also have variable degree of intellectual disability and neurobehavioural co-morbidities. In contrast to muscle, in which a single full-length dystrophin isoform (Dp427) is produced, multiple isoforms are produced in the brain, and their deficiency accounts for the variability of CNS manifestations, with increased risk of comorbidities in patients carrying mutations affecting the 3' end of the gene, which disrupt expression of shorter Dp140 and Dp71 isoforms. A mouse model (mdx mouse) lacks Dp427 in muscle and CNS and exhibits exaggerated startle responses to threat, linked to the deficiency of dystrophin in limbic structures such as the amygdala, which normalize with postnatal brain dystrophin-restoration therapies. A pathological startle response is not a recognized feature of DMD, and its characterization has implications for improved clinical management and translational research. To investigate startle responses in DMD, we used a novel fear-conditioning task in an observational study of 56 males aged 7-12 years (31 affected boys, mean age 9.7 ± 1.8 years; 25 controls, mean age 9.6 ± 1.4 years). Trials of two neutral visual stimuli were presented to participants: one 'safe' cue presented alone; one 'threat' cue paired with an aversive noise to enable conditioning of physiological startle responses (skin conductance response and heart rate). Retention of conditioned physiological responses was subsequently tested by presenting both cues without the aversive noise in an 'Extinction' phase. Primary outcomes were the initial unconditioned skin conductance and change in heart rate responses to the aversive 'threat' and acquisition and retention of conditioned responses after conditioning. Secondary and exploratory outcomes were neuropsychological measures and genotype associations. The mean unconditioned skin conductance response was greater in the DMD group than controls [mean difference 3.0 µS (1.0, 5.1); P = 0.004], associated with a significant threat-induced bradycardia only in the patient group [mean difference -8.7 bpm (-16.9, -0.51); P = 0.04]. Participants with DMD found the task more aversive than controls, with increased early termination rates during the Extinction phase (26% of DMD group versus 0% of controls; P = 0.007). This study provides the first evidence that boys with DMD show similar increased unconditioned startle responses to threat to the mdx mouse, which in the mouse respond to brain dystrophin restoration. Our study provides new insights into the neurobiology underlying the complex neuropsychiatric co-morbidities in DMD and defines an objective measure of this CNS phenotype, which will be valuable for future CNS-targeted dystrophin-restoration studies.
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Affiliation(s)
- Kate Maresh
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Queen Square Centre for Neuromuscular Diseases, University College London, London WC1N 3BG, UK
| | - Andriani Papageorgiou
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Deborah Ridout
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Neil A Harrison
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - William Mandy
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - David Skuse
- Department of Behavioural and Brain Sciences, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Queen Square Centre for Neuromuscular Diseases, University College London, London WC1N 3BG, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
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19
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Neural responding during uncertain threat anticipation in pediatric anxiety. Int J Psychophysiol 2023; 183:159-170. [PMID: 35985508 DOI: 10.1016/j.ijpsycho.2022.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 01/04/2023]
Abstract
Excessive fear responses to uncertain threat are a key feature of anxiety disorders (ADs), though most mechanistic work considers adults. As ADs onset in childhood and confer risk for later psychopathology, we sought to identify conditions of uncertain threat that distinguish 8-17-year-old youth with AD (n = 19) from those without AD (n = 33), and assess test-retest reliability of such responses in a companion sample of healthy adults across three sites (n = 19). In an adapted uncertainty of threat paradigm, visual cues parametrically signaled threat of aversive stimuli (fear faces) in 25 % increments (0 %, 25 %, 50 %, 100 %), while participants underwent functional magnetic resonance imaging (fMRI). We compared neural response elicited by cues signaling different degrees of probability regarding the subsequent delivery of fear faces. Overall, youth displayed greater engagement of bilateral inferior parietal cortex, fusiform gyrus, and lingual gyrus during uncertain threat anticipation in general. Relative to healthy youth, AD youth exhibited greater activation in ventrolateral prefrontal cortex (vlPFC)/BA47 during uncertain threat anticipation in general. Further, AD differed from healthy youth in scaling of ventral striatum/sgACC activation with threat probability and attenuated flexibility of responding during parametric uncertain threat. Complementing these results, significant, albeit modest, cross-site test-retest reliability in these regions was observed in an independent sample of healthy adults. While preliminary due to a small sample size, these findings suggest that during uncertainty of threat, AD youth engage vlPFC regions known to be involved in fear regulation, response inhibition, and cognitive control. Findings highlight the potential of isolating neural correlates of threat anticipation to guide treatment development and translational work in youth.
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20
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Bresin K, Mekawi Y, McDonald JB, Bozzay ML, Heller W, Verona E. Threat effects on attention networks in individuals with a history of externalizing behaviors. Int J Psychophysiol 2023; 183:9-18. [PMID: 36375628 PMCID: PMC10440126 DOI: 10.1016/j.ijpsycho.2022.11.002] [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: 04/18/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Research identifying the biobehavioral processes that link threat exposure to cognitive alterations can inform treatments designed to reduce perpetration of stress-induced aggression. The present study attempted to specify the effects of relatively predictable versus unpredictable threat on two attention networks, attentional alerting and executive control. In a sample of adults (n = 74, 35 % identifying as women, Mage = 32.85) with high rates of externalizing behaviors (e.g., substance use, criminal/legal system involvement, aggressivity), we measured event-related brain activity during an attention network test that manipulated cognitive systems activation under relatively unpredictable and predictable threat conditions. Results showed that threat exposure alters attentional alerting and executive control. The predictable threat condition, relative to unpredictable threat, increased visual alerting (N1 amplitude to alert vs. no alert cue conditions) and decreased attention to the task (P3 amplitude to subsequent task-relevant flankers, but these effects did not survive adjusting for multiple tests. In contrast, overall threat and unpredictable threat conditions were associated with faster response time to alert cue (versus no cue) and poorer conflict processing, operationalized as flanker N2 reductions and slower response time to incongruent (versus congruent) flanker trials. These results expand what is known about threat-related modulation of cognition in a sample of individuals with histories of externalizing behaviors.
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Affiliation(s)
- Konrad Bresin
- University of Louisville, Department of Counseling and Human Development, USA; University of Louisville, Department of Psychological and Brain Sciences, USA.
| | - Yara Mekawi
- University of Louisville, Department of Psychological and Brain Sciences, USA
| | | | - Melanie L Bozzay
- Alpert Medical School of Brown University, USA; Providence VA Medical Center, USA
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-Champaign, USA
| | - Edelyn Verona
- Department of Psychology, University of South Florida, USA; Center for Justice Research & Policy, University of South Florida, USA
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21
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Granata L, Parakoyi A, Brenhouse HC. Age- and sex-specific effects of maternal separation on the acoustic startle reflex in rats: early baseline enhancement in females and blunted response to ambiguous threat. Front Behav Neurosci 2022; 16:1023513. [PMID: 36386786 PMCID: PMC9643533 DOI: 10.3389/fnbeh.2022.1023513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Early life adversity (ELA) increases the incidence of later-life anxiety disorders. Dysregulated threat processing, including responsivity to ambiguous threats, is an indicator of anxiety disorders and can be influenced by childhood experiences. The acoustic startle response is a defensive reflex displayed by mammals when exposed to sudden intense stimuli reflecting individual variations in vigilance. These measures can be altered by previous experience and experimental modifications, including the introduction of unconditioned aversive stimuli. Rats emit ultrasonic vocalizations (USVs) in the 22 KHz range in negative contexts. As such, 22 KHz USVs are an ethologically relevant social cue of environmental threat shown to induce anxiety-like behavior in recipient rats. Because the timing of symptom manifestation after early life adversity can differ between sexes, the current study sought to identify the age- and sex-specific effects of daily maternal separation (MS) on responsivity to ambiguous threat in rats. In Experiment 1, rat pups underwent MS or control rearing from postnatal day (P) 2–20, then underwent behavioral testing beginning on P24, 34, or 54 to determine whether MS modified the baseline startle response or the modulation of startle by 22 KHz USVs. In Experiment 2, rats were tested in a light-enhanced startle paradigm at P54 after MS or control rearing to determine whether MS influenced light-enhanced startle. Results show an enhancement of the baseline startle magnitude by MS in females at P34. At P54, MS reduced the modulation of the startle response by 22 KHz USVs and prevented light-enhanced startle, indicating an MS-induced deficit in defensive responsivity when exposed to potential threat.
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22
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Mumper EE, Ferry RA, Klein DN, Nelson BD. Effects of early childhood behavioral inhibition and parental anxiety disorder on adolescents' startle response to predictable and unpredictable threat. Res Child Adolesc Psychopathol 2022; 50:1327-1338. [PMID: 35689731 PMCID: PMC9613508 DOI: 10.1007/s10802-022-00942-0] [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] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
Numerous studies in children, adolescents and adults have reported that anxiety disorders and symptoms are associated with greater threat-potentiated startle responses. This suggests that it may also be related to risk factors that have been implicated in the genesis of anxiety disorders. Therefore, we examined the roles of early childhood temperamental behavioral inhibition (BI) and parental history of anxiety disorders in predicting threat-potentiated startle response in a community sample of 346 adolescents. Parental history of anxiety disorders moderated the effects of BI on subsequent startle responses. For both total startle response and unpredictable threat startle potentiation, higher levels of BI at age 3 predicted larger startle responses at age 15, but only among offspring of parents with a history of anxiety disorders. Among offspring of parents with no lifetime history of anxiety disorder, BI was unrelated to startle magnitude. These findings were evident even after adjusting for youth's biological sex, concurrent anxiety symptoms, and lifetime history of anxiety disorders. In contrast, neither BI nor parental anxiety significantly predicted startle potentiation to predictable threat. These findings have implications for tracing pathways to the development of anxiety disorders.
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Affiliation(s)
- Emma E Mumper
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, NY, USA
| | - Rachel A Ferry
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, NY, USA
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, NY, USA.
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, NY, USA
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23
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Gorka SM, Khorrami KJ, Manzler CA, Phan KL. Acute orexin antagonism selectively modulates anticipatory anxiety in humans: implications for addiction and anxiety. Transl Psychiatry 2022; 12:308. [PMID: 35918313 PMCID: PMC9345881 DOI: 10.1038/s41398-022-02090-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Research indicates that heightened anticipatory anxiety underlies several forms of psychopathology. Anticipatory anxiety can be reliably and objectively measured in the laboratory using the No-Predictable-Unpredictable (NPU) threat paradigm. The NPU paradigm is an ideal research tool for the NIH 'Fast-Fail' approach of screening promising compounds and testing human target engagement. Evidence from preclinical studies suggests that the hypocretin/orexin (ORX) hypothalamic neuropeptide system is a potential means for modulating anticipatory anxiety and disrupting stress-related alcohol use. The current study tested this question using a psychophysiological probe of the ORX system in humans. We examined whether a single dose of suvorexant (SUV; 10 mg; dual ORX receptor antagonist) can effectively and selectively target a well-validated human laboratory index of exaggerated anticipatory anxiety using a within-subjects placebo-controlled design. A total of twenty-one volunteers completed two laboratory sessions during acute administration of 10 mg SUV or placebo. Across sessions, we administered the NPU paradigm probing sustained anticipatory anxiety and fear while startle eyeblink was recorded as an index of aversive reactivity. Questionnaires assessing mood states and subjective drug effects were also collected. Results indicated SUV was well-tolerated. Compared with placebo, SUV was associated with decreased startle reactivity during anticipatory anxiety but not fear or no-threat conditions. Therefore, SUV selectively and effectively reduced objective indicators of anticipatory anxiety in humans and engaged our laboratory target of psychopathology. ORX antagonism may be a promising strategy for modulating human anxiety and potentially, stress-related alcohol use.
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Affiliation(s)
- Stephanie M. Gorka
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210 USA ,grid.261331.40000 0001 2285 7943Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210 USA
| | - Kia J. Khorrami
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210 USA ,grid.261331.40000 0001 2285 7943Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210 USA
| | - Charles A. Manzler
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210 USA ,grid.261331.40000 0001 2285 7943Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210 USA
| | - K. Luan Phan
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W. 9th Avenue, Columbus, OH 43210 USA
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24
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Beatty CC, Ferry RA, Nelson BD. Intolerance of uncertainty and psychophysiological reactivity in anticipation of unpredictable threat in youth. Int J Psychophysiol 2022; 179:110-118. [PMID: 35787438 DOI: 10.1016/j.ijpsycho.2022.06.017] [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: 02/04/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Intolerance of uncertainty (IU) is a key transdiagnostic feature of internalizing psychopathology. An increasing body of research suggests that IU is associated with increased psychophysiological reactivity in anticipation of unpredictable threat. However, most studies examining the psychophysiological correlates of IU have been conducted in adults. There is a critical need to understand the relationship between IU and psychophysiological reactivity in anticipation of unpredictable threat during adolescence, a key developmental period associated with increased exploration of situations with uncertain outcomes. Thus, the present study examined the association between (1) youth IU and (2) parental IU (as an indicator of risk) in relation to youth defensive motivation (startle reflex) and attention (startle probe N100 and P300) in anticipation of unpredictable threat. METHODS The sample included 193 13 to 22-year-old (M = 17.33, SD = 1.97) females and a biological parent. Participants and their parent completed a self-report measure of prospective and inhibitory IU. Youth startle potentiation, probe N100 enhancement, and probe P300 suppression (indicating increased attention to threat) were measured in anticipation of predictable and unpredictable threat. RESULTS Youth prospective IU and inhibitory IU were not related to youth psychophysiological reactivity to predictable or unpredictable threat. Greater parental prospective IU was associated with greater youth startle potentiation and probe N100 enhancement in anticipation of unpredictable threat. CONCLUSION The present study suggests that parental IU, but not concurrent IU, is associated with heightened defensive motivation and attentional engagement in anticipation of unpredictable threat in youth.
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Affiliation(s)
- Clare C Beatty
- Department of Psychology, Stony Brook University, United States of America.
| | - Rachel A Ferry
- Department of Psychology, Stony Brook University, United States of America
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, United States of America
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25
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Huggins AA, McTeague LM, Davis MM, Bustos N, Crum KI, Polcyn R, Adams ZW, Carpenter LA, Hajcak G, Halliday CA, Joseph JE, Danielson CK. Neighborhood Disadvantage Associated With Blunted Amygdala Reactivity to Predictable and Unpredictable Threat in a Community Sample of Youth. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:242-252. [PMID: 35928141 PMCID: PMC9348572 DOI: 10.1016/j.bpsgos.2022.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Childhood socioeconomic disadvantage is a form of adversity associated with alterations in critical frontolimbic circuits involved in the pathophysiology of psychiatric disorders. Most work has focused on individual-level socioeconomic position, yet individuals living in deprived communities typically encounter additional environmental stressors that have unique effects on the brain and health outcomes. Notably, chronic and unpredictable stressors experienced in the everyday lives of youth living in disadvantaged neighborhoods may impact neural responsivity to uncertain threat. METHODS A community sample of children (N = 254) ages 8 to 15 years (mean = 12.15) completed a picture anticipation task during a functional magnetic resonance imaging scan, during which neutral and negatively valenced photos were presented in a temporally predictable or unpredictable manner. Area Deprivation Index (ADI) scores were derived from participants' home addresses as an index of relative neighborhood disadvantage. Voxelwise analyses examined interactions of ADI, valence, and predictability on neural response to picture presentation. RESULTS There was a significant ADI × valence interaction in the middle temporal gyrus, anterior cingulate cortex, hippocampus, and amygdala. Higher ADI was associated with less amygdala activation to negatively valenced images. ADI also interacted with predictability. Higher ADI was associated with greater activation of lingual and calcarine gyri for unpredictably presented stimuli. There was no three-way interaction of ADI, valence, and predictability. CONCLUSIONS Neighborhood disadvantage may impact how the brain perceives and responds to potential threats. Future longitudinal work is critical for delineating how such effects may persist across the life span and how health outcomes may be modifiable with community-based interventions and policies.
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Affiliation(s)
- Ashley A. Huggins
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | - Lisa M. McTeague
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Megan M. Davis
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas Bustos
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Kathleen I. Crum
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rachel Polcyn
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary W. Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura A. Carpenter
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Greg Hajcak
- Department of Biomedical Sciences, Florida State University, Tallahassee, Florida
| | - Colleen A. Halliday
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Jane E. Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Carla Kmett Danielson
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
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26
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Papenfuss I, Lommen MJJ, Huisman M, Ostafin BD. Aversive response to uncertainty as a mediator for the effect of a mindfulness intervention on symptoms of anxiety. Int J Psychophysiol 2022; 179:30-42. [PMID: 35753561 DOI: 10.1016/j.ijpsycho.2022.06.014] [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: 01/31/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
THEORETICAL BACKGROUND Intolerance of uncertainty plays a central role in anxiety and research suggests that it's an important treatment target. Investigating response to uncertainty using other dimensions than self-report, such as physiological responses, can further the effort to understand the role of uncertainty in anxiety more fully. Mindfulness interventions have become increasingly interesting in their application to anxiety, as they foster acceptance of unpleasant aspects of experience. The aims of the study were to examine whether a mindfulness intervention reduced response to uncertainty and anxiety symptoms, and to examine the associations between intolerance of uncertainty, physiological response to uncertainty, mindfulness and anxiety. METHODS Participants were 117 students who completed a two-week mindfulness or audiobook control intervention. At pre- and post-intervention assessments, measures of anxiety, mindfulness, and intolerance of uncertainty were completed and a threat-of-shock task assessing startle responding to unpredictable shock was administered. RESULTS Findings showed a significant effect of the intervention for social anxiety symptoms. Furthermore, intolerance of uncertainty mediated the effect of the intervention on symptoms for social anxiety and worry. No such effects were found for physiological response to uncertainty. CONCLUSION The study adds to the understanding of the role of response to uncertainty in anxiety as well as to its mechanistic role in the context of mindfulness practice. Implications and possible explanations for the non-significant main effects of the intervention on anxiety symptoms and physiological response to uncertainty are discussed.
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Affiliation(s)
- I Papenfuss
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712TS Groningen, the Netherlands.
| | - M J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712TS Groningen, the Netherlands.
| | - M Huisman
- Department of Sociology, University of Groningen, Grote Kruisstraat 2/1, 9712TS Groningen, Groningen, the Netherlands.
| | - B D Ostafin
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712TS Groningen, the Netherlands.
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27
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Manzler CA, Radoman M, Khorrami KJ, Gorka SM. Association between startle reactivity to uncertain threats and structural brain volume. Psychophysiology 2022; 59:e14074. [PMID: 35579909 PMCID: PMC10080733 DOI: 10.1111/psyp.14074] [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: 08/20/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Sensitivity to uncertain threat (U-threat) is a clinically important individual difference factor in multiple psychopathologies. Recent studies have implicated a specific frontolimbic circuit as a key network involved in the anticipation of aversive stimuli. In particular, the insula, thalamus, and dorsal anterior cingulate cortex (dACC) have recently been found to be robustly activated by anticipation of U-threat. However, no study to date has examined the association between U-threat reactivity and structural brain volume. In the present study, we utilized a pooled sample of 186 young adult volunteers who completed a structural MRI scan and the well-validated No-Predictable-Unpredictable (NPU) threat of electric shock task. Startle eyeblink potentiation was collected during the NPU task as an objective index of aversive reactivity. ROI-based analyses revealed that increased startle reactivity to U-threat was associated with reduced gray matter volume in the right insula and bilateral thalamus, but not the dACC. These results add to a growing literature implicating the insula and thalamus as core nodes involved in individual differences in U-threat reactivity.
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Affiliation(s)
- Charles A Manzler
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kia J Khorrami
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, USA
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28
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Qiao Z, Pan DN, Hoid D, van Winkel R, Li X. When the approaching threat is uncertain: Dynamics of defensive motivation and attention in trait anxiety. Psychophysiology 2022; 59:e14049. [PMID: 35307851 DOI: 10.1111/psyp.14049] [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: 05/12/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Uncertainty of threat has been linked to anxiety, but little is known about how neurophysiological responses change as uncertain threats approach and whether trait anxiety modulates these changes. The current study was designed to explore aspects of the dynamics of defensive motivation (startle reflex elicited by acoustic startle probes), attention (probe N100 component of event-related potentials elicited by acoustic startle probes), and autonomic nervous system activity (heart rate) when the approaching threat was certain or uncertain in a variant of the threat probability task. Behavioral results showed that high-trait anxious individuals reported higher levels of anxiety than low-trait anxious individuals only under the uncertain threat condition. Electromyographic data showed that high-trait anxious individuals tended to produce a more pronounced startle reflex, especially when the uncertain threat was proximal. This pattern was not observed in low-trait anxious individuals. By examining early attention engagement through probe N100, we observed a similar pattern in relation to defensive motivation. Moreover, under the uncertain threat condition, high-trait anxious individuals yielded a greater deceleration of heart rate than low-trait anxious individuals. These results indicate a distinct modulation effect of trait anxiety in the dynamics of defensive motivation, attention, and the autonomic nervous system during the anticipation of uncertain threats.
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Affiliation(s)
- Zhiling Qiao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium
| | - Dong-Ni Pan
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Delhii Hoid
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruud van Winkel
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium.,UPC KU Leuven, Leuven, Belgium.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Xuebing Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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29
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Zänkert S, Lindl A, Schmitz A, Kudielka BM, Mühlberger A, Wüst S. Sustained threat and phasic fear in the laboratory and cognitive-emotional processes of anxiety in everyday life - An ambulatory assessment study. Int J Psychophysiol 2022; 175:8-17. [PMID: 35217111 DOI: 10.1016/j.ijpsycho.2022.02.009] [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: 08/17/2021] [Revised: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022]
Abstract
Fear is a phasic state of apprehension to an imminent threat, whereas anxiety is a more sustained state of expecting a potential threat leading to tension and worry. The NPU-threat test is a laboratory startle paradigm allowing a reliable and valid assessment of both, fear- and anxiety-potentiated reactions. It is suggested to differentiate between anxiety disorders, but little is known on associations with everyday life experiences of cognitive-emotional processes regarding anxiety in non-clinical samples. In the present project, the NPU-threat test was applied in three studies with (1) unselected healthy individuals, (2) participants with extreme manifestations of trait anxiety (low vs. high) and (3) individuals preparing for a high-stakes exam. Self-reported states of emotionality and worry were assessed during a four-day ambulatory assessment (AA). Overall, NPU-threat test measures did not significantly differ between studies, while the AA dependent measures were sufficiently sensitive to capture differences between groups. However, there was no significant association between psychophysiological measures of the NPU-threat test and AA state measures across participants. In participants recruited for low vs. high trait anxiety we found an association with AA worry and emotionality, but no interaction with potentiated startle. The present findings do not support the idea of a link between our laboratory biomarker and adaptive regulation of cognitive-emotional states in everyday life in healthy individuals. We speculate that an association between laboratory physiological measures and everyday experience of anxious states may be detectable in clinical samples.
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Affiliation(s)
- Sandra Zänkert
- Department of Medical Psychology, Psychological Diagnostics and Research Methodology, University of Regensburg, Germany.
| | - Alfred Lindl
- Department of Educational Sciences, University of Regensburg, Germany
| | - Anja Schmitz
- Clinical Psychology and Psychotherapy, University of Regensburg, Germany
| | - Brigitte M Kudielka
- Department of Medical Psychology, Psychological Diagnostics and Research Methodology, University of Regensburg, Germany
| | - Andreas Mühlberger
- Clinical Psychology and Psychotherapy, University of Regensburg, Germany
| | - Stefan Wüst
- Institute of Experimental Psychology, University of Regensburg, Germany
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30
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Correa KA, Li LY, Nelson BD, Shankman SA. Event-related potentials to acoustic startle probes during unpredictable threat are associated with individual differences in intolerance of uncertainty. Int J Psychophysiol 2022; 174:66-75. [PMID: 35143906 PMCID: PMC8923991 DOI: 10.1016/j.ijpsycho.2022.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
Individual differences in sensitivity to unpredictable threat may be a critical mechanism for internalizing psychopathology phenotypes. The present study examined whether the startle probe-elicited N100 and P300 during unpredictable threat - two event-related potentials indexing early and elaborative attentional processing of unpredictable threat - may be endophenotypes for internalizing psychopathology, including fear and distress/misery disorders and intolerance of uncertainty (IU), a clinical trait that is transdiagnostically associated with internalizing disorders. A large sample of adult siblings (N = 375) completed the no, predictable, and unpredictable threat task, during which the N100 and P300 were recorded. Relative to the no threat condition, N100 was more strongly enhanced in anticipation of unpredictable than predictable threat while P300 was suppressed to both predictable and unpredictable threat. While neither N100 enhancement nor P300 suppression to unpredictable threat was associated with fear or distress/misery disorders, they were negatively linked to inhibitory IU (a facet of IU). Thus, individuals high in inhibitory IU showed reduced attentional engagement with the threatening context when it was unpredictable. Further, N100 enhancement and, to a lesser degree, P300 suppression to unpredictable threat showed familial aggregation - a key criterion for determining whether a biomarker is an endophenotype. In sum, N100 enhancement and P300 suppression to unpredictable threat may be endophenotypes for dimensional measures of internalizing psychopathology.
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Affiliation(s)
- Kelly A Correa
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Lilian Y Li
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
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31
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Hall OT, Phan KL, Gorka S. Childhood Adversity and the Association Between Stress Sensitivity and Problematic Alcohol Use in Adults. J Trauma Stress 2022; 35:148-158. [PMID: 34263960 PMCID: PMC8760364 DOI: 10.1002/jts.22709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023]
Abstract
Early life adversity (ELA) increases the risk of problematic alcohol use and alcohol use disorder (AUD). However, it is unclear why some but not all ELA-exposed individuals develop problematic alcohol use. Research is needed to determine how this environmental risk factor interacts with underlying neurobehavioral vulnerabilities to problem alcohol use. Hypersensitivity to uncertain threats (U-threat) has been posited as an endophenotype for AUD that might aid in the refinement of mechanistic models of problematic alcohol use. Therefore, U-threat hypersensitivity requires examination as a possible individual difference factor that facilitates problematic alcohol use among ELA-exposed individuals. We examined the unique and interactive effects of ELA and U-threat reactivity on problem drinking and depressive and anxiety symptom severity. Participants (N = 131) completed a well-validated threat-of-shock task, and startle eyeblink potentiation was recorded to index aversive responding. Individuals also completed self-report measures of alcohol use, anxiety, and depressive symptoms. Results demonstrated a positive association between ELA and higher levels of problematic alcohol use at high levels of U-threat reactivity, β = .75, t = 3.93, p < .001. Conversely, at low levels of U-threat reactivity, ELA exposure was negatively associated with problematic alcohol use, β = -.49, t = -2.30, p = .023. There was no significant ELA x U-Threat reactivity interaction on anxiety or depression. U-threat response strongly interacts with ELA exposure, affecting the direction of the association between ELA and problem drinking. U-threat reactivity may be a promising target for the prevention and treatment of problematic drinking among ELA-exposed individuals.
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Affiliation(s)
- O. Trent Hall
- Department of Psychiatry and Behavioral Health the Ohio State University Wexner Medical Center Columbus Ohio USA
| | - K. Luan Phan
- Department of Psychiatry and Behavioral Health the Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health the Ohio State University Wexner Medical Center Columbus Ohio USA
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32
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Brunner LM, Maurer F, Weber K, Weigl J, Milenkovic VM, Rupprecht R, Nothdurfter C, Mühlberger A. Differential effects of the translocator protein 18 kDa (TSPO) ligand etifoxine and the benzodiazepine alprazolam on startle response to predictable threat in a NPU-threat task after acute and short-term treatment. Psychopharmacology (Berl) 2022; 239:2233-2244. [PMID: 35278124 PMCID: PMC9205810 DOI: 10.1007/s00213-022-06111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
RATIONALE Benzodiazepines have been extensively investigated in experimental settings especially after single administration, which mostly revealed effects on unpredictable threat (U-threat) rather than predictable threat (P-threat). Given the need for pharmacological alternatives with a preferable side-effect profile and to better represent clinical conditions, research should cover also other anxiolytics and longer application times. OBJECTIVES The present study compared the acute and short-term effects of the translocator protein 18 kDa (TSPO) ligand etifoxine and the benzodiazepine alprazolam on P-threat and U-threat while controlling for sedation. METHODS Sixty healthy male volunteers, aged between 18 and 55 years, were randomly assigned to receive a daily dose of either 150 mg etifoxine, 1.5 mg alprazolam, or placebo for 5 days. On days 1 and 5 of intake, they performed a NPU-threat task including neutral (N), predictable (P), and unpredictable (U) conditions, while startle responsivity and self-reports were studied. Sedative effects were assessed using a continuous performance test. RESULTS Neither alprazolam nor etifoxine affected startle responsivity to U-threat on any of the testing days. While etifoxine reduced the startle response to P-threat on day 1 of treatment for transformed data, a contrary effect of alprazolam was found for raw values. No effects on self-reports and no evidence of sedation could be observed for either drug. CONCLUSIONS None of the anxiolytic substances had an impact on startle potentiation to U-threat even after several days of intake. The effects of the anxiolytics on startle responsivity to P-threat as well as implications for future studies are discussed.
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Affiliation(s)
- Lisa-Marie Brunner
- Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053, Regensburg, Germany. .,Department of Psychology, Clinical Psychology and Psychotherapy, University Regensburg, Regensburg, Germany.
| | - Franziska Maurer
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Kevin Weber
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Johannes Weigl
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Vladimir M. Milenkovic
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Rainer Rupprecht
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Caroline Nothdurfter
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Andreas Mühlberger
- grid.7727.50000 0001 2190 5763Department of Psychology, Clinical Psychology and Psychotherapy, University Regensburg, Regensburg, Germany
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33
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Orexin modulation of stress reactivity as a novel targeted treatment for anxiety and alcohol use disorder. Neuropsychopharmacology 2022; 47:397-398. [PMID: 34341494 PMCID: PMC8616906 DOI: 10.1038/s41386-021-01120-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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34
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Cross-species anxiety tests in psychiatry: pitfalls and promises. Mol Psychiatry 2022; 27:154-163. [PMID: 34561614 PMCID: PMC8960405 DOI: 10.1038/s41380-021-01299-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/16/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
Behavioural anxiety tests in non-human animals are used for anxiolytic drug discovery, and to investigate the neurobiology of threat avoidance. Over the past decade, several of them were translated to humans with three clinically relevant goals: to assess potential efficacy of candidate treatments in healthy humans; to develop diagnostic tests or biomarkers; and to elucidate the pathophysiology of anxiety disorders. In this review, we scrutinise these promises and compare seven anxiety tests that are validated across species: five approach-avoidance conflict tests, unpredictable shock anticipation, and the social intrusion test in children. Regarding the first goal, three tests appear suitable for anxiolytic drug screening in humans. However, they have not become part of the drug development pipeline and achieving this may require independent confirmation of predictive validity and cost-effectiveness. Secondly, two tests have shown potential to measure clinically relevant individual differences, but their psychometric properties, predictive value, and clinical applicability need to be clarified. Finally, cross-species research has not yet revealed new evidence that the physiology of healthy human behaviour in anxiety tests relates to the physiology of anxiety symptoms in patients. To summarise, cross-species anxiety tests could be rendered useful for drug screening and for development of diagnostic instruments. Using these tests for aetiology research in healthy humans or animals needs to be queried and may turn out to be unrealistic.
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35
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Correa KA, Carrillo V, Funkhouser CJ, Shenberger ER, Shankman SA. Ethnic differences in behavioral and physiological indicators of sensitivity to threat. J Anxiety Disord 2022; 85:102508. [PMID: 34864540 PMCID: PMC8760157 DOI: 10.1016/j.janxdis.2021.102508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 09/26/2021] [Accepted: 11/20/2021] [Indexed: 01/03/2023]
Abstract
The clinical presentation of anxiety may differ between Hispanics/Latinx (H/L) and non-H/L, although findings on ethnic differences in self-reported anxiety symptoms have been mixed. Fewer studies have focused on ethnic differences in quick and relatively automatic laboratory-assessed indicators of anxiety symptoms, which have the potential to be more objective indicators than self-report. Therefore, the present study examined ethnic differences in two laboratory-assessed indicators of threat sensitivity (an important transdiagnostic mechanism of anxiety): attentional bias to threat and electromyography startle reactivity to threat. White H/L (n = 117) and White non-H/L (n = 168) adults who were matched on demographics and lifetime psychopathology (including anxiety) completed a dot-probe task to assess attentional bias to threat and the No-Predictable-Unpredictable threat (NPU) task to assess startle reactivity to threat. Results indicated that H/L displayed less Slow OrientationRB (β = -0.27, p = 0.032, R2β∗ = 0.02), and increased Slow DisengagementRB (β = 0.31, p = 0.016, R2β∗ = 0.02) compared to non-H/L. H/L exhibited blunted overall startle compared to non-H/L (β = -0.30, p = 0.014, R2β∗ = 0.02), but groups did not differ in startle reactivity to either predictable or unpredictable threat. In summary, H/L and non-H/L may differ in their experience and presentation of anxiety symptoms and such differences may vary across indicators of sensitivity to threat.
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Affiliation(s)
- Kelly A Correa
- University of Illinois at Chicago, United States; Northwestern University, United States
| | | | - Carter J Funkhouser
- University of Illinois at Chicago, United States; Northwestern University, United States
| | - Elyse R Shenberger
- University of Illinois at Chicago, United States; Northwestern University, United States
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36
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Allison GO, Kamath RA, Carrillo V, Alqueza KL, Pagliaccio D, Slavich GM, Shankman SA, Auerbach RP. Self-referential Processing in Remitted Depression: An Event-Related Potential Study. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 3:119-129. [PMID: 36712564 PMCID: PMC9874080 DOI: 10.1016/j.bpsgos.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023] Open
Abstract
Background Identifying mechanisms of major depressive disorder that continue into remission is critical, as these mechanisms may contribute to subsequent depressive episodes. Biobehavioral markers related to depressogenic self-referential processing biases have been identified in adults with depression. Thus, we investigated whether these risk factors persisted during remission as well as contributed to the occurrence of stress and depressive symptoms over time. Methods At baseline, adults with remitted depression (n = 33) and healthy control subjects (n = 33) were administered diagnostic and stress interviews as well as self-report symptom measures. In addition, participants completed a self-referential encoding task while electroencephalography data were acquired. Stress interviews and self-report symptom measures were readministered at the 6-month follow-up assessment. Results Drift diffusion modeling showed that compared with healthy individuals, adults with remitted depression exhibited a slower drift rate to negative stimuli, indicating a slower tendency to reject negative stimuli as self-relevant. At the 6-month follow-up assessment, a slower drift rate to negative stimuli predicted greater interpersonal stress severity among individuals with remitted depression but not healthy individuals while controlling for both baseline depression symptoms and interpersonal stress severity. Highlighting the specificity of this effect, results were nonsignificant when predicting noninterpersonal stress. For self-relevant positive words endorsed, adults with remitted depression exhibited smaller left- than right-hemisphere late positive potential amplitudes; healthy control subjects did not show hemispheric differences. Conclusions Self-referential processing deficits persist into remission. In line with the stress generation framework, these biases predicted the occurrence of interpersonal stress, which may provide insight about a potential pathway for the re-emergence of depressive symptoms.
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Affiliation(s)
- Grace O. Allison
- Department of Psychiatry, Columbia University, New York, New York
| | - Rahil A. Kamath
- Department of Psychiatry, Columbia University, New York, New York
| | - Vivian Carrillo
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
| | - Kira L. Alqueza
- Department of Psychiatry, Columbia University, New York, New York
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, New York
| | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Stewart A. Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
| | - Randy P. Auerbach
- Department of Psychiatry, Columbia University, New York, New York,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, New York,Address correspondence to Randy P. Auerbach, Ph.D.
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37
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Benke C, Alius MG, Hamm AO, Pané-Farré CA. Defensive Mobilization During Anticipation of Symptom Provocation: Association With Panic Pathology. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 8:397-405. [PMID: 34823048 DOI: 10.1016/j.bpsc.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/22/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anxious apprehension about feared body symptoms is thought to play a crucial role in the development, chronicity, and treatment of panic disorder (PD). In this study, we therefore aimed to elucidate the role of defensive reactivity to anticipated unpleasant symptoms in PD that can contribute to a better understanding of pathomechanisms of PD as well as identification of potential targets in PD-focused interventions. By measuring amygdala-dependent potentiation of the startle reflex, we aimed to investigate whether 1) patients with PD exhibit a specifically increased defensive reactivity to anticipated unpleasant body symptoms and 2) whether clinical severity of panic symptomatology varies with magnitude of defensive activation. METHODS Defensive mobilization to anticipated threat was investigated in 73 patients with a primary diagnosis of PD with agoraphobia (PDA) and 52 healthy control subjects. Threat of symptom provocation was established by a standardized hyperventilation task and contrasted to threat of shock to the forearm of the participant. RESULTS Patients with PDA and healthy control subjects did not differ in their defensive responses during anticipation of shock. In contrast, patients with severe PDA as compared with healthy control subjects exhibited increased defensive response mobilization and reported more anxiety and panic symptoms during anticipation of feared body symptoms. Moreover, startle potentiation during anticipation of hyperventilation covaried with the severity of panic symptomatology. CONCLUSIONS The present findings suggest that increased defensive mobilization during anticipation of body symptoms is a neurobiological correlate of severe PDA that should be specifically targeted in PD interventions and might be used to monitor treatment success.
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Affiliation(s)
- Christoph Benke
- Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Manuela G Alius
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Alfons O Hamm
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Christiane A Pané-Farré
- Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, Philipps University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and University of Giessen, Marburg, Germany; Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
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Lago TR, Brownstein MJ, Page E, Beydler E, Manbeck A, Beale A, Roberts C, Balderston N, Damiano E, Pineles SL, Simon N, Ernst M, Grillon C. The novel vasopressin receptor (V1aR) antagonist SRX246 reduces anxiety in an experimental model in humans: a randomized proof-of-concept study. Psychopharmacology (Berl) 2021; 238:2393-2403. [PMID: 33970290 PMCID: PMC8376758 DOI: 10.1007/s00213-021-05861-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/26/2021] [Indexed: 12/19/2022]
Abstract
RATIONALE Arginine vasopressin (AVP) is a neuropeptide that modulates both physiological and emotional responses to threat. Until recently, drugs that target vasopressin receptors (V1a) in the human central nervous system were unavailable. The development of a novel V1a receptor antagonist, SRX246, permits the experimental validation of vasopressin's role in the regulation of anxiety and fear in humans. OBJECTIVES Here, we examined the effects of SRX246 in a proof-of-concept translational paradigm of fear (phasic response to imminent threat) and anxiety (prolonged response to potential threat). METHODS Healthy volunteers received both SRX246 and placebo in a randomized, double-blind, counter-balanced order separated by a 5-7-day wash-out period. Threat consisted of unpleasant electric shocks. The "NPU" threat test probed startle reactivity during predictable threat (i.e., fear-potentiated startle) and unpredictable threat (i.e., anxiety-potentiated startle). RESULTS As predicted, SRX246 decreased anxiety-potentiated startle independent of fear-potentiated startle. CONCLUSIONS As anxiety-potentiated startle is elevated in anxiety and trauma-associated disorders and decreased by traditional anxiolytics such as SSRIs and benzodiazepines, the V1a receptor is a promising novel treatment target.
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Affiliation(s)
- Tiffany R Lago
- National Institute of Mental Health, Bethesda, MD, USA.
- VA Boston Healthcare System, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | - Emily Page
- National Institute of Mental Health, Bethesda, MD, USA
| | - Emily Beydler
- National Institute of Mental Health, Bethesda, MD, USA
| | | | - Alexis Beale
- National Institute of Mental Health, Bethesda, MD, USA
| | | | - Nicholas Balderston
- National Institute of Mental Health, Bethesda, MD, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Eve Damiano
- Azevan Pharmaceuticals Inc, Bethlehem, PA, USA
| | - Suzanne L Pineles
- Boston University School of Medicine, Boston, MA, USA
- National Center, PTSD At VA Boston Healthcare System, Boston, MA, USA
| | - Neal Simon
- Azevan Pharmaceuticals Inc, Bethlehem, PA, USA
- Lehigh University, Bethelhem, PA, USA
| | - Monique Ernst
- National Institute of Mental Health, Bethesda, MD, USA
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39
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Weis CN, Bennett KP, Huggins AA, Parisi EA, Gorka SM, Larson C. A 7-Tesla MRI Study of the Periaqueductal Grey: Resting State and Task Activation Under Threat. Soc Cogn Affect Neurosci 2021; 17:187-197. [PMID: 34244809 PMCID: PMC8847906 DOI: 10.1093/scan/nsab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
The periaqueductal grey (PAG) is a region of the midbrain implicated in a variety of behaviors including defensive responses to threat. Despite the wealth of knowledge pertaining to the differential functional roles of the PAG columns in nonhuman and human research, the basic functional connectivity of the PAG at rest has not been well characterized. Therefore, the current study utilized 7-Tesla MRI to characterize PAG functional connectivity at rest and task activation under uncertain threat. A sample of 53 neurologically healthy undergraduate participants (Mage=22.2, SDage=3.62) underwent structural and resting state functional MRI scans. Supporting previous work, voxel-wise analyses showed the PAG is functionally connected to emotion regulation and fear networks. Comparison of functional connectivity of PAG columns did not reveal any significant differences. Thirty-five participants from the same sample also completed an uncertain threat task with blocks of 3 conditions-No shock, Predictable shock, and Unpredictable shock. There were no robust activity differences within the PAG columns or the whole PAG across conditions, though there was differential activity at the voxel level in the PAG and in other regions theoretically relevant to uncertain threat. Results of this study elucidate PAG connectivity at rest and activation in response to uncertain threat.
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Affiliation(s)
- Carissa N Weis
- University of Wisconsin, Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | | | - Ashley A Huggins
- University of Wisconsin, Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Elizabeth A Parisi
- University of Wisconsin, Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Stephanie M Gorka
- The Ohio State University, Institute for Behavioral Medicine Research, Columbus, OH, USA
| | - Christine Larson
- University of Wisconsin, Milwaukee, Department of Psychology, Milwaukee, WI, USA
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40
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Tomasi J, Zai CC, Zai G, Kennedy JL, Tiwari AK. Genetics of human startle reactivity: A systematic review to acquire targets for an anxiety endophenotype. World J Biol Psychiatry 2021; 22:399-427. [PMID: 33040669 DOI: 10.1080/15622975.2020.1834619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Startle response is an objective physiological measure integral to the human defense system and a promising target for endophenotype investigations of anxiety. Given the alterations in startle reactivity observed among anxiety and related disorders, we searched for genetic variants associated with startle reactivity as they may be further involved in pathological anxiety risk. METHODS A systematic literature review was performed to identify genetic variants associated with startle reactivity in humans, specifically baseline and fear- or anxiety-potentiated startle. RESULTS The polymorphisms Val66Met (rs6265) from brain-derived neurotrophic factor (BDNF), Val158Met (rs4680) from catechol-O-methyltransferase (COMT), and the serotonin transporter-linked polymorphic region (5-HTTLPR) from the serotonin transporter gene (SLC6A4) were most commonly studied in human startle. In addition, several other genetic variants have also been identified as potential candidates that warrant further research, especially given their novelty in in the context of anxiety. CONCLUSIONS Similar to psychiatric genetic studies, the studies on startle reactivity primarily focus on candidate genes and are plagued by non-replication. Startle reactivity is a promising endophenotype that requires concerted efforts to collect uniformly assessed, large, well-powered samples and hypothesis-free genome-wide strategies. To further support startle as an endophenotype for anxiety, this review suggests advanced genetic strategies for startle research.
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Affiliation(s)
- Julia Tomasi
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Gwyneth Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,General Adult Psychiatry and Health Systems Division, CAMH, Toronto, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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41
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Michelini G, Palumbo IM, DeYoung CG, Latzman RD, Kotov R. Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience. Clin Psychol Rev 2021; 86:102025. [PMID: 33798996 PMCID: PMC8165014 DOI: 10.1016/j.cpr.2021.102025] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.
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Affiliation(s)
- Giorgia Michelini
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90024, United States of America.
| | - Isabella M Palumbo
- Department of Psychology, Georgia State University, Atlanta, GA 30303, United States of America
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Robert D Latzman
- Department of Psychology, Georgia State University, Atlanta, GA 30303, United States of America
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY 11790, United States of America
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42
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Tactile P300 to unpredictable electric shocks: Association with anxiety symptoms, intolerance of uncertainty, and neuroticism. Biol Psychol 2021; 162:108094. [PMID: 33878371 DOI: 10.1016/j.biopsycho.2021.108094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
The no, predictable, and unpredictable threat (NPU-threat) task is an experimental paradigm that delineates the anticipation of predictable vs. unpredictable threat. The current literature suggests that heightened defensive motivation in anticipation of unpredictable threat is associated with anxiety disorders and increased symptoms. Few investigations have examined whether a heightened response to actual threat is also associated with anxiety-related phenomenology. The present study examined the relationship between the tactile P300 to shock delivery during the NPU-threat task and individual differences in anxiety symptoms, intolerance of uncertainty, and neuroticism. Overall, the tactile P300 was enhanced in response to unpredictable shocks relative to predictable shocks. Greater tactile P300 enhancement to unpredictable shocks was associated with greater anxiety symptoms, intolerance of uncertainty, and neuroticism. The present study suggests that temporal unpredictability enhances attentional engagement to threat, which is greater in individuals characterized by narrow and broad anxiety constructs.
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43
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Wazzan M, Estaitia M, Habrawi S, Mansour D, Jalal Z, Ahmed H, Hasan HA, Al Kawas S. The Effect of Music Therapy in Reducing Dental Anxiety and Lowering Physiological Stressors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021393. [PMID: 35075079 PMCID: PMC8823572 DOI: 10.23750/abm.v92i6.11668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/15/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIM The anxiolytic effects of music have been studied during the past twenty years in different medical therapies. The aim of this study is to evaluate the effect of music therapy on patients' dental anxiety, salivary cortisol, heart rate, blood pressure and body temperature during dental treatment. METHODS In this randomized control study, 46 patients were randomly selected from the Urgent Care dental clinic who needed urgent endodontic treatment (endodontic access and pulp extirpation). Participants were divided into two groups: intervention group (N=23) which was exposed to slow rhythm melody music and had no lyrics throughout the entire procedure and a control group (N=23) who undergoes the same dental procedure without being exposed to music. Participants' blood pressure, heart rate, body temperature and salivary cortisol were measured before and after the treatment for both groups. RESULTS Patients in the intervention group showed lower salivary cortisol, blood pressure, heart rate and body temperature compared to those in the control group, however, the differences did not reach to statistical significance. CONCLUSION -Despite the change in the dental anxiety and stress during treatment with music, the findings of this study could not establish evidence of the effect of music in reducing dental anxiety and lowering physiological stressors. Therefore, further studies with larger sample size may be needed. (www.actabiomedica.it).
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Affiliation(s)
- Mohammad Wazzan
- Department of Oral & Craniofacial Health, College of Dental Medicine
| | - Mohammed Estaitia
- Department of Oral & Craniofacial Health, College of Dental Medicine
| | - Sima Habrawi
- Department of Oral & Craniofacial Health, College of Dental Medicine
| | - Dina Mansour
- Department of Oral & Craniofacial Health, College of Dental Medicine
| | - Zain Jalal
- Department of Oral & Craniofacial Health, College of Dental Medicine
| | - Hadir Ahmed
- Department of Oral & Craniofacial Health, College of Dental Medicine
| | - Hayder A. Hasan
- College of Health Science, Sharjah Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sausan Al Kawas
- Department of Oral & Craniofacial Health, College of Dental Medicine, Sharjah Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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44
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Responding to uncertain threat: A potential mediator for the effect of mindfulness on anxiety. J Anxiety Disord 2021; 77:102332. [PMID: 33160276 DOI: 10.1016/j.janxdis.2020.102332] [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] [Received: 02/17/2020] [Revised: 09/23/2020] [Accepted: 10/16/2020] [Indexed: 02/01/2023]
Abstract
Mindfulness-based interventions have gained extensive support for their application in the treatment of anxiety. However, their mechanisms remain largely unexplored. Excessive reactivity to uncertainty plays a central role in anxiety, and may represent a mechanism for the effect of mindfulness on anxiety, as mindfulness training fosters an open and accepting stance towards all aspects of experience. The present study sought to investigate both (i) self-reported intolerance of uncertainty (IU) as well as (ii) physiological and subjective responding to uncertain threat in a threat-of-shock paradigm, the NPU-threat test, as mediators for the relationship between mindfulness and anxiety in a cross-sectional study of healthy participants (N = 53). The results indicated that IU mediated the effect of mindfulness on some anxiety symptoms. In contrast, scores of physiological as well as subjective responses to uncertain threat from the NPU-threat test were largely unrelated to mindfulness, anxiety, or the IU self-report measure. The results provide initial evidence that reactions to uncertainty may play a role in the mindfulness-anxiety relationship and suggest that studies are needed to address how methodological variations of the NPU-threat test affect perceived levels of uncertainty and uncertainty-related anxiety.
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45
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Rutherford AV, Tanovic E, Bradford DE, Joormann J. Psychophysiological correlates of anxious apprehension: Trait worry is associated with startle response to threat. Int J Psychophysiol 2020; 158:136-142. [DOI: 10.1016/j.ijpsycho.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
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46
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Grillon C, Ernst M. A way forward for anxiolytic drug development: Testing candidate anxiolytics with anxiety-potentiated startle in healthy humans. Neurosci Biobehav Rev 2020; 119:348-354. [PMID: 33038346 DOI: 10.1016/j.neubiorev.2020.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
This review introduces a research strategy that may radically transform the pursuit of new anxiolytics, via the use of human models of anxiety in healthy individuals. Despite enormous investments in developing novel pharmacological treatments for anxiety disorders, pharmacotherapy for these conditions remains suboptimal. Most candidate anxiolytics from animal studies fail in clinical trials. We propose an additional screening step to help select candidate anxiolytics before launching clinical trials. This intermediate step moves the evidence for the potential anxiolytic property of candidate drugs from animals to humans, using experimental models of anxiety in healthy individuals. Anxiety-potentiated startle is a robust translational model of anxiety. The review of its face, construct, and predictive validity as well as its psychometric properties in humans establishes it as a promising tool for anxiolytic drug development. In conclusion, human models of anxiety may stir a faster, more efficient path for the development of clinically effective anxiolytics.
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Affiliation(s)
- Christian Grillon
- National Institute of Mental Health, Section on the Neurobiology of Fear and Anxiety, Building 15K, Room 203, Bethesda, MD 20814 USA.
| | - Monique Ernst
- National Institute of Mental Health, Section on the Neurobiology of Fear and Anxiety, Building 15K, Room 203, Bethesda, MD 20814 USA.
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47
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Ferry RA, Nelson BD. Differential impact of threat type on defensive motivation and attention during the NPU-threat task. MOTIVATION AND EMOTION 2020. [DOI: 10.1007/s11031-020-09835-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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48
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Tomasi J, Zai CC, Zai G, Herbert D, King N, Freeman N, Kennedy JL, Tiwari AK. The effect of polymorphisms in startle-related genes on anxiety symptom severity. J Psychiatr Res 2020; 125:144-151. [PMID: 32289651 DOI: 10.1016/j.jpsychires.2020.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 01/23/2023]
Abstract
Given the limited effectiveness of treatments for pathological anxiety, there is a pressing need to identify genetic markers that can aid the precise selection of treatments and optimize treatment response. Anxiety and startle response levels demonstrate a direct relationship, and previous literature suggests that exaggerated startle reactivity may serve as an endophenotype of pathological anxiety. In addition, genetic variants related to startle reactivity may play a role in the etiology of pathological anxiety. In the current study, we selected 22 single nucleotide polymorphisms (SNPs) related to startle reactivity in the literature, and examined their association with anxiety symptom severity across psychiatric disorders (n = 508), and in a subset of patients with an anxiety disorder (n = 298). Overall, none of the SNPs pass correction for multiple independent tests. However, across psychiatric patients, rs6323 from the monoamine oxidase A (MAOA) gene and rs324981 from the neuropeptide S receptor 1 (NPSR1) gene were nominally associated with baseline anxiety symptom severity (p = 0.017, 0.023). These preliminary findings provide support for investigating startle-related genetic variants to identify biomarkers of anxiety symptom severity.
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Affiliation(s)
- Julia Tomasi
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gwyneth Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; General Adult Psychiatry and Health Systems Division, CAMH, Toronto, ON, Canada
| | - Deanna Herbert
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Nicole King
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Natalie Freeman
- Campbell Family Mental Health Research Institute and Krembil Centre for Neuroinformatics, CAMH, Toronto, ON, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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49
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Gorka SM, Kreutzer KA, Petrey KM, Radoman M, Phan KL. Behavioral and neural sensitivity to uncertain threat in individuals with alcohol use disorder: Associations with drinking behaviors and motives. Addict Biol 2020; 25:e12774. [PMID: 31173426 DOI: 10.1111/adb.12774] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 12/14/2022]
Abstract
A developing theory is that individuals with alcohol use disorder (AUD) display exaggerated reactivity to threats that are uncertain (U-threat), which facilitates excessive drinking as a means of avoidance-based coping. There is a promising initial behavioral evidence supporting this theory; however, the neural bases of reactivity to U-threat in individuals with AUD have not been examined. The extent to which biomarkers of U-threat reactivity map onto drinking behaviors and coping motives for alcohol use is also unknown. The current study therefore examined group differences in behavioral and neural reactivity to U-threat in adults with and without AUD. The study also tested whether behavior and brain responses to U-threat correlate with problematic drinking and coping motivated drinking. Volunteers (n = 65) with and without a history of AUD (38 AUD, 27 controls) were included and completed a well-validated threat-of-shock task to probe responses to U-threat and predictable threat (P-threat) while startle eyeblink potentiation was collected. Individuals also completed a newly designed, analogous version of the task during functional magnetic resonance imaging (fMRI). Results indicated that individuals with AUD displayed greater startle magnitude during U-threat, but not P-threat, and greater right insula and dorsal anterior cingulate cortex (dACC) activation during both forms of threat compared with controls. Startle magnitude and insula activation during U-threat positively correlated with self-reported problem drinking and coping motives for alcohol use. Findings demonstrate that individuals with AUD display exaggerated sensitivity to U-threat at the behavioral and neural level and that these multimethod biomarkers tap into negative reinforcement processes of alcohol abuse.
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Affiliation(s)
- Stephanie M. Gorka
- Department of PsychiatryUniversity of Illinois at Chicago Chicago Illinois USA
- Center for Alcohol Research in Epigenetics (CARE)University of Illinois at Chicago Chicago Illinois USA
- Department of PsychologyUniversity of Illinois at Chicago Chicago Illinois USA
| | - Kayla A. Kreutzer
- Department of PsychiatryUniversity of Illinois at Chicago Chicago Illinois USA
| | - Kelsey M. Petrey
- Department of PsychiatryUniversity of Illinois at Chicago Chicago Illinois USA
| | - Milena Radoman
- Department of PsychiatryUniversity of Illinois at Chicago Chicago Illinois USA
- Department of Anatomy and Cell Biology and the Graduate Program in NeuroscienceUniversity of Illinois at Chicago Chicago Illinois USA
| | - Kinh Luan Phan
- Department of PsychiatryUniversity of Illinois at Chicago Chicago Illinois USA
- Department of PsychologyUniversity of Illinois at Chicago Chicago Illinois USA
- Mental Health Service LineJesse Brown VA Medical Center Chicago Illinois USA
- Department of Anatomy and Cell Biology and the Graduate Program in NeuroscienceUniversity of Illinois at Chicago Chicago Illinois USA
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50
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Lieberman L, Funkhouser CJ, Gorka SM, Liu H, Correa KA, Berenz EC, Phan KL, Shankman SA. The Relation Between Posttraumatic Stress Symptom Severity and Startle Potentiation to Predictable and Unpredictable Threat. J Nerv Ment Dis 2020; 208:397-402. [PMID: 32053566 PMCID: PMC10627509 DOI: 10.1097/nmd.0000000000001138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aberrant threat reactivity has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD); however, the literature on this association is mixed. One factor that may contribute to this inconsistent association is differences in severity of posttraumatic stress symptoms (PTSSs) across studies, but no studies have tested this hypothesis. The relation between PTSD and threat reactivity may also differ between unpredictable threats (U-threats) and predictable threats (P-threats), given burgeoning evidence to support a particular role for aberrant responding to U-threat in PTSD. The present study examined how PTSS severity relates to startle potentiation to U-threat and P-threat in a trauma-exposed community sample (N = 258). There was a negative linear, but not quadratic, relation between PTSS severity and startle potentiation to U-threat, but not P-threat. Blunted defensive responding to U-threat may therefore contribute to higher levels of PTSSs and may represent a novel treatment target for higher levels of PTSSs.
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Affiliation(s)
- Lynne Lieberman
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
| | | | - Stephanie M. Gorka
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
| | - Huiting Liu
- Department of Psychology, University of Illinois-Chicago
| | | | - Erin C. Berenz
- Department of Psychology, University of Illinois-Chicago
| | - K. Luan Phan
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
- Anatomy and Cell Biology and the Graduate Program in Neuroscience, University of Illinois-Chicago
- Jesse Brown VA Medical Center, Mental Health Service Line
| | - Stewart A. Shankman
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
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