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Lam GN, Cooper J, Lipp OV, Mayo LM, Ney L. Exploration of stress reactivity and fear conditioning on intrusive memory frequency in a conditioned-intrusion paradigm. J Behav Ther Exp Psychiatry 2024; 85:101984. [PMID: 39116644 DOI: 10.1016/j.jbtep.2024.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 05/23/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND AND OBJECTIVES The conditioned-intrusion paradigm was designed to provide insight into the relationship between fear conditioning and intrusive memory formation, which is relevant to understanding posttraumatic stress disorder symptoms and treatment. However, boundary conditions of this new paradigm have not been explored and it is currently not known whether findings from this work are valid in a clinical context. METHODS In the current study, we explored the relationship between stress reactivity to trauma film clips, usual exposure to violent media, renewal of fear conditioning using skin conductance as well as subjective ratings, and the effect of shock versus film clip during conditioning on the frequency of intrusive memories. An adapted fear conditioning paradigm using trauma clips as unconditional stimuli was used, and participants subsequently reported intrusive memories of the trauma clips. RESULTS Skin conductance responses to conditioned stimuli paired with shocks and film clips were significantly higher than conditioned stimuli paired with film clips alone. Subjective stress reactivity, previous exposure to violent media, and film valence rating were associated with the frequency of intrusive memories. No aspects of fear conditioning were associated with intrusive memories, and factor analysis suggested the fear conditioning and stress related to film clip viewing were mostly separate constructs. Similarly, content and triggers of intrusive memories were usually film-clip related rather than conditional stimulus related. LIMITATIONS We did not observe strong conditioning effects of the unconditional stimuli to conditional stimuli, which were shapes rather than high frequency stimuli such as faces. CONCLUSIONS These findings provide potential boundary conditions for this paradigm and suggest multiple ways in which the validity of the paradigm can be tested in the future.
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Affiliation(s)
- Gia Nhi Lam
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jack Cooper
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Ottmar V Lipp
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Leah M Mayo
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Canada
| | - Luke Ney
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
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Rattel JA, Danböck S, Miedl SF, Liedlgruber M, Wilhelm FH. Hitting the Rewind Button: Imagining Analogue Trauma Memories in Reverse Reduces Distressing Intrusions. COGNITIVE THERAPY AND RESEARCH 2024; 48:932-943. [PMID: 39329077 PMCID: PMC11422422 DOI: 10.1007/s10608-024-10488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 09/28/2024]
Abstract
Background Intrusive re-experiencing of trauma is a core symptom of posttraumatic stress disorder. Intrusive re-experiencing could potentially be reduced by 'rewinding', a new treatment approach assumed to take advantage of reconsolidation-updating by mentally replaying trauma fast-backward. Methods The present analogue study was the first to investigate 'rewinding' in a controlled laboratory setting. First, 115 healthy women watched a highly aversive film and were instructed to report film-related intrusions during the following week. Twenty-four hours after film-viewing, participants reporting at least one intrusion (N = 81) were randomly allocated to an intervention (fast-backward, or fast-forward as active control condition) or a passive control condition. Intervention groups reactivated their trauma memory, followed by mentally replaying the aversive film either fast-backward or fast-forward repeatedly. Results Results indicate that replaying trauma fast-backward reduced intrusion load (intrusion frequency weighted for intrusion distress) compared to the passive group, whereas replaying fast-forward did not. No above-threshold differences between fast-backward and fast-forward emerged. Conclusion Present findings strengthen the view that 'rewinding' could be a promising intervention to reduce intrusions.
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Affiliation(s)
- Julina A. Rattel
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Sarah Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Stephan F. Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Frank H. Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
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Cohen M, Quintner J, Weisman A. "Conditioned pain" remains unproven and unlikely (comment on Kang et al. PAIN 2023; 164: 2596-2605). Pain 2024; 165:1189-1190. [PMID: 38619935 DOI: 10.1097/j.pain.0000000000003202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
| | | | - Asaf Weisman
- Department of Physical Therapy, Spinal Research Laboratory, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel
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Kang S, Van Ryckeghem DML, Vlaeyen JWS, De Paepe AL, Crombez G. In search of conditioned pain: an experimental analysis. Pain 2023; 164:2596-2605. [PMID: 37288937 DOI: 10.1097/j.pain.0000000000002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
ABSTRACT There is an ongoing debate about whether pain can be classically conditioned, but surprisingly, evidence is scarce. Here, we report 3 experiments investigating this idea. In a virtual reality task, healthy participants were approached and touched near or on their hand with a coloured pen (blue or yellow). During acquisition, participants learned that one of the colours of the pen (CS+) was predictive of a painful electrocutaneous stimulus (ECS) whereas the other coloured pen (CS-) was not. During the test phase, more frequent reports of experiencing an US when none was delivered ("false alarm") for the CS+ vs CS- qualified as evidence of conditioned pain. Notable differences between experiments were that the US was delivered when the pen touched a spot between the thumb and index finger (experiment 1; n = 23), when it virtually touched the hand (experiment 2; n = 28) and when participants were informed that the pen caused pain rather than simply predicting something (experiment 3; n = 21). The conditioning procedure proved successful in all 3 experiments: Self-reported fear, attention, pain, fear, and US expectancy were higher ( P < 0.0005) for the CS+ than the CS-. There was no evidence for conditioned pain in experiment 1, but there was some evidence in experiments 2 and 3. Our findings indicate that conditioned pain may exist, albeit most likely in rare cases or under specific situations. More research is needed to understand the specific conditions under which conditioned pain exists and the underlying processes (eg, response bias).
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Affiliation(s)
- Sahaj Kang
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands
| | - Annick L De Paepe
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Boorman DC, Keay KA. Learning pain in context: Response-conditioned placebo analgesia and nocebo hyperalgesia in male rats with chronic neuropathic pain. Physiol Behav 2023; 263:114116. [PMID: 36773736 DOI: 10.1016/j.physbeh.2023.114116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Animal models of placebo analgesia and nocebo hyperalgesia have great potential to assist in the development of novel treatments for chronic pain that exploit or inhibit these phenomena. This study sought to elicit both conditioned placebo analgesia and conditioned nocebo hyperalgesia in rats with chronic neuropathic pain using non-pharmacological, contextual conditioning approaches, similar to those most often used in humans. METHODS Sciatic nerve-injured male Sprague-Dawley rats (n = 80), and sham controls (n = 16), underwent a conditioning procedure in which three different thermal stimulus intensities (4 °C, 20 °C or 30 °C) were paired with contextual cues. Injured hind paw withdrawal behaviours were used to determine pain sensitivity, and either conditioned analgesia or conditioned hyperalgesia was evoked by re-exposing the rats to the same context with either an increased or decreased thermal stimulus, respectively. RESULTS Stronger conditioned analgesia and conditioned hyperalgesia were seen when rats were conditioned in a more complex environment, highlighting the importance of context in these processes. Rats that did not undergo conditioning procedures showed fewer hind paw withdrawals, indicating a learned component to these pain behaviours. CONCLUSIONS Our data call attention to context and learning as two critical factors in the development of placebo and nocebo effects in male rodents with a neuropathic injury. Additionally, the response-conditioning model we present in this study affords better comparisons between human and animal studies, in particular for those seeking to identify commonalities in the neurobiological mechanisms of placebo and nocebo responses.
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Affiliation(s)
- Damien C Boorman
- School of Medical Sciences and the Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia.
| | - Kevin A Keay
- School of Medical Sciences and the Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia
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Reply to Quintner. Pain 2022; 163:e1217-e1219. [DOI: 10.1097/j.pain.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Franke LK, Miedl SF, Danböck SK, Lohse J, Liedlgruber M, Bürkner PC, Pletzer B, Wilhelm FH. Estradiol during (analogue-)trauma: Risk- or protective factor for intrusive re-experiencing? Psychoneuroendocrinology 2022; 143:105819. [PMID: 35724562 DOI: 10.1016/j.psyneuen.2022.105819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/06/2023]
Abstract
Intrusions, a key symptom of posttraumatic stress disorder (PTSD), can occur in the form of images but also as pain sensations. Similar to audiovisual intrusions, the frequency and persistence of pain intrusions varies greatly between individuals. In the current study, we examined whether peritraumatic circulating 17β-estradiol (E2) levels are a biologic factor associated with subsequent audiovisual (i.e., film) and pain intrusion development, and whether peritraumatic stress levels modulate this relationship. Forty-one free-cycling women participated in an ecologically informed trauma-pain-conditioning (TPC) paradigm, using trauma-films and pain as unconditioned stimuli. Independent variables were salivary peritraumatic E2 levels and stress indexed by salivary cortisol and self-reported state-anxiety during TPC. Outcomes were film- and pain-intrusions occurring during daily-life in the week following TPC and a Memory-Triggering-Task in response to conditioned stimuli 24 h after TPC. In the week after analogue-trauma, higher peritraumatic E2 levels were associated with a greater probability of experiencing film-intrusions in the beginning of the week, which switched to a lower probability toward the end of the week. This time-dependent relationship between E2 and film-intrusions only held for higher state-anxious women. In contrast, results indicated a consistent inverse relationship between peritraumatic E2 levels and pain-intrusions during daily-life and Memory-Triggering-Task. Together, these data suggest that higher peritraumatic E2 levels could be associated with lower long-term visual trauma intrusions, as well as lower pain-intrusions, and thereby possibly constitute a protective biologic factor for PTSD and potentially also for chronic pain.
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Affiliation(s)
- Laila K Franke
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria.
| | - Stephan F Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Sarah K Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Johanna Lohse
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | | | - Belinda Pletzer
- Division of Psychoneuroendocrinology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria; Centre for Cognitive Neuroscience, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Frank H Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
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xCan pain be re-experienced as a conditioned response? Pain 2022; 163:e1102-e1103. [PMID: 35239545 DOI: 10.1097/j.pain.0000000000002622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
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