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Malbec M, Andreatta M, Wieser MJ. Multimodal assessment of the role of intolerance of uncertainty in fear acquisition and extinction. Biol Psychol 2024; 192:108860. [PMID: 39270923 DOI: 10.1016/j.biopsycho.2024.108860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024]
Abstract
Personality traits linked to internalizing disorders influence the way we develop fears, but also how we regain a sense of safety. In the present study, we investigated the effect of intolerance of uncertainty (IU) on defensive responses using a differential fear conditioning protocol with an extinction phase. The conditioned stimulus was associated with an aversive sound (90 dB) in 75 % of the presentations during acquisition. A final sample of 176 participants completed the experiment. We measured self-reports of associative (expectancy of the unconditioned stimulus in acquisition) and evaluative learning (arousal and valence), and both physiological (skin conductance response) and electrocortical responses (steady-state visually evoked potentials, ssVEPs; late positive potentials, LPP) to the conditioned stimuli. Our results show that IU's impact is limited, with no effect in both acquisition and extinction. These findings emphasize the necessity of large samples in research on inter-individual differences and contribute to our understanding of how IU may or may not be involved in fear and safety learning processes considering multiple aspects of fear responding.
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Affiliation(s)
- Marcelo Malbec
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, the Netherlands.
| | - Marta Andreatta
- Department of General Psychiatry and Psychotherapy with Outpatient Clinic, University Hospital of Tübingen, Germany
| | - Matthias J Wieser
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, the Netherlands.
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Ma Y, Jiao F, Batsikadze G, Yavari F, Nitsche MA. The impact of the left inferior frontal gyrus on fear extinction: A transcranial direct current stimulation study. Brain Stimul 2024; 17:816-825. [PMID: 38997105 DOI: 10.1016/j.brs.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/03/2024] [Accepted: 07/06/2024] [Indexed: 07/14/2024] Open
Abstract
INTRODUCTION Fear extinction is a fundamental component of exposure-based therapies for anxiety-related disorders. The renewal of fear in a different context after extinction highlights the importance of contextual factors. In this study, we aimed to investigate the causal role of the left inferior frontal gyrus (LiFG) in the context-dependency of fear extinction learning via administration of transcranial direct current stimulation (tDCS) over this area. METHODS 180 healthy subjects were assigned to 9 groups: 3 tDCS conditions (anodal, cathodal, and sham) × 3 context combinations (AAA, ABA, and ABB). The fear conditioning/extinction task was conducted over three consecutive days: acquisition, extinction learning, and extinction recall. tDCS (2 mA, 10min) was administered during the extinction learning phase over the LiFG via a 4-electrode montage. Skin conductance response (SCR) data and self-report assessments were collected. RESULTS During the extinction learning phase, groups with excitability-enhancing anodal tDCS showed a significantly higher fear response to the threat cues compared to cathodal and sham stimulation conditions, irrespective of contextual factors. This effect was stable until the extinction recall phase. Additionally, excitability-reducing cathodal tDCS caused a significant decrease of the response difference between the threat and safety cues during the extinction recall phase. The self-report assessments showed no significant differences between the conditions throughout the experiment. CONCLUSION Independent of the context, excitability enhancement of the LiFG did impair fear extinction, and led to preservation of fear memory. In contrast, excitability reduction of this area enhanced fear extinction retention. These findings imply that the LiFG plays a role in the fear extinction network, which seems to be however context-independent.
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Affiliation(s)
- Yuanbo Ma
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Fujia Jiao
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Giorgi Batsikadze
- Department of Neurology and Center for Translational Neuro and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, Essen, 45147, Germany
| | - Fatemeh Yavari
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld, Germany; German Center for Mental Health (DZPG), Bochum, Germany.
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Lemmens A, Aarts E, Dibbets P. Itsy bitsy spider: Fear and avoidance (generalization) in a free-exploratory virtual reality paradigm. Behav Res Ther 2024; 172:104442. [PMID: 38086158 DOI: 10.1016/j.brat.2023.104442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023]
Abstract
Most experimental avoidance paradigms lack either control over the experimental situation or simplify real-life avoidance behavior to a great extent, making it difficult to generalize the results to the complex approach-avoidance situations that anxious individuals face in daily life. The current study aimed to examine the usability of our recently developed free-exploratory avoidance paradigm in Virtual Reality (VR) that allows for the assessment of subjective as well as behavioral avoidance in participants with varying levels of spider fear. In a VR escape room, participants searched for cues to decipher a code-locked door. Opening a wooden box marked with a post-it note (conditioned stimulus, CS) resulted in exposure to a virtual crawling spider (unconditioned stimulus, US). Avoidance of the original CS and other objects marked with the CS (generalization stimuli, GSs; EXPgen condition) or non-marked (CONT condition) objects was measured via questionnaires and relative manipulation times in a novel room. We expected a positive linear relationship between US aversiveness (levels of spider fear) and (generalization of) fear and avoidance behaviors. Avoidance learning and generalization was demonstrated on both a subjective and behavioral level. Higher levels of spider fear were, overall, related to more negative emotions in response to the encounter with the spider, higher US expectancies for the GSs, and more self-reported and behavioral avoidance of the original CS and the GSs. Finally, we explored relationships between trait anxiety and intolerance of uncertainty and fear and avoidance (generalization), but no robust associations were observed. In conclusion, we confirmed the expected positive linear relationship between spider fear and (generalization of) fear and avoidance behaviors. Our results suggest that our free-exploratory VR avoidance paradigm is well-suited to investigate avoidance behaviors and the generalization of avoidance.
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Affiliation(s)
- Anke Lemmens
- Department of Clinical Psychological Science, Maastricht University, the Netherlands; Department of Clinical Psychology, Open University Heerlen, the Netherlands
| | - Elyan Aarts
- Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Pauline Dibbets
- Department of Clinical Psychological Science, Maastricht University, the Netherlands.
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Forkmann K, Wiech K, Schmidt K, Schmid-Köhler J, Bingel U. Neural underpinnings of preferential pain learning and the modulatory role of fear. Cereb Cortex 2023; 33:9664-9676. [PMID: 37408110 DOI: 10.1093/cercor/bhad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023] Open
Abstract
Due to its unique biological relevance, pain-related learning might differ from learning from other aversive experiences. This functional magnetic resonance imaging study compared neural mechanisms underlying the acquisition and extinction of different threats in healthy humans. We investigated whether cue-pain associations are acquired faster and extinguished slower than cue associations with an equally unpleasant tone. Additionally, we studied the modulatory role of stimulus-related fear. Therefore, we used a differential conditioning paradigm, in which somatic heat pain stimuli and unpleasantness-matched auditory stimuli served as US. Our results show stronger acquisition learning for pain- than tone-predicting cues, which was augmented in participants with relatively higher levels of fear of pain. These behavioral findings were paralleled by activation of brain regions implicated in threat processing (insula, amygdala) and personal significance (ventromedial prefrontal cortex). By contrast, extinction learning seemed to be less dependent on the threat value of the US, both on the behavioral and neural levels. Amygdala activity, however, scaled with pain-related fear during extinction learning. Our findings on faster and stronger (i.e. "preferential") pain learning and the role of fear of pain are consistent with the biological relevance of pain and may be relevant to the development or maintenance of chronic pain.
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Affiliation(s)
- Katarina Forkmann
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University Duisburg Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Katja Wiech
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom
| | - Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University Duisburg Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Julia Schmid-Köhler
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University Duisburg Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University Duisburg Essen, Hufelandstraße 55, Essen 45147, Germany
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Zhou X, Gu Y, Wang J, Huang L, Lei Y. Intolerance of uncertainty enhances generalisation of cued conditioned threat: An event-related potential study. Biol Psychol 2023; 181:108601. [PMID: 37295767 DOI: 10.1016/j.biopsycho.2023.108601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
Overgeneralisation is one of the aetiologies of anxiety disorders and is closely associated with elevated intolerance of uncertainty (IU) levels. However, the underlying mechanisms are unclear. Considering the inconsistency of previous results and the high sensitivity of IU to uncertainty, the present study investigated the effect of IU on threat generalisation in predictable and unpredictable conditions. We compared self-reported unconditioned stimuli (US) expectancy and event-related potentials (ERPs) during generalisation in high IU (n = 34) and low IU (n = 35) participants. The results indicated that high IU was associated with higher US expectancy for generalisation stimuli (GS) than with low IU. At the electrophysiological level, compared to low IU, high IU showed increased P1 to ambiguous GS as well as decreased early late positive potential (LPP) to GS in unpredictable conditions, and no differential response to GS in late LPP in predictable conditions. These findings suggest that IU enhances threat generalisation and may be related to increased early automatic attention to ambiguous stimulus and inadequate late elaborate processing in a high uncertainty context. These findings might contribute to the treatment of mood disorders characterized by high IU.
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Affiliation(s)
- Xiao Zhou
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Yuanyuan Gu
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Jinxia Wang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Lihui Huang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China.
| | - Yi Lei
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China.
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Ng KH, Sangha S. Encoding of conditioned inhibitors of fear in the infralimbic cortex. Cereb Cortex 2023; 33:5658-5670. [PMID: 36411540 PMCID: PMC10152082 DOI: 10.1093/cercor/bhac450] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
Cues in the environment signaling the absence of threat, i.e. safety, can influence both fear and reward-seeking behaviors. Heightened and maladaptive fear is associated with reduced activity in the medial prefrontal cortex. We have previously shown in male rats that the infralimbic (IL) prefrontal cortex is necessary for suppressing fear during a safety cue. The objective of the present study was to determine if there was safety cue-specific neural activity within the IL using a Pavlovian conditioning paradigm, where a fear cue was paired with shock, a safety cue was paired with no shock, and a reward cue was paired with sucrose. To investigate how safety cues can suppress fear, the fear and safety cues were presented together as a compound fear + safety cue. Single-unit activity showed a large proportion of neurons with excitatory responses to the fear + safety cue specifically, a separate group of neurons with excitatory responses to both the reward and fear + safety cues, and bidirectional neurons with excitation to the fear + safety cue and inhibition to the fear cue. Neural activity was also found to be negatively correlated with freezing during the fear + safety cue. Together, these data implicate the IL in encoding specific aspects of conditioned inhibitors when fear is being actively suppressed.
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Affiliation(s)
- Ka H Ng
- Department of Psychological Sciences, Purdue University, West Lafayette, IN 47907, United States
| | - Susan Sangha
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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7
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Radoman M, Gorka SM. Intolerance of uncertainty and functional connectivity of the anterior insula during anticipation of unpredictable reward. Int J Psychophysiol 2023; 183:1-8. [PMID: 36122824 PMCID: PMC11062179 DOI: 10.1016/j.ijpsycho.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 01/04/2023]
Abstract
Individuals with high intolerance of uncertainty (IU) tend to display maladaptive cognitive, behavioral, physiological, and/or neural responses during anticipation of uncertain or ambiguous outcomes, both positive and negative in valence. Importantly, high IU has been proposed as a key transdiagnostic phenotypic risk factor for the onset and maintenance of several psychiatric disorders. Within the context of reward processing, high IU has been related to dysfunctional reward anticipation, which may be mediated by hyperactive anterior insula (AIC) response to uncertainty. The present study further investigated the relationship between the AIC and IU by examining the association between individual differences in IU and task-based functional connectivity of the right AIC using functional magnetic resonance imaging (fMRI). Participants (N = 171) completed a self-report measure of IU and a reward anticipation task during fMRI. Generalized psychophysiological interaction (gPPI) analyses were performed with a seed in the right AIC. In the U-threat model, we found that greater self-reported levels of IU were correlated with increased functional connectivity between the right AIC and the dorsal anterior cingulate cortex (dACC) and the right dorsolateral prefrontal cortex (dlPFC). In the P-threat model, we did not find these associations, perhaps indicating that they may be more robust during uncertainty. These preliminary findings suggest that parts of salience and central executive control networks may be impacted by and underlie the expression of IU. Future studies should examine the generalizability of these findings to clinical populations and investigate how disruption of these functional networks may contribute to psychopathology.
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Affiliation(s)
- Milena Radoman
- Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor Street, Chicago, IL 60612, USA; Department of Anatomy and Cell Biology, University of Illinois at Chicago, 840 S Wood Street, Chicago, IL 60612, USA; The Graduate Program in Neuroscience, University of Illinois at Chicago, 840 S Wood Street, Chicago, IL 60612, USA.
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, 1670 Upham Drive, Columbus, OH 43205, USA
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Neural responding during uncertain threat anticipation in pediatric anxiety. Int J Psychophysiol 2023; 183:159-170. [PMID: 35985508 DOI: 10.1016/j.ijpsycho.2022.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 01/04/2023]
Abstract
Excessive fear responses to uncertain threat are a key feature of anxiety disorders (ADs), though most mechanistic work considers adults. As ADs onset in childhood and confer risk for later psychopathology, we sought to identify conditions of uncertain threat that distinguish 8-17-year-old youth with AD (n = 19) from those without AD (n = 33), and assess test-retest reliability of such responses in a companion sample of healthy adults across three sites (n = 19). In an adapted uncertainty of threat paradigm, visual cues parametrically signaled threat of aversive stimuli (fear faces) in 25 % increments (0 %, 25 %, 50 %, 100 %), while participants underwent functional magnetic resonance imaging (fMRI). We compared neural response elicited by cues signaling different degrees of probability regarding the subsequent delivery of fear faces. Overall, youth displayed greater engagement of bilateral inferior parietal cortex, fusiform gyrus, and lingual gyrus during uncertain threat anticipation in general. Relative to healthy youth, AD youth exhibited greater activation in ventrolateral prefrontal cortex (vlPFC)/BA47 during uncertain threat anticipation in general. Further, AD differed from healthy youth in scaling of ventral striatum/sgACC activation with threat probability and attenuated flexibility of responding during parametric uncertain threat. Complementing these results, significant, albeit modest, cross-site test-retest reliability in these regions was observed in an independent sample of healthy adults. While preliminary due to a small sample size, these findings suggest that during uncertainty of threat, AD youth engage vlPFC regions known to be involved in fear regulation, response inhibition, and cognitive control. Findings highlight the potential of isolating neural correlates of threat anticipation to guide treatment development and translational work in youth.
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Knowles KA, Jessup SC, Olatunji BO. Facing Uncertainty: A Comparison of Hierarchical and Variable Exposure Interventions for Contamination Fear. J Obsessive Compuls Relat Disord 2023; 36:100777. [PMID: 36582425 PMCID: PMC9794192 DOI: 10.1016/j.jocrd.2022.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N=73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d=.78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.
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Zhou T, Bao Y, Guo D, Bai Y, Wang R, Cao X, Li H, Hua Y. Intolerance of uncertainty and future career anxiety among Chinese undergraduate students during COVID-19 period: Fear of COVID-19 and depression as mediators. Front Public Health 2022; 10:1015446. [PMID: 36523580 PMCID: PMC9745131 DOI: 10.3389/fpubh.2022.1015446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
Uncertainty is mushrooming throughout COVID-19, and intolerance of uncertainty (IoU) nudges people into mental health difficulties involving fear, depression, and anxiety. The objective of this study was to investigate the role of depression and fear of COVID-19 (FoC) in the association between IoU and future career anxiety (FCA) among Chinese university students during the COVID-19 pandemic. This study involved 1,919 Chinese undergraduate students from 11 universities in eight Chinese cities with an online self-administered survey that included demographic information, IoU, FoC, depression, and FCA completed by all participants. Our study demonstrated a positive relationship between IoU and FCA and the chain mediation effect of FoC and depression. Thus, understanding how FoC affects FCA not only informs university career professionals and assists students in preparing for employment, but also motivates schools to offer career opportunities workshops and, most importantly, provides mental health support to help students effectively cope with uncertainty and overcome COVID-19-related stress.
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Affiliation(s)
- Tianshu Zhou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
- Department of Political Science, Suzhou University of Science and Technology, Suzhou, China
| | - Yuchang Bao
- Faculty of Education, University of Macau, Taipa, China
| | - Danfeng Guo
- Department of Political ScienceSuzhou University of Science and Technology, Suzhou, China
| | - Yunpeng Bai
- Department of Applied Social Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ruizhe Wang
- Department of Media and Communication, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Xinyue Cao
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Hebin Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Yidi Hua
- Faculty of Arts, Saint Mary's University, Halifax, NS, Canada
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Behavioral and neural responses during fear conditioning and extinction in a large transdiagnostic sample. Neuroimage Clin 2022; 35:103060. [PMID: 35679785 PMCID: PMC9189200 DOI: 10.1016/j.nicl.2022.103060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/28/2022] [Accepted: 05/21/2022] [Indexed: 11/23/2022]
Abstract
Behavioral and neural responses during Pavlovian fear learning were examined in a large sample of healthy and individuals with anxiety and depression. Latent profile models to threat were derived from behavioral and neural data. Demographic, cognitive, and psychological variables did not robustly characterize latent profiles. Neuroimaging data did not evidence functional role of amygdala in fear learning. Human fear learning recruited a distributed network of regions involved in interoceptive, cognitive, motivational, and psychomotor processes.
Background Dysregulation of fear learning has been associated with psychiatric disorders that have altered positive and negative valence domain function. While amygdala-insula-prefrontal circuitry is considered important for fear learning, there have been inconsistencies in neural findings in healthy and clinical human samples. This study aimed to delineate the neural substrates and behavioral responses during fear learning in a large, transdiagnostic sample with predominantly depressive and/or anxious dysfunction. Methods Two-hundred and eighty-two individuals (52 healthy participants; 230 participants with depression and/or anxiety-related problems) from the Tulsa 1000 study, an ongoing, naturalistic longitudinal study based on a dimensional psychopathological framework, completed a Pavlovian fear learning task during functional magnetic resonance imaging. Linear mixed-effects analyses examined condition-by-time effects on brain activation (CS+, CS- across familiarization, conditioning, and extinction trials). A data-driven latent profile analysis (LPA) examined distinct patterns of behavioral and neural responses to threat across fear conditioning and extinction, while logistic regression analyses evaluated cognitive-affective predictors of latent profiles. Results Whole-brain analyses revealed a condition-by-time interaction in the anterior insula, postcentral gyrus, superior temporal gyrus, middle frontal gyrus, and cerebellum but not amygdala. The LPA identified distinct latent profiles across subjective and neural levels of measurement. Anterior insula profiles were characterized by marginal differences in age and state anxiety. Conclusions Our findings demonstrate that human fear learning recruits a distributed network of regions involved in interoceptive, cognitive, motivational, and psychomotor processes. Data-driven analyses identified distinct profiles of subjective and neural responses during fear learning that transcended clinical diagnoses, but no robust relationships to demographic or cognitive-affective variable were identified.
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Wendt J, Morriss J. An examination of Intolerance of Uncertainty and contingency instruction on multiple indices during threat acquisition and extinction training. Int J Psychophysiol 2022; 177:171-178. [DOI: 10.1016/j.ijpsycho.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 12/01/2022]
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Effects of intolerance of uncertainty on subjective and psychophysiological measures during fear acquisition and delayed extinction. Int J Psychophysiol 2022; 177:249-259. [DOI: 10.1016/j.ijpsycho.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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14
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Steinman SA, Dunsmoor JE, Gazman Z, Stovezky Y, Pascucci O, Pomerenke J, Phelps EA, Fyer A, Simpson HB. A Preliminary Test of Novelty-Facilitated Extinction in Individuals With Pathological Anxiety. Front Behav Neurosci 2022; 16:873489. [PMID: 35548695 PMCID: PMC9082160 DOI: 10.3389/fnbeh.2022.873489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Studies with rodents and healthy humans suggest that replacing the expected threat with a novel outcome improves extinction and reduces the return of conditioned fear more effectively than threat omission alone. Because of the potential clinical implications of this finding for exposure-based anxiety treatments, this study tested whether the same was true in individuals with pathological anxiety (i.e., met DSM-5 diagnostic criteria for an anxiety disorder and/or obsessive-compulsive disorder (OCD). In this preliminary test of novelty-facilitated extinction, 51 unmedicated individuals with pathological anxiety were randomized to standard extinction (n = 27) or novelty-facilitated extinction (n = 24). Participants returned 24 h later to test extinction recall and fear reinstatement. Skin conductance responses (SCR) were the dependent measure of conditioned fear. Participants in both groups learned the fear association but variably extinguished it. Novelty did not facilitate extinction in this preliminary trial. Findings underscore the importance of translating paradigms from healthy humans to clinical samples, to ensure that new treatment ideas based on advances in basic neuroscience are relevant to patients.
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Affiliation(s)
- Shari A. Steinman
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Joseph E. Dunsmoor
- Department of Psychiatry and Behavioral Science, University of Texas at Austin, Austin, TX, United States
| | - Zhamilya Gazman
- The Graduate Center, City University of New York, New York, NY, United States
| | - Yael Stovezky
- New York State Psychiatric Institute, Division of Clinical Therapeutics, New York, NY, United States
| | - Olivia Pascucci
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Justin Pomerenke
- The Steven A. Cohen Military Family Center, New York University Langone Health, New York, NY, United States
| | | | - Abby Fyer
- New York State Psychiatric Institute, Division of Clinical Therapeutics, New York, NY, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - H. Blair Simpson
- New York State Psychiatric Institute, Division of Clinical Therapeutics, New York, NY, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
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Hunt C, Exline JJ, Fletcher TL, Teng EJ. Intolerance of uncertainty prospectively predicts the transdiagnostic severity of emotional psychopathology: Evidence from a Veteran sample. J Anxiety Disord 2022; 86:102530. [PMID: 35033969 DOI: 10.1016/j.janxdis.2022.102530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/01/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022]
Abstract
Intolerance of uncertainty (IU) has been conceptualized as a transdiagnostic vulnerability for emotional psychopathology, but few studies have tested whether it prospectively predicts emotional psychopathology, and none have utilized transdiagnostic and clinician-rated outcomes. To fill this gap, the present study tested whether IU prospectively predicted the clinician-rated severity of transdiagnostic emotional psychopathology six months later in a treatment-seeking Veteran sample. Participants completed the Intolerance of Uncertainty 12-item scale (IUS-12) and the Structured Clinical Interview for the DSM-5 (SCID-5) at Time 1 and again six-months later (Time 2); assessed emotional disorders included both anxiety-related disorders (i.e., post-traumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, specific phobia) and depressive conditions (i.e., major depressive disorder and persistent depressive disorder). Linear regression analyses revealed a bidirectional prospective relation between IU and emotional psychopathology, wherein higher Time 1 IUS-12 predicted greater Time 2 emotional disorder severity and greater Time 1 emotional disorder severity predicted higher Time 2 IUS-12. Follow-up analyses revealed that IU prospectively predicted the maintenance (but not the development) of anxiety-related issues, whereas prediction of Time 2 depression was nullified when controlling for Time 1 anxiety pathology. These findings implicate IU as a transdiagnostic vulnerability for emotional psychopathology and suggest the construct can be particularly useful as a treatment target and prognostic indicator for anxiety-related conditions.
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Affiliation(s)
- Christopher Hunt
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA
| | - Julie J Exline
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Rd., Cleveland, OH 44106, USA
| | - Terri L Fletcher
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, 2450 Holcombe Blvd., Houston, TX 77030, USA
| | - Ellen J Teng
- Michael E. Debakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, 2450 Holcombe Blvd., Houston, TX 77030, USA.
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16
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Assessment of intolerance of uncertainty: Validation of a modified anagram task. J Behav Ther Exp Psychiatry 2021; 73:101671. [PMID: 34182343 DOI: 10.1016/j.jbtep.2021.101671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Intolerance of uncertainty (IU) is an individual difference factor that reflects difficulty tolerating emotional distress in the context of uncertainty and is a robust transdiagnostic risk factor for emotional disorders. A limitation of prior research on IU is the heavy reliance on self-report measures to assess this construct. The aim of the present study was to examine the validity of a brief, computerized anagram task modified to assess IU (the PACT Anagram Task; PAT). METHODS Participants were 221 unselected undergraduate students (71% female; Mage = 19; 89% Caucasian) who completed the PAT and a series of self-report measures of convergent, discriminant, and incremental validity, and measures of anxiety and depression symptoms online for course credit. RESULTS Greater PAT-Distress was positively correlated measures of convergent validity and demonstrated incremental validity in relation to self-reported IU above and beyond attentional control. None of the PAT indicators were associated with compassion or empathic concern, evidencing discriminant validity. PAT-Distress and PAT-Answers were each associated with greater worry above and beyond self-reported IU. LIMITATIONS Study limitations include the cross-sectional design and lack of diversity in terms of sample demographics. Furthermore, we did not examine convergence between this task and other behavioral measures of IU. CONCLUSION Subjective distress following completion of the PAT may serve as one indicator of IU. Further research is needed in order to replicate these results and validate the use of the PAT in clinical samples.
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Wake S, Dodd H, Morriss J. Intolerance of uncertainty and novelty facilitated extinction: The impact of reinforcement schedule. Br J Psychol 2021; 113:353-369. [PMID: 34748649 DOI: 10.1111/bjop.12538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/20/2021] [Indexed: 12/01/2022]
Abstract
Individuals who score high in intolerance of uncertainty (IU) display reduced threat extinction. Recently, it was shown that replacing threat associations with novel associations during extinction learning (i.e., presenting a novel tone 100% of the time) can promote threat extinction retention in individuals with high IU. This novelty facilitated extinction (NFE) effect could be driven by the tone's novelty or reliability. Here, we sought to address this question by adjusting the reliability of the novel tone (i.e., the reinforcement rate) during NFE. We measured skin conductance response during an associative learning task in which participants (n = 92) were assigned to one of three experimental groups: standard extinction, NFE 100% reinforcement, or NFE 50% reinforcement. For standard extinction, compared to NFE 100% and 50% reinforcement groups, we observed a trend for greater recovery of the conditioned response during extinction retention. Individuals with high IU relative to low IU in the standard extinction group demonstrated a larger recovery of the conditioned response during extinction retention. These findings tentatively suggest that NFE effects are driven by the novelty rather than the reliability of the new stimulus. The implications of these findings for translational and clinical research in anxiety disorder pathology are discussed.
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Affiliation(s)
- Shannon Wake
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Helen Dodd
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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18
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Wake S, van Reekum CM, Dodd H. The effect of social anxiety on the acquisition and extinction of low-cost avoidance. Behav Res Ther 2021; 146:103967. [PMID: 34537441 DOI: 10.1016/j.brat.2021.103967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 01/10/2023]
Abstract
Excessive avoidance and safety behaviours are a hallmark feature of social anxiety disorder. However, the conditioning and extinction of avoidance behaviour in social anxiety is understudied. Here, we examined the effect of individual differences in social anxiety on low-cost operant avoidance conditioning and extinction in 80 female participants. We employed an avoidance conditioning and extinction paradigm and measured skin conductance response, threat expectancy ratings and avoidance behaviour throughout the task. Findings demonstrated that elevated levels of social anxiety predicted the generalisation of conditioned avoidance responses across to safety cues during avoidance conditioning. When the opportunity to avoid was returned after the threat extinction phase, elevated social anxiety was associated with increased avoidance behaviour to threat cues. The results suggest that compromised extinction of avoidance behaviour is a characteristic of social anxiety and supports the strategy of minimising avoidance and safety behaviours during exposure therapy for the treatment of social anxiety disorder. Future research should utilise the avoidance conditioning and extinction paradigm as a laboratory model for clinical research to investigate how, and under what circumstances, the extinction of avoidance and safety behaviours can be improved for individuals high in social anxiety.
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Affiliation(s)
- Shannon Wake
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - 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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19
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Morriss J, Wake S, Elizabeth C, van Reekum CM. I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:171-179. [PMID: 36325301 PMCID: PMC9616306 DOI: 10.1016/j.bpsgos.2021.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023] Open
Abstract
Background Intolerance of uncertainty (IU), the tendency to find uncertainty distressing, is an important transdiagnostic dimension in mental health disorders. Higher self-reported IU has been linked to poorer threat extinction training (i.e., the updating of threat to safe associations), a key process that is targeted in exposure-based therapies. However, it remains to be seen whether IU-related effects during threat extinction training are reliably and specifically driven by the IU construct or a particular subcomponent of the IU construct over other self-reported measures of anxiety. Methods A meta-analysis of studies from different laboratories (18 experiments; sample N = 1006) was conducted on associations between different variants of self-reported IU (i.e., 27-item, 12-item, inhibitory, and prospective subscales), trait anxiety, and threat extinction training via skin conductance response. The specificity of IU and threat extinction training was assessed against measures of trait anxiety. Results All the self-reported variants of IU, but not trait anxiety, were associated with threat extinction training via skin conductance response (i.e., continued responding to the old threat cue). Specificity was observed for the majority of self-reported variants of IU over trait anxiety. Conclusions The findings suggest that the IU construct broadly accounts for difficulties in threat extinction training and is specific over other measures of self-reported anxiety. These findings demonstrate the robustness and specificity of IU-related effects during threat extinction training and highlight potential opportunities for translational work to target uncertainty in therapies that rely on threat extinction principles such as exposure therapy.
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Affiliation(s)
| | | | - Charlotte Elizabeth
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Carien M. van Reekum
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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20
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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21
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Intolerance of uncertainty is associated with heightened responding in the prefrontal cortex during cue-signalled uncertainty of threat. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 22:88-98. [PMID: 34312816 PMCID: PMC8791867 DOI: 10.3758/s13415-021-00932-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
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.
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22
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Abstract
Web-based experimental testing has seen exponential growth in psychology and cognitive neuroscience. However, paradigms involving affective auditory stimuli have yet to adapt to the online approach due to concerns about the lack of experimental control and other technical challenges. In this study, we assessed whether sounds commonly used to evoke affective responses in-lab can be used online. Using recent developments to increase sound presentation quality, we selected 15 commonly used sound stimuli and assessed their impact on valence and arousal states in a web-based experiment. Our results reveal good inter-rater and test-retest reliabilities, with results comparable to in-lab studies. Additionally, we compared a variety of previously used unpleasant stimuli, allowing us to identify the most aversive among these sounds. Our findings demonstrate that affective sounds can be reliably delivered through web-based platforms, which help facilitate the development of new auditory paradigms for affective online experiments.
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23
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Morriss J, Zuj DV, Mertens G. The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research. Int J Psychophysiol 2021; 166:116-126. [PMID: 34097936 DOI: 10.1016/j.ijpsycho.2021.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Daniel V Zuj
- Experimental Psychopathology Lab, Department of Psychology, Swansea University, Swansea, UK
| | - Gaëtan Mertens
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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24
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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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25
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Morriss J, Biagi N, Lonsdorf TB, Andreatta M. The role of intolerance of uncertainty in the acquisition and extinction of reward. Eur J Neurosci 2021; 53:3063-3071. [DOI: 10.1111/ejn.15173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics School of Psychology and Clinical Language Sciences University of Reading Reading UK
| | - Nicolo Biagi
- Centre for Integrative Neuroscience and Neurodynamics School of Psychology and Clinical Language Sciences University of Reading Reading UK
| | - Tina B. Lonsdorf
- Institute for Systems Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Marta Andreatta
- Department of Psychology, Education & Child Studies Erasmus University Rotterdam Rotterdam The Netherlands
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26
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Lemmens A, Smeets T, Beckers T, Dibbets P. Avoiding at all costs? An exploration of avoidance costs in a novel Virtual Reality procedure. LEARNING AND MOTIVATION 2021. [DOI: 10.1016/j.lmot.2021.101710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Kanen JW, Arntz FE, Yellowlees R, Christmas DM, Price A, Apergis-Schoute AM, Sahakian BJ, Cardinal RN, Robbins TW. Effect of Tryptophan Depletion on Conditioned Threat Memory Expression: Role of Intolerance of Uncertainty. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:590-598. [PMID: 33631385 PMCID: PMC8099731 DOI: 10.1016/j.bpsc.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022]
Abstract
Background Responding emotionally to danger is critical for survival. Normal functioning also requires flexible alteration of emotional responses when a threat becomes safe. Aberrant threat and safety learning occur in many psychiatric disorders, including posttraumatic stress disorder, obsessive-compulsive disorder, and schizophrenia, in which emotional responses can persist pathologically. While there is evidence that threat and safety learning can be modulated by the serotonin systems, there have been few studies in humans. We addressed a critical clinically relevant question: How does lowering serotonin affect memory retention of conditioned threat and safety memory? Methods Forty-seven healthy participants underwent conditioning to two stimuli predictive of threat on day 1. One stimulus but not the other was subsequently presented in an extinction session. Emotional responding was assessed by the skin conductance response. On day 2, we employed acute dietary tryptophan depletion to lower serotonin temporarily, in a double-blind, placebo-controlled, randomized between-groups design. We then tested for the retention of conditioned threat and extinction memory. We also measured self-reported intolerance of uncertainty, known to modulate threat memory expression. Results The expression of emotional memory was attenuated in participants who had undergone tryptophan depletion. Individuals who were more intolerant of uncertainty showed even greater attenuation of emotion following depletion. Conclusions These results support the view that serotonin is involved in predicting aversive outcomes and refine our understanding of the role of serotonin in the persistence of emotional responsivity, with implications for individual differences in vulnerability to psychopathology.
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Affiliation(s)
- Jonathan W Kanen
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.
| | - Frederique E Arntz
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Psychology, Leiden University, Leiden, the Netherlands
| | - Robyn Yellowlees
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David M Christmas
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Annabel Price
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Annemieke M Apergis-Schoute
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Rudolf N Cardinal
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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From Uncertainty to Anxiety: How Uncertainty Fuels Anxiety in a Process Mediated by Intolerance of Uncertainty. Neural Plast 2020; 2020:8866386. [PMID: 33299402 PMCID: PMC7704173 DOI: 10.1155/2020/8866386] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/16/2020] [Accepted: 11/10/2020] [Indexed: 12/26/2022] Open
Abstract
Uncertainty about future events may lead to worry, anxiety, even inability to function. The highly related concept-intolerance of uncertainty (IU)-emerged in the early 1990s, which is further developed into a transdiagnostic risk factor in multiple forms of anxiety disorders. Interests in uncertainty and intolerance of uncertainty have rapidly increased in recent years; little is known about the construct and phenomenology of uncertainty and IU and the association between them. In an attempt to reveal the nature of two concepts, we reviewed broad literature surrounding uncertainty and intolerance of uncertainty (IU). We followed the process in which the whole IU theory developed and extended, including two aspects: (1) from uncertainty to intolerance of uncertainty and (2) definition of uncertainty and intolerance of uncertainty, and further concluded uncertainty fuels to negative emotions, biased expectancy, and inflexible response. Secondly, this paper summarized the experimental research concerning uncertainty and IU, consisted of three parts: (1) uncertainty-based research, (2) measurements of IU, and (3) domain-specific IU. Lastly, we pointed out what remains unknown and needed to be investigated in future research. This result provides a comprehensive overview in this domain, enhancing our understanding of uncertainty and IU and contributing to further theoretical and empirical explorations.
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Over-activation of primate subgenual cingulate cortex enhances the cardiovascular, behavioral and neural responses to threat. Nat Commun 2020; 11:5386. [PMID: 33106488 PMCID: PMC7588412 DOI: 10.1038/s41467-020-19167-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023] Open
Abstract
Stress-related disorders such as depression and anxiety are characterized by enhanced negative emotion and physiological dysfunction. Whilst elevated activity within area 25 of the subgenual anterior cingulate cortex (sgACC/25) has been implicated in these illnesses, it is unknown whether this over-activity is causal. By combining targeted intracerebral microinfusions with cardiovascular and behavioral monitoring in marmosets, we show that over-activation of sgACC/25 reduces vagal tone and heart rate variability, alters cortisol dynamics during stress and heightens reactivity to proximal and distal threat. 18F-FDG PET imaging shows these changes are accompanied by altered activity within a network of brain regions including the amygdala, hypothalamus and dorsolateral prefrontal cortex. Ketamine, shown to have rapid antidepressant effects, fails to reverse elevated arousal to distal threat contrary to the beneficial effects we have previously demonstrated on over-activation induced reward blunting, illustrating the symptom-specificity of its actions. Alexander et al. causally implicate over-activity in primate subgenual cingulate in affective and cardiovascular dysfunction relevant to anxiety and depression. Over-activation led to elevated activity in a stress-related network whilst decreasing activity in higher-order prefrontal cognitive regions.
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Morriss J, Biagi N, Dodd H. Your guess is as good as mine: A registered report assessing physiological markers of fear and anxiety to the unknown in individuals with varying levels of intolerance of uncertainty. Int J Psychophysiol 2020; 156:93-104. [DOI: 10.1016/j.ijpsycho.2020.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
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Sjouwerman R, Scharfenort R, Lonsdorf TB. Individual differences in fear acquisition: multivariate analyses of different emotional negativity scales, physiological responding, subjective measures, and neural activation. Sci Rep 2020; 10:15283. [PMID: 32943701 PMCID: PMC7498611 DOI: 10.1038/s41598-020-72007-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/20/2020] [Indexed: 01/13/2023] Open
Abstract
Negative emotionality is a well-established and stable risk factor for affective disorders. Individual differences in negative emotionality have been linked to associative learning processes which can be captured experimentally by computing CS-discrimination values in fear conditioning paradigms. Literature suffers from underpowered samples, suboptimal methods, and an isolated focus on single questionnaires and single outcome measures. First, the specific and shared variance across three commonly employed questionnaires [STAI-T, NEO-FFI-Neuroticism, Intolerance of Uncertainty (IU) Scale] in relation to CS-discrimination during fear-acquisition in multiple analysis units (ratings, skin conductance, startle) is addressed (NStudy1 = 356). A specific significant negative association between STAI-T and CS-discrimination in SCRs and between IU and CS-discrimination in startle responding was identified in multimodal and dimensional analyses, but also between latent factors negative emotionality and fear learning, which capture shared variance across questionnaires/scales and across outcome measures. Second, STAI-T was positively associated with CS-discrimination in a number of brain areas linked to conditioned fear (amygdala, putamen, thalamus), but not to SCRs or ratings (NStudy2 = 113). Importantly, we replicate potential sampling biases between fMRI and behavioral studies regarding anxiety levels. Future studies are needed to target wide sampling distributions for STAI-T and verify whether current findings are generalizable to other samples.
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Affiliation(s)
- Rachel Sjouwerman
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Robert Scharfenort
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Tina B Lonsdorf
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
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Prospective intolerance of uncertainty is associated with maladaptive temporal distribution of avoidance responses: An extension of Flores, López, Vervliet, and Cobos (2018). J Behav Ther Exp Psychiatry 2020; 68:101527. [PMID: 31743800 DOI: 10.1016/j.jbtep.2019.101527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Excessive maladaptive avoidance has been claimed to be one of the mechanisms through which intolerance of uncertainty (IU) may play its causal role in the development and maintenance of several anxiety and compulsive disorders. Consistently, Flores et al. (2018) found that individuals with higher Prospective IU (P-IU), a specific IU subfactor, display excessive avoidance response repetitions in a free-operant discriminative task to avoid an aversive noise. In the present study we tested the hypothesis that P-IU not only predicts the amount of avoidance responses but also how well the temporal distribution of such responses fits the temporal distribution of threats. METHODS Further correlation and hierarchical regression analysis of Flores et al.'s (2018) data served to test this hypothesis. We evaluated two aspects of the temporal distribution of responses: a) for how long participants were performing the responses; b) the behavioral discrimination between threatening and safe time periods. RESULTS The results showed that scoring high in P-IU was positively associated with longer periods of time dedicated to avoiding and with worse behavioral discrimination between threatening and safe time periods. Hierarchical regression analyses indicated that later addition of inhibitory intolerance of uncertainty and trait anxiety did not significantly improved the explained variance. LIMITATIONS Our results are exclusively based on the use of a low-cost avoidance response, and the present study does not clarify the precise mechanisms that lead high P-IU people to engage in non-optimal avoidance response distribution through time. CONCLUSIONS These results suggest that excessive avoidance is also driven by uncertainty of threat timing and highlight the relevance of P-IU as a vulnerability factor for excessive and outspread avoidance behaviors.
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How many times do I need to see to believe? The impact of intolerance of uncertainty and exposure experience on safety-learning and retention in young adults. Int J Psychophysiol 2020; 153:8-17. [DOI: 10.1016/j.ijpsycho.2020.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 01/21/2023]
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The Impact of Intolerance of Uncertainty and Cognitive Behavioural Instructions on Safety Learning. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10113-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Difficulty updating threat associations to safe associations has been observed in individuals who score high in self-reported Intolerance of Uncertainty (IU). Here we sought to determine whether an instruction based on fundamental principles of Cognitive Behavioural Therapy could promote safety learning in individuals with higher levels of IU, whilst controlling for self-reported trait anxiety (STICSA).
Methods
We measured skin conductance response, pupil dilation and expectancy ratings during an associative threat learning task in which participants either received a cognitive behavioural instruction or no instruction prior to threat extinction (n = 92).
Results
Analyses revealed that both self-reported IU and STICSA similarly predicted differences in skin conductance response. Only individuals with lower IU/STICSA in the cognitive behavioural instruction condition displayed successful safety learning via skin conductance response.
Conclusions
These initial results provide some insight into how simple cognitive behavioural instructions combined with exposure are applied differently in individuals with varying levels of self-reported anxiety. The results further our understanding of the role of basic cognitive behavioural principles and self-reported anxiety in safety learning.
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Bauer EA, MacNamara A, Sandre A, Lonsdorf TB, Weinberg A, Morriss J, van Reekum CM. Intolerance of uncertainty and threat generalization: A replication and extension. Psychophysiology 2020; 57:e13546. [PMID: 32057120 DOI: 10.1111/psyp.13546] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/24/2023]
Abstract
Intolerance of uncertainty (IU) is a transdiagnostic risk factor for internalizing disorders. Prior work has found that IU may be associated with either increased reactivity to threat or, alternatively, with decreased differential responding between threat and nonthreat/safety cues (i.e., threat generalization). For example, work by Morriss, Macdonald, & van Reekum (2016) found that higher IU was associated with increased threat generalization during acquisition (using skin conductance response (SCR)), as well as less differentiation between acquisition and extinction (using subjective uneasiness ratings). Here, three labs attempted direct and conceptual replications of Morriss, Macdonald, et al. (2016). Results showed that the direct replication failed, despite being conducted at the same lab site as the original study; moreover, in contrast to Morriss, Macdonald, et al. (2016), the direct replication found that higher IU was associated with greater SCR discrimination between threat and safety cues (across acquisition and extinction), as well as greater differences in uneasiness ratings between acquisition and extinction. Nonetheless, in the conceptual replications, higher IU was associated with greater threat generalization, as well as less discrimination between acquisition and extinction, as measured using SCR. Higher IU was also associated with larger late positive potentials to threat versus safety cues during extinction-results that mirror those observed by Morriss, Macdonald, et al. (2016) using SCR. Results are discussed with regards to the challenge involved in defining a successful replication attempt, the benefits of collaborative replication and the use and reliability of multiple measures.
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Affiliation(s)
- Elizabeth A Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Aislinn Sandre
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Tina B Lonsdorf
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Weinberg
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Jayne Morriss
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Jentsch VL, Wolf OT, Merz CJ. Temporal dynamics of conditioned skin conductance and pupillary responses during fear acquisition and extinction. Int J Psychophysiol 2020; 147:93-99. [DOI: 10.1016/j.ijpsycho.2019.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
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Weis CN, Huggins AA, Bennett KP, Parisi EA, Larson CL. High-Resolution Resting-State Functional Connectivity of the Extended Amygdala. Brain Connect 2019; 9:627-637. [DOI: 10.1089/brain.2019.0688] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Carissa N. Weis
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Ashley A. Huggins
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Kenneth P. Bennett
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Elizabeth A. Parisi
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
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Ganho-Ávila A, Gonçalves ÓF, Guiomar R, Boggio PS, Asthana MK, Krypotos AM, Almeida J. The effect of cathodal tDCS on fear extinction: A cross-measures study. PLoS One 2019; 14:e0221282. [PMID: 31532768 PMCID: PMC6750569 DOI: 10.1371/journal.pone.0221282] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Extinction-based procedures are often used to inhibit maladaptive fear responses. However, because extinction procedures show efficacy limitations, transcranial direct current stimulation (tDCS) has been suggested as a promising add-on enhancer. OBJECTIVE In this study, we tested how cathodal tDCS over the right dorsolateral prefrontal cortex affects extinction and tried to unveil the processes at play that boost the effectiveness of extinction procedures and its translational potential to the treatment of anxiety disorders. METHODS We implemented a fear conditioning paradigm whereby 41 healthy women (mean age = 20.51 ± 5.0) were assigned to either cathodal tDCS (n = 27) or sham tDCS (n = 16). Fear responses were measured with self-reports, autonomic responses, and implicit avoidance tendencies. RESULTS Cathodal tDCS shows no statistically significant effect in extinction, according to self-reports, and seems to even negatively affect fear conditioned skin conductance responses. However, one to three months after the tDCS session and extinction, we found a group difference in the action tendencies towards the neutral stimuli (F (1, 41) = 12.04, p = .001, ηp2 = .227), with the cathodal tDCS group (as opposed to the sham group) showing a safety learning (a positive bias towards the CS-), with a moderate effect size. This suggests that cathodal tDCS may foster stimuli discrimination, leading to a decreased generalization effect. DISCUSSION Cathodal tDCS may have enhanced long-term distinctiveness between threatening cues and perceptively similar neutral cues through a disambiguation process of the value of the neutral stimuli-a therapeutic target in anxiety disorders. Future studies should confirm these results and extend the study of cathodal tDCS effect on short term avoidance tendencies.
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Affiliation(s)
- Ana Ganho-Ávila
- Proaction Laboratory, Cognitive and Behavior Center for Research and Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Óscar F. Gonçalves
- Neuropsychophysiology Lab, CiPsi, School of Psychology, University of Minho, Braga, Portugal
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Raquel Guiomar
- Proaction Laboratory, Cognitive and Behavior Center for Research and Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paulo Sérgio Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Manish Kumar Asthana
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
- Department of Humanities and Social Sciences, Indian Institute of Technology, Roorkee, India
| | | | - Jorge Almeida
- Proaction Laboratory, Cognitive and Behavior Center for Research and Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Picó-Pérez M, Alemany-Navarro M, Dunsmoor J, Radua J, Albajes-Eizagirre A, Vervliet B, Cardoner N, Benet O, Harrison B, Soriano-Mas C, Fullana M. Common and distinct neural correlates of fear extinction and cognitive reappraisal: A meta-analysis of fMRI studies. Neurosci Biobehav Rev 2019; 104:102-115. [DOI: 10.1016/j.neubiorev.2019.06.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/22/2019] [Accepted: 06/20/2019] [Indexed: 12/25/2022]
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40
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Morriss J, Saldarini F, van Reekum CM. The role of threat level and intolerance of uncertainty in extinction. Int J Psychophysiol 2019; 142:1-9. [PMID: 31158397 DOI: 10.1016/j.ijpsycho.2019.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 12/27/2022]
Abstract
Recent evidence suggests that individual differences in intolerance of uncertainty (IUS) are associated with disrupted threat extinction. However, it is unknown what maintains the learned threat association in high IUS individuals: is it the experienced uncertainty during extinction or the combination of experienced uncertainty with potential threat during extinction? Here we addressed this question by running two independent experiments with uncertain auditory stimuli that varied in threat level (Experiment 1, aversive human scream (n = 30); Experiment 2, neutral tone (n = 47) and mildly aversive tone (n = 49)). During the experiments, we recorded skin conductance responses and subjective ratings to the learned cues during acquisition and extinction. In experiment 1, high IUS was associated with heightened skin conductance responding to the learned threat vs. safe cue during extinction. In experiment 2, high IUS was associated only with larger skin conductance responding to the learned cues with more threatening properties during extinction i.e. mildly aversive tone. These findings suggest that uncertainty in combination with threat, even when mild, disrupts extinction in high IUS individuals. Such findings help us understand the link between IUS and threat extinction, and its relevance to anxiety disorder pathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Francesco Saldarini
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Carien M van Reekum
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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41
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Morriss J, Christakou A, van Reekum CM. Multimodal evidence for delayed threat extinction learning in adolescence and young adulthood. Sci Rep 2019; 9:7748. [PMID: 31123292 PMCID: PMC6533253 DOI: 10.1038/s41598-019-44150-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/07/2019] [Indexed: 01/20/2023] Open
Abstract
Previous research in rodents and humans points to an evolutionarily conserved profile of blunted threat extinction learning during adolescence, underpinned by brain structures such as the amygdala and medial prefrontal cortex (mPFC). In this study, we examine age-related effects on the function and structural connectivity of this system in threat extinction learning in adolescence and young adulthood. Younger age was associated with greater amygdala activity and later engagement of the mPFC to learned threat cues as compared to safety cues. Furthermore, greater structural integrity of the uncinate fasciculus, a white matter tract that connects the amygdala and mPFC, mediated the relationship between age and mPFC engagement during extinction learning. These findings suggest that age-related changes in the structure and function of amygdala-mPFC circuitry may underlie the protracted maturation of threat regulatory processes.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics School of Psychology and Clinical Language Sciences University of Reading, Reading, UK.
| | - Anastasia Christakou
- Centre for Integrative Neuroscience and Neurodynamics School of Psychology and Clinical Language Sciences University of Reading, Reading, UK
| | - Carien M van Reekum
- Centre for Integrative Neuroscience and Neurodynamics School of Psychology and Clinical Language Sciences University of Reading, Reading, UK
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42
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Morriss J. What do I do now? Intolerance of uncertainty is associated with discrete patterns of anticipatory physiological responding to different contexts. Psychophysiology 2019; 56:e13396. [DOI: 10.1111/psyp.13396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences University of Reading Reading UK
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43
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Morriss J, van Reekum CM. I feel safe when i know: Contingency instruction promotes threat extinction in high intolerance of uncertainty individuals. Behav Res Ther 2019; 116:111-118. [DOI: 10.1016/j.brat.2019.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 12/22/2022]
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Morriss J, McSorley E. Intolerance of uncertainty is associated with reduced attentional inhibition in the absence of direct threat. Behav Res Ther 2019; 118:1-6. [PMID: 30921530 DOI: 10.1016/j.brat.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/10/2023]
Abstract
Intolerance of uncertainty (IU) is a dispositional tendency to find uncertain situations aversive. There is limited understanding as to how IU may bias attention to uncertainty in the absence of direct threat. Here we examined the extent to which uncertain distractors and individual differences in IU impacted eye-movements during an attentional capture task. Participants were asked to move their eyes towards a target, whilst ignoring an array of distractors. An additional distractor could appear before or after the target in a near or far location from the target. We observed high IU individuals to display fewer first saccades to the target in all conditions. The results were specific to IU, over trait anxiety. Overall, these results suggest that IU modulates attention to uncertainty in the absence of direct threat. Such findings inform the conceptualisation of IU and its relation to psychopathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, United Kingdom.
| | - Eugene McSorley
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, United Kingdom
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Individual differences in anxiety and fear learning: The role of working memory capacity. Acta Psychol (Amst) 2019; 193:42-54. [PMID: 30590285 DOI: 10.1016/j.actpsy.2018.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/05/2018] [Accepted: 12/14/2018] [Indexed: 01/01/2023] Open
Abstract
Anxiety disorders are characterised by the perception of fear and threat in the presence of stimuli that are neutral or ambiguous. Attempts in previous research to explain the relationship between anxiety and fear learning have been inconsistent, possibly due to the influence of an unmeasured mechanism that mediates the relationship between them. Working memory capacity has been suggested as one such mechanism. The current study investigated the influence of anxiety-based individual differences upon associative fear learning, while accounting for individual differences in working memory. We hypothesised that individuals high in both anxiety and working memory would show unimpaired fear learning whereas individuals high in anxiety and low in working memory would exhibit dysfunctional fear learning. Sixty participants completed a battery of anxiety and working memory tests, as well as a fear conditioning experiment that tested for blocking, conditioned inhibition and fear discrimination. We found that anxious individuals were more likely to show impaired fear discrimination only if they also had a low working memory capacity. Furthermore, anxiety was particularly associated with poorer learning about safety cues. Such relationships were not observed for blocking and conditioned inhibition. These results suggest that the relationship between anxiety and fear learning is complex and warrants further investigation of the potential mediating role of higher-order cognitive faculties.
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Knowles KA, Olatunji BO. Enhancing Inhibitory Learning: The Utility of Variability in Exposure. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 26:186-200. [PMID: 31787834 PMCID: PMC6884337 DOI: 10.1016/j.cbpra.2017.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Exposure therapy has strong empirical support as a treatment for anxiety and related disorders, yet not all participants see clinically meaningful reduction in symptoms, and some experience return of fear. In this review, we examine the theoretical models of exposure therapy, from early precursors to the contemporary inhibitory learning model. The inhibitory learning model is applied to examine one potential method of improving outcomes in exposure therapy: increasing variability in the progression of the exposure hierarchy. We explore mechanisms that support the use of variability in exposure, including the violation of expectancies to enhance learning. In addition, the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders. Suggestions for future research are then offered.
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Morriss J, Gell M, van Reekum CM. The uncertain brain: A co-ordinate based meta-analysis of the neural signatures supporting uncertainty during different contexts. Neurosci Biobehav Rev 2018; 96:241-249. [PMID: 30550858 DOI: 10.1016/j.neubiorev.2018.12.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 12/23/2022]
Abstract
Uncertainty is often inevitable in everyday life and can be both stressful and exciting. Given its relevance to psychopathology and wellbeing, recent research has begun to address the brain basis of uncertainty. In the current review we examined whether there are discrete and shared neural signatures for different uncertain contexts. From the literature we identified three broad categories of uncertainty currently empirically studied using functional MRI (fMRI): basic threat and reward uncertainty, decision-making under uncertainty, and associative learning under uncertainty. We examined the neural basis of each category by using a coordinate based meta-analysis, where brain activation foci from previously published fMRI experiments were drawn together (1998-2017; 87 studies). The analyses revealed shared and discrete patterns of neural activation for uncertainty, such as the insula and amygdala, depending on the category. Such findings will have relevance for researchers attempting to conceptualise uncertainty, as well as clinical researchers examining the neural basis of uncertainty in relation to psychopathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Martin Gell
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Carien M van Reekum
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Morriss J, Chapman C, Tomlinson S, van Reekum CM. Escape the bear and fall to the lion: The impact of avoidance availability on threat acquisition and extinction. Biol Psychol 2018; 138:73-80. [DOI: 10.1016/j.biopsycho.2018.08.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/29/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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49
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Flores A, López FJ, Vervliet B, Cobos PL. Intolerance of uncertainty as a vulnerability factor for excessive and inflexible avoidance behavior. Behav Res Ther 2018. [DOI: 10.1016/j.brat.2018.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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50
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Fullana MA, Albajes-Eizagirre A, Soriano-Mas C, Vervliet B, Cardoner N, Benet O, Radua J, Harrison BJ. Fear extinction in the human brain: A meta-analysis of fMRI studies in healthy participants. Neurosci Biobehav Rev 2018. [PMID: 29530516 DOI: 10.1016/j.neubiorev.2018.03.002] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The study of fear extinction represents an important example of translational neuroscience in psychiatry and promises to improve the understanding and treatment of anxiety and fear-related disorders. We present the results of a set of meta-analyses of human fear extinction studies in healthy participants, conducted with functional magnetic resonance imaging (fMRI) and reporting whole-brain results. Meta-analyses of fear extinction learning primarily implicate consistent activation of brain regions linked to threat appraisal and experience, including the dorsal anterior cingulate and anterior insular cortices. An overlapping anatomical result was obtained from the meta-analysis of extinction recall studies, except when studies directly compared an extinguished threat stimulus to an unextinguished threat stimulus (instead of a safety stimulus). In this latter instance, more consistent activation was observed in dorsolateral and ventromedial prefrontal cortex regions, together with other areas including the hippocampus. While our results partially support the notion of a shared neuroanatomy between human and rodent models of extinction processes, they also encourage an expanded account of the neural basis of human fear extinction.
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Affiliation(s)
- Miquel A Fullana
- FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, CIBERSAM, Barcelona, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Bram Vervliet
- Center for Excellence on Generalization in Health and Psychopathology, University of KU Leuven, Leuven, Belgium; Department of Psychiatry, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Narcís Cardoner
- Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain; Depression and Anxiety Unit, Mental Health Department, CIBERSAM, Parc Taulí Sabadell University Hospital, Barcelona, Spain
| | | | - Joaquim Radua
- FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Institute of Psychiatry, King's College London, De Crespigny Park, London, UK; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Level 3, 161 Barry Street, Melbourne, Victoria, Australia.
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