Revisiting sex differences in the acquisition and extinction of threat conditioning in humans

Using unconditioned responses to predict fear acquisition, fear extinction learning, and extinction retention patterns: Sex hormone status matters

Following a traumatic event, fear dysregulation can increase the likelihood of developing post-traumatic stress disorder (PTSD). This psychopathology is twice as prevalent in women than in men. High physiological reactivity following trauma may be an early risk indicator for the development of PTSD. Elevated physiological reactivity and low estradiol levels have individually been associated with higher fear acquisition and/or lower extinction retention. Thus, sex hormone status may also modulate fear regulation abilities. However, it is unknown whether these two vulnerability factors interact to modulate fear learning and regulation. Using a fear conditioning and extinction protocol, we examined whether physiological reactivity to the aversive stimulus during fear acquisition training predicted fear responses during fear learning, extinction learning, and extinction retention. We verified whether these associations differed according to sex hormone status. Seventy-seven non-clinical participants were recruited including oral contraceptive users (n = 18), early follicular women (n = 20, [low estradiol]), mid-cycle women (n = 20, [high estradiol]), and men (n = 19). Participants underwent a three-day fear conditioning and extinction protocol (day 1: fear acquisition training; day 2: extinction training; day 3: retention test). Skin conductance responses were recorded. In early follicular women, physiological reactivity predicted conditioned and extinguished stimulus fear responses during all phases. For the remaining women, this effect was only present during fear learning and extinction learning. These findings highlight the importance of considering physiological reactivity and sex hormone status following a traumatic event. This knowledge could aid in the early identification of those at higher risk of developing PTSD.

Predicting Fear Extinction in Posttraumatic Stress Disorder

Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.

Sex differences in learning and performing the Go/NoGo tasks

BACKGROUND

The quality of learning and post-learning performances is critical for daily life. The behavioral flexibility is equally important for adapting the changing circumstances. The learning process requires repeated practices, which enhances prompt and proper behavioral responses, in turn, which promotes habits formation as well. Despite the well-documented sex differences in learning and performances, contradictory results were reported. A possible cause might be a systematic analysis due to specific research interests, regardless of the continuity of natural acquisition process. Here, we investigate the potential sex differences in learning, performances and adjustments of habited behaviors with regular and reversal Go/NoGo tasks.

METHODS

Both male and female Sprague-Dawley rats were used in this study. All rats were trained for a regular rodent Go/NoGo task and a subset of rats were trained for a reversal rodent Go/NoGo task, both with strict elimination criteria. The behavioral performance data were stored in PC for off-line analysis. Multiple behavioral indices were analyzed for both passed and retired rats.

RESULTS

The ability of learning the regular the reversal Go/NoGo tasks was similar for both male and female rats, however, the female rats took longer time to master the task principles in later stages for both tasks. In the regular Go/NoGo task, the female rats spent more time on completing the trial in performance optimization phases, which implied female rats were more cautious than male rats. Along with the progression of training, both male and female rats developed Go-preference strategies to perform the regular Go/NoGo task, which induced failure to meet the setting success criteria. The retired male rats exhibited shorter RTs and MTs than the retired female rats after developing Go-preference. Moreover, the time needed to complete the Go trials was significantly prolonged for male rats in the reversal Go/NoGo task.

CONCLUSIONS

Overall, we conclude that distinctive strategies were employed in performing Go/NoGo tasks for both male and female rats. Male rats required less time to stabilize the performance in behavioral optimization phase. In addition, male rats were more accurate in estimating time elapsing. In contrast, female rats took more cautious considerations in performing the task, through which minimal influences were manifested in the reversal version of task.

Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity

Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, and sleep disturbances are linked to many mental disorders including post-traumatic stress disorder (PTSD). Previous studies examining associations between sleep and fear or extinction processes primarily focused on objectively measured sleep architecture. Little research has so far focused on subjective sleep measures and particularly in clinical populations, which often experience subjectively poor sleep, including PTSD. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity (n = 248). Overall, we did not find that subjective sleep was associated with fear conditioning or extinction processes. However, exploratory analyses examining the moderating effect of sex found that shorter sleep onset latency and greater sleep efficiency were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective in highly symptomatic women against the commonly observed impaired extinction recall in PTSD. More studies are needed to explore sex-specific effects further.