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Reinhard J, Mittermeier A, Brandstetter L, Mowat K, Slyschak A, Reiter AMF, Gamer M, Romanos M. Fear conditioning and fear generalization in children and adolescents with anxiety disorders. Eur Child Adolesc Psychiatry 2024; 33:2163-2172. [PMID: 37794273 PMCID: PMC11255079 DOI: 10.1007/s00787-023-02304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
Overgeneralization of conditioned fear is associated with anxiety disorders (AD). Most results stem from studies done in adult patients, but studies with children are rare, although the median onset of anxiety disorders lies already in childhood. Thus, the goal of the present study was to examine fear learning and generalization in youth participants, aged 10-17 years, with AD (n = 39) compared to healthy controls (HC) (n = 40). A discriminative fear conditioning and generalization paradigm was used. Ratings of arousal, valence, and US expectancy (the probability of an aversive noise following each stimulus) were measured, hypothesizing that children with AD compared to HC would show heightened ratings of arousal and US expectancy, and decreased positive valence ratings, respectively, as well as overgeneralization of fear. The results indicated that children with AD rated all stimuli as more arousing and less pleasant, and demonstrated higher US expectancy ratings to all stimuli when compared to HC. Thus, rather than displaying qualitatively different generalization patterns (e.g., a linear vs. quadratic slope of the gradient), differences between groups were more quantitative (similar, but parallel shifted gradient). Therefore, overgeneralization of conditioned fear does not seem to be a general marker of anxiety disorders in children and adolescents.
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Affiliation(s)
- Julia Reinhard
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
| | - Anna Mittermeier
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Lisa Brandstetter
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Kimberly Mowat
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Anna Slyschak
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Andrea M F Reiter
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Matthias Gamer
- Department of Psychology (Experimental Clinical Psychology), University of Würzburg, Würzburg, Germany
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
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Wake S, Morriss J, Johnstone T, van Reekum CM, Dodd H. Intolerance of uncertainty, and not social anxiety, is associated with compromised extinction of social threat. Behav Res Ther 2021; 139:103818. [PMID: 33567362 DOI: 10.1016/j.brat.2021.103818] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/11/2020] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
Extinction-resistant threat is regarded as a central hallmark of pathological anxiety. However, it remains relatively under-studied in social anxiety. Here we sought to determine whether self-reported trait social anxiety is associated with compromised threat extinction learning and retention. We tested this hypothesis within two separate, socially relevant conditioning studies. In the first experiment, a Selective Extinction Through Cognitive Evaluation (SECE) paradigm was used, which included a cognitive component during the extinction phase, while experiment 2 used a traditional threat extinction paradigm. Skin conductance responses and subjective ratings of anxiety (experiment 1 and 2) and expectancy (experiment 2) were collected across both experiments. The findings of both studies demonstrated no effect of social anxiety on extinction learning or retention. Instead, results from experiment 1 indicated that individual differences in Intolerance of Uncertainty (IU) were associated with the ability to use contextual cues to decrease a conditioned response during SECE. However, during extinction retention, high IU predicted greater generalisation across context cues. Findings of experiment 2 revealed that higher IU was associated with impaired extinction learning and retention. The results from both studies suggest that compromised threat extinction is likely to be a characteristic of high levels of IU and not social anxiety.
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Affiliation(s)
- Shannon Wake
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Jayne Morriss
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tom Johnstone
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK; Swinburne University of Technology, John Street, Hawthorn, Victoria, 3122, Australia
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Helen Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
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Response Inhibition, Cognitive Flexibility and Working Memory in Obsessive-Compulsive Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073642. [PMID: 33807425 PMCID: PMC8036460 DOI: 10.3390/ijerph18073642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/22/2022]
Abstract
This study analyzed response inhibition, cognitive flexibility and working memory in three groups of patients diagnosed with obsessive-compulsive disorder, social anxiety disorder and generalized anxiety disorder, considering some variables that may influence results (nonverbal reasoning, comorbidity, use of pharmacotherapy). Neuropsychological measures were completed using a computerized Wisconsin card sorting test, Stroop color word test, go/no-go task, digits and Corsi. Significant differences were obtained among groups in cognitive flexibility and working memory variables. The obsessive-compulsive disorder (OCD) group showed the worst results. The social anxiety disorder group obtained greater effect sizes in visuospatial memory. However, significant differences between groups in visuospatial memory were no longer present when nonverbal reasoning was controlled. Comorbidity influenced interference in the OCD and generalized anxiety disorder (GAD) groups. In addition, the executive functions were differently influenced by the level of obsessions and anxiety, and the use of pharmacotherapy. Study limitations include a non-random selection of participants, modest sample size and design type (cross-sectional). The OCD group showed the worst results in flexibility cognitive and verbal working memory. Comorbidity, use of pharmacotherapy and level anxiety and obsessions were variables influencing the performance of executive functions.
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Rainer C, Nasrouei S, Tschofen S, Bliem HR, Wilhelm FH, Marksteiner J. Fear acquisition and extinction in elderly patients with depression. J Affect Disord 2020; 276:197-204. [PMID: 32697699 DOI: 10.1016/j.jad.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression in elderly patients is common and characterized by anxiety symptoms and cognitive impairment. To our knowledge, no studies have yet investigated the process of fear extinction in these patients. We investigated fear extinction with a paradigm consisting of habituation, acquisition and extinction. METHODS We included three age matched (mean age: 75.7 years) groups: Late Life Depression (LLD, n = 33), Mild Cognitive Impairment (MCI, n = 39), healthy controls (HC, n = 39). All participants were diagnosed with a standardized procedure including clinical examination, CERAD cognitive test battery, as well as magnetic resonance imaging. Participants underwent a fear conditioning paradigm consisting of habituation, acquisition, and extinction. During acquisition, a neutral face (conditioned stimulus, CS+) was paired with an electrical unconditioned stimulus, whereas another face (safety stimulus, CS-) was unpaired. Conditioned responses were measured by US-expectancy and valence ratings. RESULTS Compared to HC, both patient groups showed a significantly lower, differential (CS+ vs. CS-) fear acquisition across all measurements. Patients with cognitive impairment showed a significantly slower extinction, which is characterized by higher US-expectancy and reduced positive valence for CS+. Fear extinction was significantly less differential (CS+ vs. CS-) in patients with LLD. LIMITATIONS Due to the cross-sectional design we cannot distinguish whether the observed differences in fear extinction are state or trait markers in the LLD patients. CONCLUSIONS In this study, we demonstrate that fear extinction is impaired in elderly patients with depression. These results can have influence on treatment strategies.
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Affiliation(s)
- Christina Rainer
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Department of Psychology, University of Innsbruck, Innsbruck, Austria.
| | - Sarah Nasrouei
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Simon Tschofen
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
| | - Harald R Bliem
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
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Abstract
The Mnemonic Similarity Task (MST) measures mnemonic discrimination, or the ability to correctly identify new stimuli from highly similar, old stimuli. Poor mnemonic discrimination is a potential risk or maintenance factor for anxiety, and recent studies suggest state affect may moderate relations between mnemonic discrimination and trait anxiety. No studies have evaluated mnemonic discrimination in specific subtypes of anxiety or with clinically relevant stressors. This preregistered study evaluated the role of social anxiety and the anticipation of a future speech on MST performance. Participants with high (n = 66) and low (n = 64) levels of social anxiety were randomly assigned to a stressor condition or a control condition prior to the MST. State anxiety was measured throughout the study. Results did not indicate significant effects of trait (high vs. low social anxiety) or state anxiety (stressor condition vs. control condition) on mnemonic discrimination. Results are compared with previous research and implications and future directions are discussed.
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Affiliation(s)
| | - Shari A Steinman
- Department of Psychology, West Virginia University, Morgantown, USA
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Park D, Lee HJ, Lee SH. Generalization of Conscious Fear Is Positively Correlated with Anxiety, but Not with Depression. Exp Neurobiol 2018. [PMID: 29535568 PMCID: PMC5840460 DOI: 10.5607/en.2018.27.1.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Generalization of learned fear has been considered to be critical for our survival. Patients with anxiety problems show overgeneralization of learned fear, as reflected by defensive physiological responses to harmless stimuli. Together with these physiological responses, conscious feeling of fear is a seminal part of emotional process that is directly related to the suffering of anxiety patients. However, the effect of anxiety on the generalization of conscious feeling remains unclear. We thus focused on the question whether the generalization of conscious feeling of fear depends on individual anxiety level in nonpatient participants. To address this question, we developed a fear generalization paradigm using natural scene images. We found that subjective feeling of fear was generalized to similar stimuli with the conditioned stimuli (CS), and that this generalization of conscious fear was positively correlated with the level of individual anxiety. Anxiety and depression frequently co-occur, but the individual depression level was not correlated with the fear generalization. These suggest that individual anxiety level mainly affects the generalization of conscious fear.
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Affiliation(s)
- Doyoung Park
- Department of Bio and Brain Engineering, College of Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
| | - Hwa-Jin Lee
- Department of Bio and Brain Engineering, College of Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
| | - Sue-Hyun Lee
- Department of Bio and Brain Engineering, College of Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea.,Program of Brain and Cognitive Engineering, College of Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
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Adolph D, von Glischinski M, Wannemüller A, Margraf J. The influence of frontal alpha-asymmetry on the processing of approach- and withdrawal-related stimuli-A multichannel psychophysiology study. Psychophysiology 2017; 54:1295-1310. [PMID: 28444963 DOI: 10.1111/psyp.12878] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 01/13/2023]
Abstract
The approach-withdrawal model of hemispheric activation suggests that left frontal cortical areas mediate approach, while right frontal cortical areas mediate withdrawal motivation. Within this framework, the present study investigates the association of frontal cortical asymmetry with attentional and emotional responses toward approach- and withdrawal-related emotional stimuli. Resting frontal asymmetry was measured from 43 students before they passively viewed negative, neutral, and positive emotional pictures. The startle reflex, skin conductance response, and subjective ratings of valence and arousal were assessed to quantify emotional responding, while attention was assessed with ERPs. We also assessed frontal asymmetry in response to the pictures. Results indicated that relatively stronger right frontal cortical activation was associated with increased N1 amplitudes and more negative subjective emotional evaluation of all stimuli. Furthermore, enhanced right frontal asymmetry (state and trait) was associated with diminished emotional modulation of the late positive potential. In contrast, no association of frontal asymmetry with defensive reflex physiology or activation of sympathetic nervous system activity was found. The current data suggest dissociable influence of resting frontal brain asymmetry on attentional and physiological processing of withdrawal- and approach-related stimuli. That is, asymmetrical frontal cortical brain activation might not modulate approach-/withdrawal-related motor responses and sympathetic arousal directly, but instead enhances allocation of attentional resources to subjectively significant stimuli. The results are discussed in terms of their potential importance for emotion perception in anxiety disorders and their contribution to the understanding of frontal asymmetry.
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Affiliation(s)
- Dirk Adolph
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | | | | | - Jürgen Margraf
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Qi Y, Gu R, Cao J, Bi X, Wu H, Liu X. Response bias-related impairment of early subjective face discrimination in social anxiety disorders: An event-related potential study. J Anxiety Disord 2017; 47:10-20. [PMID: 28187303 DOI: 10.1016/j.janxdis.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 12/06/2016] [Accepted: 02/03/2017] [Indexed: 11/16/2022]
Abstract
Considerable research has shown that social anxiety disorder (SAD) is accompanied by various negative cognitive biases, such as social feedback expectancy bias, memory bias, and interpretation bias. However, whether the memory bias in individuals with SAD is actually a manifestation of response bias, and whether such response bias is associated with deficits in face discrimination, remains unclear. In the present study, we investigated response bias (i.e., a tendency to recognize more negative evaluations) to faces with positive (social acceptance) or negative (social rejection) social evaluations in individuals with SAD and healthy controls (HCs) using event-related potentials (ERPs). Behavioral results revealed significant group differences in response bias in the forced-choice recall task, but no difference in overall memory accuracy. ERP results demonstrated that HCs showed a larger N170 to faces that had rejected them as compared to those that had accepted them, but this effect was not evident in the SAD group. Further analysis showed that response bias was correlated with the ΔN170 (rejected - accepted) amplitude. We concluded that the response bias in individuals with SAD is resulted from impairments in early discrimination of social faces, as reflected by the absent early N170 differentiation effect, which was associated with their combined negative biases.
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Affiliation(s)
- Yanyan Qi
- CAS Key Laboratory of Behavioral Science, Institute of Psychology; Department of Psychology, University of Chinese Academy of Sciences
| | - Ruolei Gu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology; Department of Psychology, University of Chinese Academy of Sciences
| | - Jianqin Cao
- Department of Nursing, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Xuejing Bi
- Department of Nursing, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Haiyan Wu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology; Department of Psychology, University of Chinese Academy of Sciences.
| | - Xun Liu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology; Department of Psychology, University of Chinese Academy of Sciences.
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Ahrens LM, Pauli P, Reif A, Mühlberger A, Langs G, Aalderink T, Wieser MJ. Fear conditioning and stimulus generalization in patients with social anxiety disorder. J Anxiety Disord 2016; 44:36-46. [PMID: 27728838 DOI: 10.1016/j.janxdis.2016.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Although overgeneralization seems to be a hallmark of several anxiety disorders, this until now has not been investigated in social anxiety disorder (SAD). Therefore, we examined fear generalization in 26 SAD patients and 29 healthy controls (HC) using two faces as conditioned stimuli (CS+, CS-), and a loud scream and a fearful face as unconditioned stimulus (US). Generalization was tested by presenting both CS and four morphs of the two faces (generalization stimuli [GSs]), while ratings, heart rate (HR) and skin conductance responses (SCR) were recorded. Results revealed that SAD patients rated all stimuli as less pleasant and more arousing compared to HC. Moreover, ratings and SCR indicated that both groups generalized their acquired fear from the CS+ to GSs. Remarkably, only SAD patients showed generalization in HR responses (fear bradycardia). Overall, SAD seems not to be characterized by strong overgeneralization but discrepancies in fear responses to both conditioned and generalized threat stimuli.
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Affiliation(s)
- Lea M Ahrens
- Department of Psychology I, University of Würzburg, Germany.
| | - Paul Pauli
- Department of Psychology I, University of Würzburg, Germany; Center of Mental Health, Medical Faculty, University of Würzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Germany
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Germany
| | | | | | - Matthias J Wieser
- Department of Psychology I, University of Würzburg, Germany; Institute of Psychology, Erasmus University Rotterdam, Netherlands
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Abstract
PURPOSE OF REVIEW Stress exacerbates mental illnesses such as depression but also appears to increase risk of dementia, suggesting a common mechanism for development of stress-induced affective and cognitive impairment. The purpose of this review is to address the question of whether anxiety 'damages' the brain, and to identify potential mechanisms for the link between stress and neuropsychiatric illness. RECENT FINDINGS Anxiety disorders are associated with alterations in fear neurocircuitry such that 'bottom-up' processes in the amygdala which respond to threat are exaggerated, and regulation of these processes by the prefrontal cortex (PFC) and hippocampus is impaired. Chronic stress exposure similarly alters fear neurocircuitry by enhancing amygdalar functioning while causing structural degeneration in the PFC and hippocampus thereby inhibiting PFC/hippocampus control over the stress response. Pharmacological (e.g., antidepressant medications) and nonpharmacological interventions (cognitive-behavioral therapy, exercise) may reverse stress-induced damage in the brain. SUMMARY Pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus and the PFC, which may account for the increased risk of developing neuropsychiatric disorders, including depression and dementia. Longitudinal studies are needed to determine whether reversal of stress-induced brain changes by interventions such as cognitive-behavioral therapy can reduce risk of neuropsychiatric illness.
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Ahrens LM, Mühlberger A, Pauli P, Wieser MJ. Impaired visuocortical discrimination learning of socially conditioned stimuli in social anxiety. Soc Cogn Affect Neurosci 2014; 10:929-37. [PMID: 25338634 DOI: 10.1093/scan/nsu140] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/20/2014] [Indexed: 12/18/2022] Open
Abstract
In search of causative factors of social anxiety disorder (SAD), classical conditioning has been discussed as a potential trigger mechanism for many years. Recent findings suggest that the social relevance of the unconditioned stimulus (US) might play a major role in learning theories of SAD. Thus, this study applied a social conditioning paradigm with disorder-relevant US to examine the electrocortical correlates of affective learning. Twenty-four high socially anxious (HSA) and 23 age- and gender-matched low socially anxious (LSA) subjects were conditioned to 3 different faces flickering at a frequency of 15 Hz which were paired with auditory insults, compliments or neutral comments (US). The face-evoked electrocortical response was measured via steady-state visually evoked potentials and subjective measures of valence and arousal were obtained. Results revealed a significant interaction of social anxiety and conditioning, with LSA showing highest cortical activity to faces paired with insults and lowest activity to faces paired with compliments, while HSA did not differentiate between faces. No group differences were discovered in the affective ratings. The findings indicate a potentially impaired ability of HSA to discriminate between relevant and irrelevant social stimuli, which may constitute a perpetuating factor of SAD.
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Affiliation(s)
- Lea M Ahrens
- Department of Psychology, University of Würzburg, Würzburg, Germany, and Department of Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Andreas Mühlberger
- Department of Psychology, University of Würzburg, Würzburg, Germany, and Department of Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Paul Pauli
- Department of Psychology, University of Würzburg, Würzburg, Germany, and Department of Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Matthias J Wieser
- Department of Psychology, University of Würzburg, Würzburg, Germany, and Department of Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
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12
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Dibbets P, van den Broek A, Evers EAT. Fear conditioning and extinction in anxiety- and depression-prone persons. Memory 2014; 23:350-64. [DOI: 10.1080/09658211.2014.886704] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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O'Toole MS, Pedersen AD. A systematic review of neuropsychological performance in social anxiety disorder. Nord J Psychiatry 2011; 65:147-61. [PMID: 21428862 DOI: 10.3109/08039488.2011.565801] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Over the past few years, there has been an increasing interest in the neuropsychological performance of patients with anxiety disorders, yet the literature does not provide a systematic review of the results concerning adult patients with social anxiety disorder (SAD). AIMS The primary aim of this paper is to review the literature on neuropsychological performance in adult patients with SAD. METHODS This paper is a systematic review of empirical studies investigating neuropsychological performance as assessed by cognitive tests. RESULTS 30 papers were located comprising a total number of 698 adult patients with SAD. The review revealed indication for decreased performance regarding visual scanning and visuoconstructional ability as well as some indication for verbal memory difficulties. CONCLUSION The impact of possible confounding variables on the neuropsychological performance is discussed. It is suggested that the decreased performance should be attributed to an increased level of situational anxiety, and an engagement in disorder-related, cognitively costly activities rather than trait-like cognitive dysfunctions. Future experimental studies are needed to explore the causal relationship between these constructs. Knowledge from such studies is important in order to improve the understanding of why SAD is such a disabling disorder, both educationally and interpersonally, and could assist in the planning and evaluation of psychotherapeutic treatment.
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14
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DeVido J, Jones M, Geraci M, Hollon N, Blair RJR, Pine DS, Blair K. Stimulus-reinforcement-based decision making and anxiety: impairment in generalized anxiety disorder (GAD) but not in generalized social phobia (GSP). Psychol Med 2009; 39:1153-1161. [PMID: 19102795 PMCID: PMC2999404 DOI: 10.1017/s003329170800487x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Generalized social phobia (GSP) involves the fear/avoidance of social situations whereas generalized anxiety disorder (GAD) involves an intrusive worry about everyday life circumstances. It remains unclear whether these, highly co-morbid, conditions represent distinct disorders or alternative presentations of a single underlying pathology. In this study, we examined stimulus-reinforcement-based decision making in GSP and GAD. METHOD Twenty unmedicated patients with GSP, 16 unmedicated patients with GAD and 19 age-, IQ- and gender-matched healthy comparison (HC) individuals completed the Differential Reward/Punishment Learning Task (DRPLT). In this task, the subject chooses between two objects associated with different levels of reward or punishment. Thus, response choice indexes not only reward/punishment sensitivity but also sensitivity to reward/punishment level according to between-object reinforcement distance. RESULTS We found that patients with GAD committed a significantly greater number of errors than both the patients with GSP and the HC individuals. By contrast, the patients with GSP and the HC individuals did not differ in performance on this task. CONCLUSIONS These results link GAD with anomalous non-affective-based decision making. They also indicate that GSP and GAD are associated with distinct pathophysiologies.
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Affiliation(s)
- Jeffrey DeVido
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Matthew Jones
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Marilla Geraci
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Nick Hollon
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - R. J. R. Blair
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Daniel S. Pine
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Karina Blair
- Mood & Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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15
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Arndt TL, Stodgell CJ, Rodier PM. The teratology of autism. Int J Dev Neurosci 2005; 23:189-99. [PMID: 15749245 DOI: 10.1016/j.ijdevneu.2004.11.001] [Citation(s) in RCA: 245] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 10/25/2022] Open
Abstract
Autism spectrum disorders affect behaviors that emerge at ages when typically developing children become increasingly social and communicative, but many lines of evidence suggest that the underlying alterations in the brain occur long before the period when symptoms become obvious. Studies of the behavior of children in the first year of life demonstrate that symptoms are often detectable in the first 6 months. The environmental factors known to increase the risk of autism have critical periods of action during embryogenesis. Minor malformations that occur frequently in people with autism are known to arise in the same stages of development. Anomalies reported from histological studies of the brain are consistent with an early alteration of development. Congenital syndromes with high rates of autism include somatic that originate early in the first trimester. In addition, it is possible to duplicate a number of anatomic and behavioral features characteristic of human cases by exposing rat embryos to a teratogenic dose of valproic acid at the time of neural tube closure.
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Affiliation(s)
- Tara L Arndt
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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