If or when? Uncertainty's role in anxious anticipation

Anticipatory worry and returning to campus during the COVID-19 pandemic

BACKGROUND

Assessing the psychological needs of students and employees as they return to campus is crucial to resuming University life in a safe and secure way. The current research aimed to explore how safety concerns, anticipatory worry, and mitigation efforts affected the well-being of individuals within a campus community.

METHODS

A five-part survey was distributed via student & employee listservs in the Fall 2020 at a midsize private university in the Mid-Atlantic Mid-Atlantic United States. Participants were surveyed about sources of worry regarding Covid-19, levels of anticipatory worry, amenability to various mitigation strategies and whether intended implementation of safety mitigation measures impacted worry levels.

RESULTS

Data collected from 559 students and employees indicated a relationship between source of worry and level of distress, with the greatest source of worry being fear of getting sick. Anticipatory worry after thinking about safety mechanisms was significantly lower than anticipated worry before thinking about safety mechanisms. No differences were found between students and employee experiences of worry, and there was no moderating effect of role on the difference between anticipated worry after, as compared to before, thinking about the mechanisms.

CONCLUSION

Findings highlight how different sources of concern related to Covid-19 are associated with varying levels of distress, the significant impact that the presence of mitigation strategies can have on reducing overall levels of anticipatory worry, and the universality of distress associated with Covid-19.

Contingency Reversal in Conditioned Fear Learning: The Moderated Mediation Model of Intolerance of Uncertainty and Instruction

Objective

The study aimed to examine the roles of anxiety and intolerance of uncertainty (IU) in conditioned fear learning under an uncertain context induced by the contingency reversal of the association between the conditioned stimulus and the unconditioned stimulus (CS-US).

Methods

The study sample comprised 53 participants, randomly divided into two groups: a non-instruction group and an instruction group. The experimental procedure encompassed five stages: pre-acquisition, acquisition, generalization, reversal acquisition, and reversal generalization. Our study primarily focused on analyzing a moderated mediation model.

Results

In the instructed group, we observed that the reversed fear generalization response was directly influenced by the pre-reversal fear generalization response, while also being indirectly mediated by the IU factor. However, in the non-instructed group, we did not find a significant mediating effect of IU. Moreover, we noted that the mediation of IU was contingent on the instructional information. It is noteworthy that anxiety did not exhibit a discernible role in conditioned fear within the uncertainty condition in our study.

Conclusion

The findings provide novel insights into fear-related phenomena, emphasizing the intricate interplay between individual traits and fear generalization under conditions of uncertainty. They contribute to understanding the mechanisms of emotional and cognitive interactions in uncertain conditions.

Manipulating reinforcement probability changes the temporal overestimation of anticipated aversive stimuli

The interval timing can be distorted by emotions. Previous studies indicated that anticipated fear stimuli can lead to temporal overestimation, similar to the effects observed from direct exposure to fear stimuli. However, this time distortion may not always manifest when anticipated. This study aimed to systematically examine the effect of the reinforcement probability of anticipated fear stimuli on time perception in predictable emotional scenarios. The experiment established 100% fear conditioning by associating a conditioned stimulus (CS+) with an aversive unconditioned stimulus (US), electrical stimulation. Participants completed a temporal bisection task under different cues (threat CS+ and safe CS-) expectations. Participants were explicitly informed that an aversive electrical stimulus would always follow the threat cues (CS+) with 100% probability, though in reality, different blocks presented the threat cue with probability manipulation of 50 and 100%. Results showed that only in the 50% reinforcement probability, participants overestimated the duration when anticipating aversive electrical stimulation, while no significant differences were observed in the 100% reinforcement probability. Additionally, the effect of anxiety on temporal judgment failed to capture the overall trend as fixed effects but only contributed to the individual variations as random effects. The findings suggest that the anticipated aversive electrical stimulation may lead to temporal overestimation. Furthermore, the results indicate that a reliable approach for manipulating the effect of anticipated aversive electrical stimulation on temporal overestimation is to establish 100% fear conditioning and use a reinforcement probability like 50%.

Understanding anxiety through uncertainty quantification

Uncertainty has been a central concept in psychological theories of anxiety. However, this concept has been plagued by divergent connotations and operationalizations. The lack of consensus hinders the current search for cognitive and biological mechanisms of anxiety, jeopardizes theory creation and comparison, and restrains translation of basic research into improved diagnoses and interventions. Drawing upon uncertainty decomposition in Bayesian Decision Theory, we propose a well-defined conceptual structure of uncertainty in cognitive and clinical sciences, with a focus on anxiety. We discuss how this conceptual structure provides clarity and can be naturally applied to existing frameworks of psychopathology research. Furthermore, it allows formal quantification of various types of uncertainty that can benefit both research and clinical practice in the era of computational psychiatry.

Modulation of attention to pain by goal-directed action: a somatosensory evoked potentials approach

Background

Attentional processes are modulated by current goal pursuit. While pursuing salient cognitive goals, individuals prioritize goal-related information and suppress goal-irrelevant ones. This occurs in the context of pain too, where nonpain cognitive goal pursuit was found to have inhibitory effects on pain-related attention. Crucially, how pursuing nonpain motor goals affects pain-related somatosensory attention is still unknown. The aim of this study was to investigate whether nonpain motor goal pursuit would attenuate pain-related somatosensory attention.

Methods

Healthy volunteers (N = 45) performed a robotic arm conditioning task where movements were paired with conflicting (pain and reward), threatening (only pain) or neutral (no pain and no reward) outcomes. To increase the motivational value of pursuing the nonpain motor goal, in the conflicting condition participants could receive a reward for a good motor performance. To examine somatosensory attention during movement, somatosensory evoked potentials (SEPs; N120 and P200) were obtained in response to innocuous tactile stimuli administered on a pain-relevant or pain-irrelevant body location. We expected that the threat of pain would enhance somatosensory attention. Furthermore, we expected that the possibility of getting a reward would inhibit this effect, due to pain-reward interactions.

Results

Against our predictions, the amplitude of the N120 did not differ across movement types and locations. Furthermore, the P200 component showed significantly larger SEPs for conflicting and threat movements compared to neutral, suggesting that the threat of pain increased somatosensory attention. However, this effect was not modulated by nonpain motor goal pursuit, as reflected by the lack of modulation of the N120 and P200 in the conflicting condition as compared to the threat condition. This study corroborates the idea that pain-related somatosensory attention is enhanced by threat of pain, even when participants were motivated to move to obtain a reward.

The interactive effects of different facets of threat uncertainty and cognitive load in shaping fear and anxiety responses

A large body of research indicates that exaggerated response to uncertainty of a future threat is at the core of anxiety and related disorders, underscoring the need for a better understanding of the underlying mechanisms. Although behavioral and neuroimaging studies have suggested a close relationship between uncertainty responses and cognitive control, little is known about what elements of uncertainty are more or less vulnerable to cognitive modulation in shaping aversive responses. Leveraging a novel paradigm, an n-back working memory task embedded within a modified threat-of-shock paradigm, we examined how the influences of different facets of uncertainty (i.e., occurrence and timing) on psychophysiological responses were modulated by cognitive load. Psychophysiological responses were assessed using the acoustic startle reflex. Replicating prior work, the effects of cognitive load and temporal unpredictability of threat on startle responses were evident. The effect of occurrence unpredictability appears to depend on other factors. Under low cognitive load, startle response was potentiated when both the occurrence and the timing of threat were predictable. Under high cognitive load, startle response was significantly reduced, especially when a threat context involves uncertainty in both temporal and probability domains. These observations provide a framework for refining the model of fear and anxiety and for understanding the etiology of psychological disorders characterized by maladaptive uncertainty responses.

Intolerance of Uncertainty and Cognition in Breast Cancer Survivors: The Mediating Role of Anxiety

Cancer-related cognitive impairment (CRCI) is one of the most prevalent symptoms that breast cancer survivors experience. While cancer treatments are established contributors to CRCI, inter-individual differences in CRCI are not well understood. Individual differences in sensitivity to uncertainty are potential contributors to CRCI; however, no prior studies have attempted to examine this link in the context of breast cancer. To address the gap, we used preliminary findings from an ongoing cross-sectional study. A total of 38 women with stage I-III breast cancer (1-4 years post-treatment) were included in this study. Intolerance of uncertainty (IU) was assessed using the Intolerance of Uncertainty Scale. Self-reported cognitive function was assessed with the Neuro-QoL questionnaire. Anxiety was assessed using the Patient-Reported Outcomes Measurement System Bank. From this study, we found that anxiety mediates the association between IU and cognitive function of survivors. In other words, among post-menopausal breast cancer survivors, those with higher IU showed higher anxiety and consequently had lower cognitive function. This finding suggests that assessing IU may help predict the risk of CRCI. This study expands the current knowledge that addresses the importance of IU as a factor associated with cognitive health.

Don't worry, it won't be fine. Contributions of worry and anxious arousal to startle responses and event-related potentials in threat anticipation

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.

Sensory sensitivity, intolerance of uncertainty and sex differences predicting anxiety in emerging adults

As multiple vulnerability factors have been defined for anxiety disorders, it is important to investigate the interactions among these factors to understand why and how some individuals develop anxiety. Sensory Sensitivity (SS) and Intolerance of Uncertainty (IU) are independent vulnerability factors of anxiety, but their unique relationship in predicting anxiety has rarely been studied in non-clinical populations. The objective of this investigation was to examine the combined effects of SS and IU on self-reported anxiety in a sample of university students. In addition, with the frequently reported sex bias in anxiety literature, we expected that the combined effects of vulnerability factors would be different for females and males. A convenience sample of 313 university students, ages 17-26 years was recruited. The participants completed the Intolerance of Uncertainty Scale (IUS-12), the Adult/Adolescent Sensory Profile (AASP), and the Beck Anxiety Inventory (BAI). Results of moderated mediation analyses demonstrated a strong partial mediation between SS and anxiety through IU, providing evidence that IU, a cognitive bias against the unknown, was one mechanism that explained how SS was related to anxiety. Further, the effect of IU on anxiety was approximately twice as strong in females. Our results highlight the importance of studying the unique relationships among multiple vulnerability factors to better understand anxiety susceptibility in emerging adults.

A rare scare: The role of intolerance of uncertainty in startle responses and event-related potentials in anticipation of unpredictable threat

Intolerance of uncertainty (IU) represents a transdiagnostic risk factor for internalizing psychopathology. However, little is known regarding its psychophysiological correlates. IU is thought to render individuals hypersensitive to threatening events, even if the occurrence probability is low. To test this, we recruited 90 students who completed two NPU-threat tests separating temporal unpredictability from probabilistic unpredictability (i.e., probability of occurrence): First, a NPU version in which the timing of threat (i.e., shock) was either predictable or unpredictable but the shock probability was 100 % in each trial. Second, a probabilistic NPU version in which the timing of the shock was also either predictable or unpredictable, but the shock probability was 33 % in each trial. Startle reflex, event-related potentials N1 and P3 locked to auditory startle probes, and anxiety ratings were analyzed. As expected, temporally unpredictable threat modulated startle, N1, and anxiety ratings. IU predicted increased startle to lower shock probability, regardless of the temporal predictability. No evidence emerged for IU affecting N1 or P3. However, IU predicted anxiety ratings to threat conditions regardless of temporal or probabilistic predictability. Individual differences in IU shape startle responses to eventual threat: IU increases automatic defensive responding to unpredictable and potentially threatening situations if the threat probability is low. Individuals with higher IU may tend to "err on the side of caution" with a mismatch between physiological preparation and threat probability, such that the effects of IU are particularly observable in low threat probability conditions.

Intolerance of uncertainty and psychophysiological reactivity in anticipation of unpredictable threat in youth

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.

Aversive response to uncertainty as a mediator for the effect of a mindfulness intervention on symptoms of anxiety

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.

Early Safety Discrimination Under Uncertainty in Trait Anxiety: An Event-Related Potential Study

Detection of safety-threat signals during uncertainty is an important mechanism of developmental anxiety disorder (AD). Although extensive research has focused on the detection of uncertain threat signals in anxious individuals, relatively little attention has been given to the identification of safety signals during uncertainty, which is an important way to relieve anxiety in individuals with AD. To investigate this phenomenon, 16 subjects with high trait anxiety (HTA) and 16 with low trait anxiety (LTA) completed a modified cue-target task in certain and uncertain stimulus blocks. In the uncertain block, the cue was followed by a threat picture or safety picture in 20% of trials, respectively; in the certain block, the cue could be followed by a threat picture or a safety picture on 100% of trials. Behavioral responses and event-related potentials (ERPs) were recorded. The ERP results demonstrated that LTA participants exhibited larger P2 amplitudes in the detection of safety cues than of threat cues during the uncertain block, whereas HTA participants showed significant P2 amplitudes between the safety and threat cues during the certain block, impairing the detection of safety stimuli during uncertainty. However, all participants exhibited greater N2 amplitudes following threat cues in certainty or uncertainty conditions. These findings pertaining to the P2 amplitude suggested distinctive attentional biases between HTA and LTA individuals, whereas the N2 amplitude showed association learning in uncertain conditions, compensating for safety-threat detection in HTA individuals.

Uncertain in the face of change: Lack of contingency shift awareness during extinction is associated with higher fear-potentiated startle and PTSD symptoms in children

Intolerance of uncertainty is a transdiagnostic risk factor for fear-related disorders and is associated with higher levels of anxiety in children and adolescents. It is unclear how uncertainty relates to development of psychopathology in children who have experienced trauma in early life. The present study used a fear-potentiated startle paradigm in children to examine associations between uncertainty (assessed as unawareness of a change in reinforcement during fear extinction) and symptoms of anxiety and posttraumatic stress disorder (PTSD), as well as startle potentiation to threat and safety cues. Results showed that unaware children had strong positive associations between trauma exposure and PTSD symptoms, whereas aware children did not. Uncertainty interacted with anxiety in that children who were both unaware and had higher anxiety displayed higher fear-potentiated startle to safety cues and did not show discrimination between threat and safety during fear conditioning. These results suggest that anxious children who persist in associating a threat cue with an aversive event during extinction, after repeated presentations of the no longer reinforced conditioned stimulus, may express psychophysiological phenotypes related to PTSD.

Association between startle reactivity to uncertain threats and structural brain volume

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.

When the approaching threat is uncertain: Dynamics of defensive motivation and attention in trait anxiety

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.

Demarcating the boundary conditions of memory reconsolidation: An unsuccessful replication

Disrupting memory reconsolidation provides an opportunity to abruptly reduce the behavioural expression of fear memories with long-lasting effects. The success of a reconsolidation intervention is, however, not guaranteed as it strongly depends on the destabilization of the memory. Identifying the necessary conditions to trigger destabilization remains one of the critical challenges in the field. We aimed to replicate a study from our lab, showing that the occurrence of a prediction error (PE) during reactivation is necessary but not sufficient for destabilization. We tested the effectiveness of a reactivation procedure consisting of a single PE, compared to two control groups receiving no or multiple PEs. All participants received propranolol immediately after reactivation and were tested for fear retention 24 h later. In contrast to the original results, we found no evidence for a reconsolidation effect in the single PE group, but a straightforward interpretation of these results is complicated by the lack of differential fear retention in the control groups. Our results corroborate other failed reconsolidation studies and exemplify the complexity of experimentally investigating this process in humans. Thorough investigation of the interaction between learning and memory reactivation is essential to understand the inconsistencies in the literature and to improve reconsolidation interventions.

Neural and Self-report Measures of Sensitivity to Uncertainty as Predictors of COVID-Related Negative Affect

The COVID-19 pandemic has been a period of unprecedented uncertainty. Research indicates individuals differ in their response to uncertainty and these differences are mediated by anterior insula (aINS) function. Those most sensitive to uncertainty are likely vulnerable to negative affect in the context of the pandemic. The current study was designed to directly test this question using both neural and self-reported measures of sensitivity to uncertainty. Fifty-nine volunteers completed a task designed to probe neural response to anticipation of predictable (P-) and unpredictable (U-) threat-of-electric-shock during functional magnetic resonance imaging and a self-report measure of intolerance of uncertainty (IU). Approximately two years later, during the peak of the pandemic, participants reported their emotional reactions to the COVID-19 crisis. Multilevel mixed models revealed that greater aINS activation to U-threat and greater self-reported IU were independent predictors of increased COVID-related negative affect. These findings were significant when adjusting for biological sex and depression and anxiety symptom severity. The results add to a growing literature demonstrating that individual differences in response to uncertainty have a robust impact on mood and functioning. Results also highlight that individuals highly sensitive to uncertainty may be at increased risk for poor mental health during the ongoing pandemic.

Greater intolerance to uncertainty predicts poorer quality of life in adults with cyclic vomiting syndrome

BACKGROUND

Cyclic vomiting syndrome (CVS) is an idiopathic disorder of gut-brain interaction characterized by recurrent bouts of nausea and vomiting. Although CVS negatively impacts quality of life (QOL), the determinants of impaired QOL among adult CVS sufferers are not fully understood. The unpredictability of CVS attacks may generate anticipatory anxiety and worsen quality of life in a substantial proportion of patients with CVS. Intolerance to uncertainty (IU) is a cognitive trait in which individuals experience distress when faced with unpredictable situations, particularly those with potentially negative consequences. Higher trait IU is a well-established vulnerability factor linked to the development of multiple psychiatric conditions, including anxiety. However, the extent to which higher IU is associated with impaired QOL in adults with CVS is not known.

METHODS

To explore this issue, we surveyed 118 adult CVS patients and obtained demographic information, clinical features, reported healthcare utilization, and standardized assessments of IU, anxiety and panic, and QOL.

KEY RESULTS

Adult CVS patients with higher IU did not report a greater frequency of CVS attacks or overall CVS-related healthcare utilization than those with lower IU. Yet, this group demonstrated substantially poorer physical and mental health-related QOL and higher rates of anxiety-spectrum disorders.

CONCLUSIONS & INFERENCES

Higher degrees of IU are associated with increased anxiety and reduced QOL in patients with CVS. IU is a malleable cognitive trait that can be targeted by cognitive behavioral therapy (CBT). Our results suggest that some CVS patients may benefit from non-pharmacologic therapies such as CBT.

Some fear, more loathing? Threats and anxieties shaping protective gun ownership and gun carry in the U.S

Given notable recent spikes in gun purchases in the U.S., we revisit the 'fear and loathing' hypothesis of firearm demand by (1) establishing how crime/victimization fears are shaped by broader economic, cultural, and racial status anxieties (those emerging from group status threats [loathing]) and (2) illustrating how both fear and loathing matter for protective gun ownership and gun carry (among owners), and openness to future protective ownership among non-owners. Using data from a nationwide survey of adults in the U.S. (n = 2,262) collected in 2019, we find that fears of crime and victimization are often more strongly associated with status anxieties than with safety threats. Both status anxieties and victimization are associated with protective ownership and carry. Among non-owners, those higher in cultural anxiety are especially likely to be open toward future protective gun ownership. This study illustrates the multidimensional fear-guns link, wherein both status-related threats and victimization-related fears shape why individuals own guns, and how they use guns.

Dissociable impact of childhood trauma and deployment trauma on affective modulation of startle

Trauma disorders are often associated with alterations in aversive anticipation and disruptions in emotion/fear circuits. Heightened or blunted anticipatory responding to negative cues in adulthood may be due to differential trauma exposure during development, and previous trauma exposure in childhood may also modify effects of subsequent trauma in adulthood. The aim of the current investigation was to examine the contributions of childhood trauma on affective modulation of startle before and after trauma exposure in adulthood (a combat deployment). Adult male participants from the Marine Resilience Study with (n = 1145) and without (n = 1312) a history of reported childhood trauma completed an affective modulation of startle task to assess aversive anticipation. Affective startle response was operationalized by electromyography (EMG) recording of the orbicularis oculi muscle in response to acoustic stimuli when anticipating positive and negative affective images. Startle responses to affective images were also assessed. Testing occurred over three time-points; before going on a 7 month combat deployment and 3 and 6 months after returning from deployment. Startle response when anticipating negative images was greater compared to pleasant images across all three test periods. Across all 3 time points, childhood trauma was consistently associated with significantly blunted startle when anticipating negative images, suggesting reliable effects of childhood trauma on aversive anticipation. Conversely, deployment trauma was associated with increased startle reactivity post-deployment compared to pre-deployment, which was independent of childhood trauma and image valence. These results support the hypothesis that trauma exposure during development vs. adulthood may have dissociable effects on aversive anticipation and arousal mechanisms. Further study in women and across more refined age groups is needed to test generalizability and identify potential developmental windows for these differential effects.

Intolerance of uncertainty is associated with heightened responding in the prefrontal cortex during cue-signalled uncertainty of threat

Heightened responding to uncertain threat is considered a hallmark of anxiety disorder pathology. We sought to determine whether individual differences in self-reported intolerance of uncertainty (IU), a key transdiagnostic dimension in anxiety-related pathology, underlies differential recruitment of neural circuitry during cue-signalled uncertainty of threat (n = 42). In an instructed threat of shock task, cues signalled uncertain threat of shock (50%) or certain safety from shock. Ratings of arousal and valence, skin conductance response (SCR), and functional magnetic resonance imaging were acquired. Overall, participants displayed greater ratings of arousal and negative valence, SCR, and amygdala activation to uncertain threat versus safe cues. IU was not associated with greater arousal ratings, SCR, or amygdala activation to uncertain threat versus safe cues. However, we found that high IU was associated with greater ratings of negative valence and greater activity in the medial prefrontal cortex and dorsomedial rostral prefrontal cortex to uncertain threat versus safe cues. These findings suggest that during cue-signalled uncertainty of threat, individuals high in IU rate uncertain threat as aversive and engage prefrontal cortical regions known to be involved in safety-signalling and conscious threat appraisal. Taken together, these findings highlight the potential of IU in modulating safety-signalling and conscious appraisal mechanisms in situations with cue-signalled uncertainty of threat, which may be relevant to models of anxiety-related pathology.

Shared and unique neural circuitry underlying temporally unpredictable threat and reward processing

Temporally unpredictable stimuli influence behavior across species, as previously demonstrated for sequences of simple threats and rewards with fixed or variable onset. Neuroimaging studies have identified a specific frontolimbic circuit that may become engaged during the anticipation of temporally unpredictable threat (U-threat). However, the neural mechanisms underlying processing of temporally unpredictable reward (U-reward) are incompletely understood. It is also unclear whether these processes are mediated by overlapping or distinct neural systems. These knowledge gaps are noteworthy given that disruptions within these neural systems may lead to maladaptive response to uncertainty. Here, using functional magnetic resonance imaging data from a sample of 159 young adults, we showed that anticipation of both U-threat and U-reward elicited activation in the right anterior insula, right ventral anterior nucleus of the thalamus and right inferior frontal gyrus. U-threat also activated the right posterior insula and dorsal anterior cingulate cortex, relative to U-reward. In contrast, U-reward elicited activation in the right fusiform and left middle occipital gyrus, relative to U-threat. Although there is some overlap in the neural circuitry underlying anticipation of U-threat and U-reward, these processes appear to be largely mediated by distinct circuits. Future studies are needed to corroborate and extend these preliminary findings.

The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research

Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.

Dissociating the effect of reward uncertainty and timing uncertainty on neural indices of reward prediction errors: A reward positivity (RewP) event-related potential (ERP) study

Accurate reward predictions include forecasting both what a reward will be and when a reward will occur. We tested how variations in the certainty of reward outcome and certainty in timing of feedback presentation modulate neural indices of reward prediction errors using the reward positivity (RewP) component of the scalp-recorded brain event-related potential (ERP). In a within-subjects design, seventy-three healthy individuals completed two versions of a cued doors task; one cued the probability of a reward outcome while the other cued the probability of a delay before feedback. Replicating previous results, RewP amplitude was larger for uncertain feedback compared to certain feedback. Additionally, RewP amplitude was differentially associated with uncertainty of presence/absence of reward, but not uncertainty of feedback timing. Findings suggest a dissociation in that RewP amplitude is modulated by reward prediction certainty but is less affected by certainty surrounding timing of feedback.

Tactile P300 to unpredictable electric shocks: Association with anxiety symptoms, intolerance of uncertainty, and neuroticism

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.

Threat-anticipatory psychophysiological response is enhanced in youth with anxiety disorders and correlates with prefrontal cortex neuroanatomy

Background

Threat anticipation engages neural circuitry that has evolved to promote defensive behaviours; perturbations in this circuitry could generate excessive threat-anticipation response, a key characteristic of pathological anxiety. Research into such mechanisms in youth faces ethical and practical limitations. Here, we use thermal stimulation to elicit pain-anticipatory psychophysiological response and map its correlates to brain structure among youth with anxiety and healthy youth.

Methods

Youth with anxiety (n = 25) and healthy youth (n = 25) completed an instructed threat-anticipation task in which cues predicted nonpainful or painful thermal stimulation; we indexed psychophysiological response during the anticipation and experience of pain using skin conductance response. High-resolution brain-structure imaging data collected in another visit were available for 41 participants. Analyses tested whether the 2 groups differed in their psychophysiological cue-based pain-anticipatory and pain-experience responses. Analyses then mapped psychophysiological response magnitude to brain structure.

Results

Youth with anxiety showed enhanced psychophysiological response specifically during anticipation of painful stimulation (b = 0.52, p = 0.003). Across the sample, the magnitude of psychophysiological anticipatory response correlated negatively with the thickness of the dorsolateral prefrontal cortex (pFWE < 0.05); psychophysiological response to the thermal stimulation correlated positively with the thickness of the posterior insula (pFWE < 0.05).

Limitations

Limitations included the modest sample size and the cross-sectional design.

Conclusion

These findings show that threat-anticipatory psychophysiological response differentiates youth with anxiety from healthy youth, and they link brain structure to psychophysiological response during pain anticipation and experience. A focus on threat anticipation in research on anxiety could delineate relevant neural circuitry.

I told you it was safe: Associations between intolerance of uncertainty and different parameters of uncertainty during instructed threat of shock

BACKGROUND AND OBJECTIVES

Self-reported Intolerance of Uncertainty (IU) is the tendency to find uncertainty aversive. There is a lack of empirical research on how IU modulates anticipatory responding during threatening contexts with different parameters of uncertainty.

METHODS

Exploratory secondary analyses were conducted on an existing data set (n = 45) to examine whether IU is related to a particular parameter of uncertainty during instructed threat of shock (i.e. certain shock, certain safety from shock, outcome uncertainty of shock, temporal uncertainty of shock).

RESULTS

Analyses revealed that IU was associated with larger auditory startle blink during the anticipatory period for the certain safety from shock condition relative to the certain shock condition.

LIMITATIONS

The sample was relatively small.

CONCLUSIONS

Individuals with higher self-reported IU may be more inclined to generalize threat to safety cues in the context of instructed threat of shock.

An experimental investigation into the mediating role of pain-related fear in boosting nocebo hyperalgesia

Nocebo hyperalgesia refers to increases in perceived pain that putatively result from negative expectations regarding a nocebo stimulus (eg, an inert treatment, compared with no treatment). The precise cognitive-emotional factors contributing to the origins of nocebo effects are poorly understood. We aimed to test the effects of experimentally induced pain-related fear on the acquisition and extinction of nocebo hyperalgesia in healthy participants (N = 72). Acquisition and extinction of nocebo hyperalgesia were compared between a group receiving standard nocebo conditioning (Control group) and 2 groups receiving distinct fear inductions: high intensity of pain stimulations (High-pain group) or a threat manipulation (High-threat group). During nocebo acquisition, the Control and High-threat groups were administered thermal pain stimulations of moderate intensity paired with sham electrical stimulation (nocebo trials), whereas high pain intensity was administered to the High-pain group. During extinction, equivalent pain intensities were administered across all trials. Pain-related fear was measured by eyeblink startle electromyography and self-report. Nocebo hyperalgesia occurred in all groups. Nocebo effects were significantly larger in the High-pain group than those in the Control group. This effect was mediated by self-reported fear, but not by fear-potentiated startle. Groups did not differ in the extinction rate. However, only the High-pain group maintained significant nocebo responses at the end of extinction. Anticipatory pain-related fear induced through a threat manipulation did not amplify nocebo hyperalgesia. These findings suggest that fear of high pain may be a key contributor to the amplification of nocebo hyperalgesia, only when high pain is experienced and not when it is merely anticipated.

Responding to uncertain threat: A potential mediator for the effect of mindfulness on anxiety

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.

Anxiety and the Neurobiology of Temporally Uncertain Threat Anticipation

When extreme, anxiety-a state of distress and arousal prototypically evoked by uncertain danger-can be debilitating. Uncertain anticipation is a shared feature of situations that elicit signs and symptoms of anxiety across psychiatric disorders, species, and assays. Despite the profound significance of anxiety for human health and wellbeing, the neurobiology of uncertain-threat anticipation remains unsettled. Leveraging a paradigm adapted from animal research and optimized for fMRI signal decomposition, we examined the neural circuits engaged during the anticipation of temporally uncertain and certain threat in 99 men and women. Results revealed that the neural systems recruited by uncertain and certain threat anticipation are anatomically colocalized in frontocortical regions, extended amygdala, and periaqueductal gray. Comparison of the threat conditions demonstrated that this circuitry can be fractionated, with frontocortical regions showing relatively stronger engagement during the anticipation of uncertain threat, and the extended amygdala showing the reverse pattern. Although there is widespread agreement that the bed nucleus of the stria terminalis and dorsal amygdala-the two major subdivisions of the extended amygdala-play a critical role in orchestrating adaptive responses to potential danger, their precise contributions to human anxiety have remained contentious. Follow-up analyses demonstrated that these regions show statistically indistinguishable responses to temporally uncertain and certain threat anticipation. These observations provide a framework for conceptualizing anxiety and fear, for understanding the functional neuroanatomy of threat anticipation in humans, and for accelerating the development of more effective intervention strategies for pathological anxiety.SIGNIFICANCE STATEMENT Anxiety-an emotion prototypically associated with the anticipation of uncertain harm-has profound significance for public health, yet the underlying neurobiology remains unclear. Leveraging a novel neuroimaging paradigm in a relatively large sample, we identify a core circuit responsive to both uncertain and certain threat anticipation, and show that this circuitry can be fractionated into subdivisions with a bias for one kind of threat or the other. The extended amygdala occupies center stage in neuropsychiatric models of anxiety, but its functional architecture has remained contentious. Here we demonstrate that its major subdivisions show statistically indistinguishable responses to temporally uncertain and certain threat. Collectively, these observations indicate the need to revise how we think about the neurobiology of anxiety and fear.

BNST and amygdala activation to threat: Effects of temporal predictability and threat mode

Recent animal and human studies highlight the uncertainty about the onset of an aversive event as a crucial factor for the involvement of the centromedial amygdala (CM) and bed nucleus of the stria terminalis (BNST) activity. However, studies investigating temporally predictable or unpredictable threat anticipation and confrontation processes are rare. Furthermore, the few existing fMRI studies analyzing temporally predictable and unpredictable threat processes used small sample sizes or limited fMRI paradigms. Therefore, we measured functional brain activity in 109 predominantly female healthy participants during a temporally predictable-unpredictable threat paradigm, which aimed to solve limited aspects of recent studies. Results showed higher BNST activity compared to the CM during the cue indicating that the upcoming confrontation is aversive relative to the cue indicating an upcoming neutral confrontation. Both the CM and BNST showed higher activity during the confrontation with unpredictable and aversive stimuli, but the reaction to aversive confrontation relative to neutral confrontation was stronger in the CM compared to the BNST. Additional modulation analyses by NPSR1 rs324981 genotype revealed higher BNST activity relative to the CM in unpredictable anticipation relative to predictable anticipation in T-carriers compared to AA carriers. Our results indicate that during the confrontation with aversive or neutral stimuli, temporal unpredictability modulates CM and BNST activity. Further, there is a differential activity concerning threat processing, as BNST is more involved when focussing on fear-related anticipation processes and CM is more involved when focussing on threat confrontation.

Attention and anticipation in response to varying levels of uncertain threat: An ERP study

Individual differences in responding to uncertainty have been proposed as a key mechanism of how anxiety disorders develop and are maintained. However, most empirical work has compared responding to uncertain versus certain threat dichotomously. This is a significant limitation because uncertainty in daily life occurs along a continuum of probability, ranging from very low to high chances of negative outcomes. The current study investigated (1) how varying levels of uncertainty impact attention and anticipatory emotion, and (2) how these effects are moderated by individual differences in risk factors for anxiety disorders, particularly intolerance of uncertainty (IU) and worry. Participants (n = 65) completed a card task in which the probability of shock varied across trials. Two event-related potential components were examined: the P2, an index of attention, and the stimulus-preceding negativity (SPN), an index of anticipation. The P2 tracked the level of uncertainty and was smaller for more uncertain outcomes. Participants higher in IU exhibited greater differences in the P2 across levels of uncertainty. The SPN did not track specific levels of uncertainty but was largest for uncertain threat compared with certain threat and safety. Greater worry was associated with blunting of the SPN in anticipation of all outcomes. Thus, attention appears to be sensitive to variations in uncertainty, whereas anticipation seems sensitive to uncertainty globally. The two processes appear to be distinctly related to anxiety risk factors. These results highlight the value of examining multiple aspects of anticipatory responding to varying levels of uncertainty for understanding risk for anxiety disorders.

Bed nucleus of the stria terminalis regulates fear to unpredictable threat signals

The bed nucleus of the stria terminalis (BNST) has been implicated in conditioned fear and anxiety, but the specific factors that engage the BNST in defensive behaviors are unclear. Here we examined whether the BNST mediates freezing to conditioned stimuli (CSs) that poorly predict the onset of aversive unconditioned stimuli (USs) in rats. Reversible inactivation of the BNST selectively reduced freezing to CSs that poorly signaled US onset (e.g., a backward CS that followed the US), but did not eliminate freezing to forward CSs even when they predicted USs of variable intensity. Additionally, backward (but not forward) CSs selectively increased Fos in the ventral BNST and in BNST-projecting neurons in the infralimbic region of the medial prefrontal cortex (mPFC), but not in the hippocampus or amygdala. These data reveal that BNST circuits regulate fear to unpredictable threats, which may be critical to the etiology and expression of anxiety.