Illusory correlations between neutral and aversive stimuli can be induced by outcome aversiveness

Aversive contexts enhance defensive responses to conditioned threat

The ability to flexibly transition between defensive states is crucial for adaptive responding in life-threatening situations. Potentially threatening situations typically induce a sustained feeling of apprehension in association with hypervigilance, while acute threat is usually characterized by an intense and transient response to cope with the imminent danger. While potential and acute threat states have traditionally been viewed as mutually exclusive, this distinction is being challenged by a growing body of evidence suggesting a more complex interplay during simultaneous activation of these states. However, the interaction between potential and acute threat on a psychophysiological level remains elusive. To fill this gap, 94 healthy individuals participated in one of two contextual fear-conditioning paradigms. In both paradigms, a differential fear-learning phase was conducted, followed by a test phase in which the conditioned stimuli were presented in front of either conditioned or inherently aversive contextual images compared to neutral contexts. To capture defensive responses, we recorded subjective (threat and expectancy ratings) and physiological (electrodermal and cardiovascular) activity to the conditioned stimuli as a function of contextual threat. Besides indices of successful fear conditioning, our results revealed stronger threat and unconditioned stimulus expectancy ratings, cardiac deceleration, and skin conductance responses for threat and safety cues presented in inherently aversive compared to neutral contexts. Conditioned contexts had less impact on physiological responses to threat and safety cues than inherently aversive contexts. These findings provide new insights into the additive nature of defensive responses to fear cues and situations of contextual threat.

The role of consciousness in threat extinction learning

Extinction learning is regarded as a core mechanism underlying exposure therapy. The extent to which learned threats can be extinguished without conscious awareness is a controversial and on-going debate. We investigated whether implicit vs. explicit exposure to a threatened stimulus can modulate defence responses measured using pupillometry. Healthy participants underwent a threat conditioning paradigm in which one of the conditioned stimuli (CS) was perceptually suppressed using continuous flash suppression (CFS). Participants' pupillary responses, CS pleasantness ratings, and trial-by-trial awareness of the CS were recorded. During Extinction, participants' pupils dilated more in the trials in which they were unaware of the CS than in those in which they were aware of it (Cohen's d = 0.57). After reinstatement, the percentage of fear recovery was greater for the CFS-suppressed CS than the CS with full awareness. The current study suggests that the modulation of fear responses by extinction with reduced visual awareness is weaker compared to extinction with full perceptual awareness.

The effect of inherently threatening contexts on visuocortical engagement to conditioned threat

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.

Mental Resilience and Coping With Stress: A Comprehensive, Multi-level Model of Cognitive Processing, Decision Making, and Behavior

Aversive events can evoke strong emotions that trigger cerebral neuroactivity to facilitate behavioral and cognitive shifts to secure physiological stability. However, upon intense and/or chronic exposure to such events, the neural coping processes can be maladaptive and disrupt mental well-being. This maladaptation denotes a pivotal point when psychological stress occurs, which can trigger subconscious, "automatic" neuroreactivity as a defence mechanism to protect the individual from potential danger including overwhelming unpleasant feelings and disturbing or threatening thoughts.The outcomes of maladaptive neural activity are cognitive dysfunctions such as altered memory, decision making, and behavior that impose a risk for mental disorders. Although the neurocognitive phenomena associated with psychological stress are well documented, the complex neural activity and pathways related to stressor detection and stress coping have not been outlined in detail. Accordingly, we define acute and chronic stress-induced pathways, phases, and stages in relation to novel/unpredicted, uncontrollable, and ambiguous stressors. We offer a comprehensive model of the stress-induced alterations associated with multifaceted pathophysiology related to cognitive appraisal and executive functioning in stress.

Reappraising fear: is up-regulation more efficient than down-regulation?

Catastrophizing thoughts may contribute to the development of anxiety, but functional emotion regulation may help to improve treatment. No study so far directly compared up- and down-regulation of fear by cognitive reappraisal. Here, healthy individuals took part in a cued fear experiment, in which multiple pictures of faces were paired twice with an unpleasant scream or presented as safety stimuli. Participants (N = 47) were asked (within-subjects) to down-regulate, to up-regulate and to maintain their natural emotional response. Valence and arousal ratings indicated successful up- and down-regulation of the emotional experience, while heart rate and pupil dilation increased during up-regulation, but showed no reduction in down-regulation. State and trait anxiety correlated with evaluations of safety but not threat stimuli, which supports the role of deficient safety learning in anxiety. Reappraisal did not modulate this effect. In conclusion, this study reveals evidence for up-regulation effects in fear, which might be even more efficient than down-regulation on a physiological level and highlights the importance of catastrophizing thoughts for the maintenance of fear and anxiety.

From Uncertainty to Anxiety: How Uncertainty Fuels Anxiety in a Process Mediated by Intolerance of Uncertainty

Uncertainty about future events may lead to worry, anxiety, even inability to function. The highly related concept-intolerance of uncertainty (IU)-emerged in the early 1990s, which is further developed into a transdiagnostic risk factor in multiple forms of anxiety disorders. Interests in uncertainty and intolerance of uncertainty have rapidly increased in recent years; little is known about the construct and phenomenology of uncertainty and IU and the association between them. In an attempt to reveal the nature of two concepts, we reviewed broad literature surrounding uncertainty and intolerance of uncertainty (IU). We followed the process in which the whole IU theory developed and extended, including two aspects: (1) from uncertainty to intolerance of uncertainty and (2) definition of uncertainty and intolerance of uncertainty, and further concluded uncertainty fuels to negative emotions, biased expectancy, and inflexible response. Secondly, this paper summarized the experimental research concerning uncertainty and IU, consisted of three parts: (1) uncertainty-based research, (2) measurements of IU, and (3) domain-specific IU. Lastly, we pointed out what remains unknown and needed to be investigated in future research. This result provides a comprehensive overview in this domain, enhancing our understanding of uncertainty and IU and contributing to further theoretical and empirical explorations.

Covariation bias in depression - a predictor of treatment response?

Covariation bias, defined as an overestimation of the relationship between fear-relevant stimuli and aversive consequences, is a well-investigated cognitive bias in anxiety disorders. As patients with affective disorders also show biased information processing, the aim of the present study was to investigate whether depressed patients also display a covariation bias between negative stimuli and aversive consequences. Covariation estimates of 62 inpatients with a current severe depressive episode were assessed at admission (n = 31) or after 6 weeks of treatment (n = 31) and were compared in a between-group design with 31 age- and sex-matched healthy controls. All participants showed a covariation bias for the relationship between negative stimuli and aversive consequences. Moreover, covariation bias at admission was significantly associated with various clinician- and self-reported dimensional measures of treatment response assessed 6 weeks later (Global Assessment of Functioning, Clinical Global Impression Scale, and Beck Depression Inventory), i.e., patients with a stronger bias showed greater impairment after 6 weeks of treatment. Categorical analyses revealed that overall, treatment non-responders-but not responders-were characterized by a covariation bias. The naturalistic study design without standardized pharmacological and psychotherapeutic treatments is a central limitation. We conclude that the covariation bias may constitute a possible marker in the field of emotional information processing in the search for effective predictors of therapy outcome.

Anticipation of Uncertain Threat Modulates Subsequent Affective Responses and Covariation Bias

Uncertainty contributes to stress and anxiety-like behaviors by impairing the ability of participants to objectively estimate threat. Our study used the cue-picture paradigm in conjunction with the event-related potential (ERP) technique to explore the temporal dynamics of anticipation for and response to uncertain threat in healthy individuals. This task used two types of cue. While ‘certain’ cues precisely forecasted the valence of the subsequent pictures (negative or neutral), the valence of pictures following ‘uncertain’ cues was not predictable. ERP data showed that, during anticipation, uncertain cues elicited similar Stimulus-Preceding Negativity (SPN) to certain-negative cues, while both of them elicited larger SPN than certain-neutral cues. During affective processing, uncertainty enlarged the mean amplitude of late positive potential (LPP) for both negative and neutral pictures. Behavioral data showed that participants reported more negative mood ratings of uncertain-neutral pictures relative to certain-neutral pictures and overestimated the probability of negative pictures following uncertain cues. Importantly, the enlarged anticipatory activity evoked by uncertain cues relative to that evoked by certain-neutral cues positively modulated the more negative mood ratings of uncertain-neutral pictures relative to certain-neutral pictures. Further, this more negative mood ratings and the general arousal anticipation during anticipatory stage contributed to the covariation bias. These results can provide a novel insight into understanding the neural mechanism and pathological basis of anxiety.

Diminishing covariation bias in women with a negative body evaluation and the potential roles of outcome aversiveness and interpretation of social feedback

Women with a more negative body evaluation perceive that their body is associated with more negative social feedback. This covariation bias could reinforce negative body evaluation. We investigated whether covariation bias could be diminished and explored the potential roles of outcome aversiveness and interpretation of negative social feedback associated with one's body. Ninety-seven undergraduate women completed a computer task wherein photos of their body, a control woman's body, and a neutral object were followed by negative social feedback or nothing. When the relation between each category and the negative feedback was random, women with a more negative body evaluation perceived more negative feedback following their body. They also experienced negative feedback following their body and the control woman's body as more aversive. After a manipulation block, women with a more negative body evaluation no longer perceived more negative feedback for their body. These effects coincided with improvements in state body evaluation.

How fear-relevant illusory correlations might develop and persist in anxiety disorders: A model of contributing factors

Fear-relevant illusory correlations (ICs) are defined as the overestimation of the relationship between a fear-relevant stimulus and aversive consequences. ICs reflect biased cognitions affecting the learning and unlearning of fear in anxiety disorders, and a deeper understanding might help to improve treatment. A model for the maintenance of ICs is proposed that highlights the importance of amplified aversiveness and salience of fear-relevant outcomes, impaired executive contingency monitoring and an availability heuristic. The model explains why ICs are enhanced in high fearful individuals and allows for some implications that might be applied to augment the effectiveness of cognitive behavior therapy, such as emotion regulation and the direction of attention to non-aversive experiences. Finally, we suggest possible future research directions and an alternative measure of ICs.

Neural correlates of pupil dilation during human fear learning

BACKGROUND

Fear conditioning and extinction are prevailing experimental and etiological models for normal and pathological anxiety. Pupil dilations in response to conditioned stimuli are increasingly used as a robust psychophysiological readout of fear learning, but their neural correlates remain unknown. We aimed at identifying the neural correlates of pupil responses to threat and safety cues during a fear learning task.

METHODS

Thirty-four healthy subjects underwent a fear conditioning and extinction paradigm with simultaneous functional magnetic resonance imaging (fMRI) and pupillometry. After a stringent preprocessing and artifact rejection procedure, trial-wise pupil responses to threat and safety cues were entered as parametric modulations to the fMRI general linear models.

RESULTS

Trial-wise magnitude of pupil responses to both conditioned and safety stimuli correlated positively with activity in dorsal anterior cingulate cortex (dACC), thalamus, supramarginal gyrus and insula for the entire fear learning task, and with activity in the dACC during the fear conditioning phase in particular. Phasic pupil responses did not show habituation, but were negatively correlated with tonic baseline pupil diameter, which decreased during the task. Correcting phasic pupil responses for the tonic baseline pupil diameter revealed thalamic activity, which was also observed in an analysis employing a linear (declining) time modulation.

CONCLUSION

Pupil dilations during fear conditioning and extinction provide useful readouts to track fear learning on a trial-by-trial level, particularly with simultaneous fMRI. Whereas phasic pupil responses reflect activity in brain regions involved in fear learning and threat appraisal, most prominently in dACC, tonic changes in pupil diameter may reflect changes in general arousal.

Fear-relevant illusory correlations in different fears and anxiety disorders: A review of the literature

Fearful individuals often overestimate the relationship between fear-relevant stimuli and aversive consequences. Such fear-relevant illusory correlations (ICs) might be involved in the maintenance of anxiety disorders. In this literature review, we found clear evidence that ICs are present and enhanced in fear of animals. We also revealed some evidence for ICs related to fear of flying, social anxiety, contamination fear, panic disorder, and post-traumatic stress disorder, but with considerably less clarity. Fear-relevant ICs seem to be best explained by both a priori expectancies and biased encoding of the experienced associations. Studies to date suggest that one important biased encoding process is the enhanced aversiveness/salience of fear-relevant outcomes. Future studies may improve insight by developing more reliable IC measures and testing the effect of encoding processes on treatment outcomes.

Brain activity associated with illusory correlations in animal phobia

Anxiety disorder patients were repeatedly found to overestimate the association between disorder-relevant stimuli and aversive outcomes despite random contingencies. Such an illusory correlation (IC) might play an important role in the return of fear after extinction learning; yet, little is known about how this cognitive bias emerges in the brain. In a functional magnetic resonance imaging study, 18 female patients with spider phobia and 18 healthy controls were exposed to pictures of spiders, mushrooms and puppies followed randomly by either a painful electrical shock or nothing. In advance, both patients and healthy controls expected more shocks after spider pictures. Importantly, only patients with spider phobia continued to overestimate this association after the experiment. The strength of this IC was predicted by increased outcome aversiveness ratings and primary sensory motor cortex activity in response to the shock after spider pictures. Moreover, increased activation of the left dorsolateral prefrontal cortex (dlPFC) to spider pictures predicted the IC. These results support the theory that phobia-relevant stimuli amplify unpleasantness and sensory motor representations of aversive stimuli, which in turn may promote their overestimation. Hyper-activity in dlPFC possibly reflects a pre-occupation of executive resources with phobia-relevant stimuli, thus complicating the accurate monitoring of objective contingencies and the unlearning of fear.

Pupillometry

Pupillometry is the study of changes in the diameter of the pupil as a function of cognitive processing. This review paper provides a brief historical overview of the study of pupillometry in cognitive science. The physiology of pupillary responses is introduced, leading to an outline of early pupillometry work, which began with the seminal work of Hess and Polt in the 1960s. The paper then presents a broad review of contemporary research in cognitive sciences that relies on pupillometry. This review is organized around five general domains, namely perception, language processing, memory and decision making, emotion and cognition, and cognitive development. In order to illustrate the nature of the method, and the challenges of analysis, the next section of the review details the process of compiling, processing, and analyzing data from a simple, typical pupillometry study. WIREs Cogn Sci 2014, 5:679-692. doi: 10.1002/wcs.1323 For further resources related to this article, please visit the WIREs website.

CONFLICT OF INTEREST

The authors have declared no conflicts of interest for this article.