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Excessive avoidance is a key feature of pathological anxiety. However, the precise mechanisms underlying the development of excessive avoidance are still unknown. In the present study, we tested the hypothesis that excessive avoidance, especially in individuals with high Intolerance of Uncertainty (IU) is aimed at distress reduction via the enhancement of subjective perceived control in uncertain-threat environments. In our experiment, participants learned to avoid an uncertain aversive sound through a discriminated free operant procedure. In a later test phase in extinction, we manipulated the amount of avoidance responses available per trial by creating a limited and an unrestricted response condition. Nonetheless, the aversive sound could be effectively avoided in both conditions. We measured response frequency, avoidance confidence ratings and anxiety-predisposing traits such as intolerance of uncertainty, trait anxiety and distress tolerance. The degree of distress suffered during trials was inferred from post-trial relief ratings that were requested after trials in which the aversive sound had been omitted. In the avoidance acquisition phase, we found a positive association between prospective intolerance of uncertainty (P-IU) and the decline rate of distress. This relationship was not significant, however, when inhibitory intolerance of uncertainty (I-IU) was controlled for. At test, we found that the increase in avoidance responses led to distress reduction through the enhancement of avoidance confidence. Finally, we found a significant modulating role of P-IU in the effect of response limit on distress reduction that lends further support to our hypothesis. Specifically, P-IU was positively associated with the effect of response limit on distress. However, such modulating role was not significant when controlling for trait anxiety or I-IU. ispartof: INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY vol:179 pages:89-100 ispartof: location:Netherlands status: published

Return of fear poses a problem for extinction-based therapies of clinical anxiety. Experimental research has discovered several pathways to return of fear, one of which is known as reinstatement. Here, we evaluated in rats the potential of scopolamine, a non-selective muscarinic receptor antagonist that is also safe for use in humans, to prevent the reinstatement of extinguished fear. We conducted three experiments with a total sample of 96 female rats. All rats went through a fear acquisition session (tone-shock pairings, CS-US), followed by two extinction sessions (CS only) and a post-extinction fear memory test. Twenty-four hours later, rats were placed in the same or a different context from extinction and received two unsignaled foot shock (US) presentations. On the following day, CS-evoked freezing returned when the reinstating USs had occurred in the same context compared to a different context (context-dependent reinstatement, Experiment 1). Systemic administration of scopolamine before or after the reinstating USs blocked the return of CS-evoked freezing on the following day (Experiments 2 and 3). Our findings suggest that administering scopolamine around the time of an aversive experience could prevent relapse of extinguished fears in humans.

ispartof: BIOLOGICAL PSYCHIATRY vol:87 issue:10 pages:870-871 ispartof: location:United States status: published

Generalised avoidance behaviours are a common diagnostic feature of anxiety-related disorders and a barrier to affecting changes in anxiety during therapy. However, strategies to mitigate generalised avoidance are under-investigated. Even less attention is given to reducing the category-based generalisation of avoidance. We therefore investigated the potential of an operant-based approach. Specifically, it was examined whether reinforcing competing (non-avoidance) behaviours to threat-predictive cues would interfere with the expression of generalised avoidance. Using a matching-to-sample task, artificial stimulus categories were established using physically dissimilar nonsense shapes. A member of one category (conditioned stimulus; CS1) was then associated with an aversive outcome in an Acquisition context, unless an avoidance response was made. Next, competing behaviours were reinforced in response to the CS1 in new contexts. Finally, we tested for the generalisation of avoidance to another member of the stimulus category (generalisation stimulus; GS1) in both a Novel context and the Acquisition context. The selective generalisation of avoidance to GS1 was observed, but only in the Acquisition context. In the Novel context, the generalisation of avoidance to GSs was significantly reduced. A comparison group (Experiment 2), which did not learn any competing behaviours, avoided GS1 in both contexts. These findings suggest that reinforcing competing behavioural responses to threat-predictive cues can lead to reductions in generalised avoidance. This study is among the first study to demonstrate sustained reductions in generalised avoidance resulting from operant-based protocols, and the clinical and research implications are discussed. ispartof: QUARTERLY JOURNAL OF EXPERIMENTAL PSYCHOLOGY vol:73 issue:12 pages:2119-2131 ispartof: location:England status: published

Recent studies have shown that avoidance behavior may become excessive and inflexible (i.e., detached from its incentive value and resistant to extinction). On the other hand, prospective intolerance of uncertainty (P-IU) has been defined as a factor leading to excessive responding in uncertain situations. Thus, uncertain avoidance situations may be taken as a relevant scenario to examine the role of intolerance of uncertainty as a factor that facilitates excessive and inflexible avoidance behavior. In our experiment, we tested the hypothesis that P-IU is associated with excessive and inflexible avoidance in an outcome devaluation paradigm. Specifically, healthy participants learned in a free-operant discriminative task to avoid an aversive sound, and were tested in extinction to measure the sensitivity of avoidance responses to the devaluation of the sound aversiveness. The results showed that an increase in P-IU was positively associated to an increase in insensitivity to the devaluation. Moreover, P-IU was also related to an increase in the frequency of avoidance responses during the instrumental learning phase, and to resistance to extinction. Interestingly, these associations involving P-IU were still significant when trait anxiety was controlled for. The pattern of results suggests that P-IU may be a vulnerability factor for excessive and inflexible avoidance, which, in turn, has been found to be associated with several mental disorders.

This study examined developmental differences in contextual and perceptual generalization of fear and avoidance learning. Adults (N = 39) and adolescents (N = 44) completed differential fear acquisition wherein each conditional stimulus (CS) appeared in a background context. In the dangerous context, one stimulus (CS+) predicted an aversive sound, and the other stimulus (CS-) did not. In the safe context, the aversive sound was never administered with either CS. During fear generalization, participants were presented with three generalization stimuli (GSs), ranging on a perceptual continuum from threat to safety stimuli, in both contexts. Participants then completed avoidance conditioning and avoidance generalization phases, allowing them to actively avoid the upcoming aversive sound by pressing an avoidance button. Developmental differences emerged in threat perception, physiological arousal, avoidance behavior, and eye movements during contextual fear learning and generalization. Adolescents showed less discrimination between stimuli and contexts than adults, resulting primarily from their elevated fear responses to safety and generalized stimuli. Developmental differences in fear learning should be further explored in future research, as they could explain why adolescence is a sensitive developmental period for anxiety.

Fear extinction models have a key role in our understanding of anxiety disorders and their treatment with exposure therapy. Here, we tested whether individual differences in fear extinction learning and fear extinction recall in the laboratory were associated with the outcomes of an exposure therapy analog (ETA). Fifty adults with fear of spiders participated in a two-day fear-learning paradigm assessing fear extinction learning and fear extinction recall, and then underwent a brief ETA. Correlational analyses indicated that enhanced extinction learning was associated with better ETA outcome. Our results partially support the idea that individual differences in fear extinction learning may be associated with exposure therapy outcome, but suggest that further research in this area is needed. This work was supported by an ANPIR grant to E. F. (grant numberBA-3/2016); a KU Leuven program funding grant (grant number PF/10/005) and FP7 Marie Curie International Outgoing Fellowship (grantnumber 627743) to B. V.; PROMOSAM Investigación en procesos, me-canismos y tratamientos psicológicos para la promoción de la saludmental grant to M. T-F. (grant number PSI2014-56303-RED); Carlos IIIHealth Institute/FEDER grant to M. A. F. (grant number PI16/00144).

Avoidance behaviors are central to the anxiety disorders and implicated in many other forms of psychopathology, but the reinforcing mechanism of avoidance remains largely elusive. It has been suggested that subjective relief during successful omission of threat may serve as a reinforcer and contribute to the development of excessive avoidance. Also, relatively little is known about how avoidance behaviors generalize and what the role is of relief in generalization. The purpose of this experiment was three-fold: (1) to investigate the influence of anxiety-traits on the dynamics of relief during avoidance learning, (2) to characterize the dynamics of relief during avoidance generalization, and (3) to investigate the generalization of avoidance behavior over a dimension of avoidability. In a large sample of 101 participants, two lamp colors (CS+) were first associated with an aversive electrical stimulation (US), while a third color was not (CS-). Next, clicking a button during one CS + could effectively avoid the US (CS + av), but not during the other (CS + unav). Finally, avoidance generalization was tested via button clicks during morphed colors between CS + av and CS + unav (avoidability dimension), and to morphed colors between CS + av and CS- (safety dimension). Throughout the experiment, a relief rating scale appeared whenever a lamp color was not followed by the US. Results revealed that anxiety traits (distress tolerance and intolerance of uncertainty) were associated with higher levels of avoidance and subjective relief. In addition, gradients of avoidance generalization and relief were observed over dimensions of avoidability (CS + av → CS + unav) and safety (CS + av → CS-). Together, these results suggest a role for excessive relief in the development and generalization of maladaptive avoidance.

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.

BACKGROUND AND OBJECTIVES: Excessive avoidance of potential threat is a hallmark of anxiety and is thought to maintain fear by preserving the perceived high-threat value of avoided situations. Previous research has shown that the availability of avoidance maintains low-level threat. Here, we investigated whether an opportunity to engage in avoidance in the presence of a low-threat value safety cue would maintain its perceived threat value when avoidance was unavailable. METHODS: In a threat conditioning procedure, one conditional danger stimulus (CS+; A+) was followed by an aversive unconditioned stimulus (US; electric shock), and two safety stimuli (CS-; B- and C-) were never followed by the US. Next, clicking a button present during A+ avoided the scheduled US. Avoidance was then made available during C- for participants in the Experimental group but not in the Control group. In the test, all stimuli were presented without the opportunity to avoid. Threat expectancy, eyeblink startle electromyography (EMG), and skin conductance responses (SCRs) were measured. RESULTS: Findings showed an increase in threat expectancy for only C- in the Experimental group during the test phase following avoidance learning to similar levels as during threat conditioning. Compared to the Control group, threat expectancy for both B- and C- remained higher in Experimental group. SCR and startle EMG data did not corroborate these findings. LIMITATIONS: Further research is needed to test the commonly held clinical assumption that avoidance can increase threat value. CONCLUSIONS: Low-cost avoidance maintains low-threat value of safety cues. ispartof: Journal Of Behavior Therapy And Experimental Psychiatry vol:62 pages:57-64 ispartof: location:Netherlands status: published

Deficient safety learning has been implicated in the pathogenesis of anxiety disorders. Despite increased translational interest, there has been limited research on the basis of safety learning in humans. Here, we examined safety learning in seventy-three healthy participants via a modified Pavlovian conditioned inhibition paradigm, featuring a conditioned threat stimulus that was reinforced alone (A+), but not when combined with a second stimulus (the conditioned inhibitor, AX-). During a test phase, X and a control safety cue (C) were combined with a second threat stimulus to assess their inhibition of threat responses, measured via skin conductance (SCRs) and US-expectancy ratings. Both stimuli exhibited conditioned inhibition, but X suppressed ratings by a greater magnitude than C. Trait anxiety also predicted increased US-expectancy ratings of X. These findings suggest that a Pavlovian inhibitor accrues greater safety value than a merely unreinforced safety signal. Conditioned inhibition paradigms may have utility in the ongoing study of safety learning and its relevance to anxious psychopathology.

Attention plays an important role in the treatment of anxiety. Research has yet to elucidate how individual differences in attention or, particularly, gaze fixation can influence learning during tr...

Anxiety disorders are often treated by repeatedly presenting stimuli that are perceptually similar to original stimuli to which fear was originally acquired. Fear can return after it is extinguished because of the differences between these stimuli. It may possible to attenuate return of fear by manipulating attention to the commonalities between feared stimuli and extinction stimuli. After acquiring fear for an animal-like stimulus by pairing with an electro-cutaneous shock, fear was extinguished by repeatedly presenting a similar stimulus. During extinction participants were asked questions that instructed them to attend towards the features in common between the acquisition and extinction stimulus or towards the unique features of the extinction stimulus. Return of fear was assessed by presenting a second perceptually similar stimulus after extinction. Participants showed a return in skin conductance responding after extinction in the unique condition, and not in the common condition. Both groups showed a return in self-report ratings of US expectancy. Neither group showed a return in fear potentiated startle, but there was evidence that this may have been due to individual differences in emotional attentional control. Our conclusions are limited by the use of a self-report measure of emotional attentional control and the absence of limits on the length of time participants could take to answer the extinction questions. It may be possible to enhance extinction and prevent a return of the physiological aspects of fear by manipulating attention during extinction. However, this does not appear to influence explicit expectancy of aversive outcomes. Individual differences in attentional control may influence this process.

Potentially life-threatening interoceptive sensations easily engage the behavioral defensive system. Resulting fear and anxiety toward interoceptive threat are functionally distinct states that are hypothesized to play a prominent role in the etiology of panic disorder. The present study aimed to investigate whether fear- and anxiety-potentiated startle responses occur to predictable and unpredictable interoceptive threat, respectively. Therefore, we modified the NPU threat test (Schmitz & Grillon, ) and replaced the aversive electrocutaneous stimulus with an aversive interoceptive stimulus (a breathing occlusion, making it briefly impossible to breathe). Healthy participants (N = 48) underwent three instructed conditions. A visual cue signaled the occlusion in the predictable condition (P), whereas another cue was unrelated to the occurrence of the occlusion in the unpredictable condition (U). The safe condition (N) also had a visual cue, but no occlusion. Both fear- and anxiety-potentiated startle blink responses were observed in response to predictable and unpredictable respiratory threat, respectively. The current study presents and validates the NPU respiratory threat test (NPUr) as an ecologically valid paradigm to study both anxiety and fear in response to a panic-relevant interoceptive threat. The paradigm allows future testing of contextual generalization, investigation of different clinical groups, and more explicit comparisons of defensive responding to interoceptive versus exteroceptive threats.

Exposure therapy for anxiety is effective but fear can still return afterward. This may be because the stimuli that people are exposed to are dissimilar from the stimuli to which fear was originally acquired. After pairing an animal-like image (A) with a shock stimulus (US), a perceptually similar stimulus (B) was presented without the US in extinction. Participants were then shown A (ABA), a second generalization stimulus (ABC) or B (ABB). Groups ABA and ABC evidenced a return of US expectancy relative to participants who were shown B (ABB). Participants in group ABC who self-reported high levels of attentional control evidenced greater return of expectancy relative to participants low in attentional control. Participants with a high level of attentional control also showed steeper extinction gradients. Attentional control may influence perceptions of similarity and the learning that follows. Making note of such differences may be valuable in exposure treatment for anxiety.

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.

Abnormal fear conditioning processes (including fear acquisition and conditioned fear-generalization) have been implicated in the pathogenesis of anxiety disorders. Previous research has shown that individuals with panic disorder present enhanced conditioned fear-generalization in comparison to healthy controls. Enhanced conditioned fear-generalization could also characterize generalized anxiety disorder (GAD), but research so far is inconclusive. An important confounding factor in previous research is comorbidity. The present study examined conditioned fear-acquisition and fear-generalization in 28 patients with GAD and 30 healthy controls using a recently developed fear acquisition and generalization paradigm assessing fear-potentiated startle and online expectancies of the unconditioned stimulus. Analyses focused on GAD patients without comorbidity but included also patients with comorbid anxiety disorders. Patients and controls did not differ as regards fear acquisition. However, contrary to our hypothesis, both groups did not differ either in most indexes of conditioned fear-generalization. Moreover, dimensional measures of GAD symptoms were not correlated with conditioned fear-generalization indexes. Comorbidity did not have a significant impact on the results. Our data suggest that conditioned fear-generalization is not enhanced in GAD. Results are discussed with special attention to the possible effects of comorbidity on fear learning abnormalities. ispartof: BEHAVIOR THERAPY vol:46 issue:5 pages:627-639 ispartof: location:England status: published

Exposure therapy is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear after treatment. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure-based procedures. Although evidence supports an inhibitory learning model of extinction, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a 'fear habituation' approach and 'belief disconfirmation' approach within standard cognitive-behavior therapy. Exposure optimization strategies include 1) expectancy violation, 2) deep- ened extinction, 3) occasional reinforced extinction, 4) removal of safety signals, 5) variability, 6) retrieval cues, 7) multiple contexts, and 8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, specific phobia, and panic disorder.

Extinction memories are fragile and their formation has been proposed to partially rely on vagus nerve activity. We tested whether stimulating the auricular branch of the vagus (transcutaneous VNS; tVNS) accelerates extinction and reduces spontaneous recovery of fear. Forty-two healthy students participated in a 3-day fear conditioning study, where we tested fear acquisition (day 1), fear extinction (day 2) and the retention of the extinction memory (day 3). During extinction, participants were randomly allocated to receive tVNS or sham stimulation concurrently with each CS presentation. During the acquisition and retention phases, all participants received sham stimulation. Indexes of fear included US-expectancy, startle blink EMG and skin conductance responses. Results showed successful acquisition and extinction of fear in all measures. tVNS facilitated the extinction of declarative fear (US expectancy ratings), but did not promote a stronger retention of the declarative extinction memory. No clear effects of tVNS on extinction and retention of extinction were found for the psychophysiological indexes. The present findings provide tentative indications that tVNS could be a promising tool to improve fear extinction and call for larger scale studies to replicate these effects.

Although enhanced fear conditioning has been implicated in the origins of social anxiety disorder (SAD), laboratory evidence in support of this association is limited. Using a paradigm employing socially relevant unconditioned stimuli, we conducted two separate studies to asses fear conditioning in individuals with SAD and non-clinical individuals with high social anxiety (subclinical social anxiety [SSA]). They were compared with age-matched and gender-matched individuals with another anxiety disorder (panic disorder with agoraphobia) and healthy controls (Study 1) and with individuals with low social anxiety (Study 2). Contrary to our expectations, in both studies, self-report measures (ratings of anxiety, unpleasantness and arousal to the conditioned stimuli) of fear conditioning failed to discriminate between SAD or SSA and the other participant groups. Our results suggest that enhanced fear conditioning does not play a major role in pathological social anxiety. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message  We used a social conditioning paradigm to study fear conditioning in clinical and subclinical social anxiety.  We found no evidence of enhanced fear conditioning in social anxiety individuals.  Enhanced fear conditioning may not be a hallmark of pathological social anxiety.

Exposure-based treatments for clinical anxiety generally are very effective, but relapse is not uncommon. Likewise, laboratory studies have shown that conditioned fears are easy to extinguish, but they recover easily. This analogy is striking, and numerous fear extinction studies have been published that highlight the processes responsible for the extinction and return of acquired fears. This review examines and integrates the most important results from animal and human work. Overall, the results suggest that fear extinction is relatively easy to “learn” but difficult to “remember.” It follows that treatments will benefit from an enhanced focus on the long-term retrieval of fear extinction. We review the available studies on the prevention of return of fear and the prospects of weakening fear memories forever. We show that the behavioral principles outlined in learning theory provide a continuous inspiration for preclinical (neurobiological) and clinical research on the extinction and return of fear.

The modeling of abnormal behavior in ‘normal’ subjects (often animals) has a long history in pharmacological research for the screening of novel drug compounds. Systematic criteria have been outlined in that literature to estimate the external validity of a model, that is to estimate how closely the model is linked to the disorder of interest. Experimental psychopathology (EPP) also uses behavioral models to study the psychological processes that underlie abnormal behavior. Although EPP researchers may occasionally feel uneasy about the validity of the model that they use, the issue has not received direct attention in this literature. Here, we review the criteria of validity as set out in pharmacology research (face, predictive and construct validity) and discuss their relevance for EPP research. Furthermore, we propose diagnostic validity as an additional criterion of external validity that is relevant to EPP research. We evaluate two models for the study of anxiety and depression, and show that they have good face, diagnostic and construct validity. However, EPP research generally lacks direct tests of predictive validity. We conclude that combined evaluations of predictive, diagnostic and construct validity provide a sound basis to infer the external validity of behavioral models in EPP research.

In anxiety, maladaptive avoidance behavior provides for near-perfect controllability of potential threat. There has been little laboratory-based treatment research conducted on controllability as a contributing factor in the transition from adaptive to maladaptive avoidance. Here, we investigated for the first time whether partial reinforcement rate, or the reliability of avoidance at controlling or preventing contact with an aversive event, influences subsequent extinction of avoidance in humans. Five groups of participants were exposed to different partial reinforcement rates where avoidance cancelled upcoming shock on 100%, 75%, 50%, 25% or 0% of trials. During extinction, all shocks were withheld. Avoidance behavior, online shock expectancy ratings and skin conductance responses (SCRs) were measured throughout. We found that avoidance was a function of relative controllability: higher reinforcement rate groups engaged in significantly more extinction-resistant avoidance than lower reinforcement groups, and shock expectancy was inversely related with reinforcement rate during avoidance acquisition. Partial reinforcement effects were not evident in SCRs. Overall, the current study highlights the clinical relevance of laboratory-based treatment research on partial reinforcement or controllability effects on extinction of avoidance.

Adaptive defensive actions necessitate a fear learning system that is both fast and specific. Fast learning serves to minimize the number of threat confrontations, while specific learning ensures that the acquired fears are tied to threat-relevant cues only. In Pavlovian fear conditioning, fear acquisition is typically studied via repetitive pairings of a single cue with an aversive experience, which is not optimal for the examination of fast specific fear learning. In this study, we adopted the one-trial overshadowing procedure from basic learning research, in which a combination of two visual cues is presented once and paired with an aversive electrical stimulation. Using on-line shock expectancy ratings, skin conductance reactivity and startle reflex modulation as indices of fear learning, we found evidence of strong fear after a single conditioning trial (fast learning) as well as attenuated fear responding when only half of the trained stimulus combination was presented (specific learning). Moreover, specificity of fear responding tended to correlate with levels of state and trait anxiety. These results suggest that one-trial overshadowing can be used as a model to study fast specific fear learning in humans and individual differences therein. publisher: Elsevier articletitle: One-trial overshadowing: Evidence for fast specific fear learning in humans journaltitle: Behaviour Research and Therapy articlelink: http://dx.doi.org/10.1016/j.brat.2016.12.001 content_type: article copyright: © 2016 Elsevier Ltd. All rights reserved. ispartof: Behaviour Research and Therapy vol:90 pages:16-24 ispartof: location:England status: published

Classical Pavlovian fear conditioning remains the most widely employed experimental model of fear and anxiety, and continues to inform contemporary pathophysiological accounts of clinical anxiety disorders. Despite its widespread application in human and animal studies, the neurobiological basis of fear conditioning remains only partially understood. Here we provide a comprehensive meta-analysis of human fear-conditioning studies carried out with functional magnetic resonance imaging (fMRI), yielding a pooled sample of 677 participants from 27 independent studies. As a distinguishing feature of this meta-analysis, original statistical brain maps were obtained from the authors of 13 of these studies. Our primary analyses demonstrate that human fear conditioning is associated with a consistent and robust pattern of neural activation across a hypothesized genuine network of brain regions resembling existing anatomical descriptions of the 'central autonomic-interoceptive network'. This finding is discussed with a particular emphasis on the neural substrates of conscious fear processing. Our associated meta-analysis of functional deactivations-a scarcely addressed dynamic in fMRI fear-conditioning studies-also suggests the existence of a coordinated brain response potentially underlying the 'safety signal' (that is, non-threat) processing. We attempt to provide an integrated summary on these findings with the view that they may inform ongoing studies of fear-conditioning processes both in healthy and clinical populations, as investigated with neuroimaging and other experimental approaches. This work was supported by ‘Miguel Servet’ contracts from the Carlos III Health Institute (Spain) to CS-M CP10/00604) and JR (CP14/00041), grants from Carlos III Health Institute/FEDER to MAF/NC (PI12/00273) and CS-M (PI13/01958), and an Australian NHMRC Project Grant to BJH (APP1025619).

Hypothalamic-pituitary-adrenal (HPA) axis irregularities have been associated with several psychological disorders. Hence, the identification of individual difference variables that predict variations in HPA-axis activity represents an important challenge for psychiatric research. We investigated whether self-reported attentional control in emotionally demanding situations prospectively predicted changes in diurnal salivary cortisol secretion following exposure to a prolonged psychosocial stressor. Low ability to voluntarily control attention has previously been associated with anxiety and depressive symptomatology. Attentional control was assessed using the Emotional Attentional Control Scale. In students who were preparing for academic examination, salivary cortisol was assessed before (time 1) and after (time 2) examination. Results showed that lower levels of self-reported emotional attentional control at time 1 (N = 90) predicted higher absolute diurnal cortisol secretion and a slower decline in cortisol throughout the day at time 2 (N = 71). Difficulty controlling attention during emotional experiences may lead to chronic HPA-axis hyperactivity after prolonged exposure to stress. These results indicate that screening for individual differences may foster prediction of HPA-axis disturbances, paving the way for targeted disorder prevention. publisher: Elsevier articletitle: Emotional attentional control predicts changes in diurnal cortisol secretion following exposure to a prolonged psychosocial stressor journaltitle: Psychoneuroendocrinology articlelink: http://dx.doi.org/10.1016/j.psyneuen.2015.10.013 content_type: article copyright: Copyright © 2015 Elsevier Ltd. All rights reserved. ispartof: Psychoneuroendocrinology vol:63 pages:291-295 ispartof: location:England status: published

Background and ObjectivesIn a blocking procedure, a single conditioned stimulus (CS) is paired with an unconditioned stimulus (US), such as electric shock, in the first stage. During the subsequent stage, the CS is presented together with a second CS and this compound is followed by the same US. Fear conditioning studies in non-human animals have demonstrated that fear responding to the added second CS typically remains low, despite its being paired with the US. Accordingly, the blocking procedure is well suited as a laboratory model for studying (deficits in) selective threat appraisal. The present study tested the relation between trait anxiety and blocking in human aversive conditioning.MethodsHealthy participants filled in a trait anxiety questionnaire and underwent blocking treatment in the human aversive conditioning paradigm. Threat appraisal was measured through shock expectancy ratings and skin conductance.ResultsAs hypothesized, trait anxiety was positively associated with shock expectancy ratings to the blocked stimulus.LimitationsIn skin conductance responding, no significant effects of stimulus type could be detected during blocking training or testing. The current study does not allow strong claims to be made regarding the theoretical process underlying the expectancy bias we observed.ConclusionsThe observed shock expectancy bias might be one of the mechanisms leading to non-specific fear in individuals at risk for developing anxiety disorders. A deficit in blocking, or a deficit in selective threat appraisal at the more general level, indeed results in fear becoming non-specific and disconnected from the most likely causes or predictors of danger.

It has been suggested that prior experiences with unpredictable/uncontrollable stressors facilitate subsequent fear learning and the development of anxiety disorders. However, animal research documents that preexposure to unpredictable stressors (USs) impede later fear conditioning with that US. These differential predictions were tested in a human experimental model of clinical anxiety. One (US-only) group was preexposed to unpredictable shocks, a second (Unpaired) group received explicitly unpaired presentations of a neutral shape and the shock, and a third (Paired) group received paired shape-shock presentations. Next, all groups received training with a novel shape, using the same shock (50% reinforcement). Fear responding was assessed through startle modulation and online shock-expectancy ratings. Results showed retarded fear learning in the unpredictable groups compared to the predictable group. We argue that prior experiences of unpredictability may still contribute to the development of clinical anxiety, by impeding adaptive fear learning and perpetuating the perception of unpredictability/uncontrollability.

Purpose of review Extinction learning is a major mechanism for fear reduction by means of exposure. Current research targets innovative strategies to enhance fear extinction and thereby optimize exposure-based treatments for anxiety disorders. This selective review updates novel behavioral strategies that may provide cutting-edge clinical implications. Recent findings Recent studies provide further support for two types of enhancement strategies. Procedural enhancement strategies implemented during extinction training translate to how exposure exercises may be conducted to optimize fear extinction. These strategies mostly focus on a maximized violation of dysfunctional threat expectancies and on reducing context and stimulus specificity of extinction learning. Flanking enhancement strategies target periods before and after extinction training and inform optimal preparation and post-processing of exposure exercises. These flanking strategies focus on the enhancement of learning in general, memory (re-)consolidation, and memory retrieval. Summary Behavioral strategies to enhance fear extinction may provide powerful clinical applications to further maximize the efficacy of exposure-based interventions. However, future replications, mechanistic examinations, and translational studies are warranted to verify long-term effects and naturalistic utility. Future directions also comprise the interplay of optimized fear extinction with (avoidance) behavior and motivational antecedents of exposure.

Phil. Trans. R. Soc. B 373 , 20170025. (Published 19 January 2018) ([doi:10.1098/rstb.2017.0025][1]) Owing to a clerical error … [1]: http://dx.doi.org/10.1098/rstb.2017.0025

Chronic anxiety may differ from cued fear and hence require other treatment strategies. In a human fear conditioning paradigm, chronic anxiety to the experimental context was experimentally induced by presenting unpredictable shocks. Two methods to reduce chronic anxiety were tested and compared. First, in parallel with the standard extinction procedure, participants were exposed to the anxiety-eliciting context in the absence of shocks (context-exposure group). Second, an alternative procedure was tested in which the previously unpredictable shocks were now signaled by a specific cue (signaled group). A control group continued to receive unsignaled shocks. Results indicated that chronic contextual anxiety, as measured by fear-potentiated startle and US-expectancy ratings, was equally reduced in the context-exposure group as in the signaled group compared with the control group. When applied to the treatment of, for example, panic disorder, these findings support the idea that exposure to the context in which the unpredictable panic attacks occurred and making unpredictable panic attacks predictable, are both valuable methods in order to reduce chronic anxiety.

Fear generalization lies at the heart of many anxiety problems, but little is known about the factors that can influence this phenomenon. The present study investigated whether verbal instructions about specific stimulus features can influence conditioned fear generalization. All participants were fear conditioned to a yellow triangle, using an electric shock. Participants had received pre-experimental instructions saying that the shapes (or colours) of the stimuli were informative for the occurrence of shock (group Shape and group Colour, respectively). Next, generalization was tested to presentations of a blue triangle (same shape) as well as a yellow square (same colour). Fear reactions were measured through skin conductance and online ratings of shock-expectancy. The results showed strongest generalization to the same shape stimulus in group Shape, versus the same colour stimulus in group Colour. Hence, the same learning experience can have opposite effects in terms of fear generalization, depending on verbally transmitted information about the relative importance of individual stimulus features.

Clinical fear of spiders was assessed in 39 patients before and after exposure treatment and at a 3-month follow-up. The assessment included behavioral, physiological and self-report measures. Some patients were tested in the treatment context (group Same), while others were tested in a different context (group Different). Both groups demonstrated a significant fear reduction from pre- to post-treatment in all measures, which persisted at the 3-month follow-up. Contrary to our expectations, no clear difference was observed between the groups at any moment. However, a 1-year follow-up test of the self-report measure revealed a return of fear in group Same, but not in group Different. These results show (1) that the effects of exposure treatment persisted over contexts and time in the short term, and (2) that conducting treatment and tests in different contexts enhanced efficiency of exposure treatment in the long term.

Associative learning plays an important role in the development of anxiety disorders, but a thorough understanding of the variables that impact such learning is still lacking. We investigated whether individual differences in autobiographical memory specificity are related to discrimination learning and generalization. In an associative learning task, participants learned the association between two pictures of female faces and a non-aversive outcome. Subsequently, six morphed pictures functioning as generalization stimuli (GSs) were introduced. In a sample of healthy participants (Study 1), we did not find evidence for differences in discrimination learning as a function of memory specificity. In a sample of anxiety disorder patients (Study 2), individuals who were characterized by low memory specificity showed deficient discrimination learning relative to high specific individuals. In contrast to previous findings, results revealed no effect of memory specificity on generalization. These results indicate that impaired discrimination learning, previously shown in patients suffering from an anxiety disorder, may be – in part – due to limited memory specificity. Together, these studies emphasize the importance of incorporating cognitive variables in associative learning theories and their implications for the development of anxiety disorders. In addition, re-analyses of the data (Study 3) showed that patients suffering from panic disorder showed higher outcome expectancies in the presence of the stimulus that was never followed by an outcome during discrimination training, relative to patients suffering from other anxiety disorders and healthy participants. Because we used a neutral, non-aversive outcome (i.e., drawing of a lightning bolt), these data suggest that learning abnormalities in panic disorder may not be restricted to fear learning, but rather reflect a more general associative learning deficit that also manifests in fear irrelevant contexts. ispartof: Frontiers in Psychology vol:6 pages:1-12 ispartof: location:Switzerland status: published

Potentially life-threatening interoceptive sensations easily engage the behavioral defensive system. Resulting fear and anxiety toward interoceptive threat are functionally distinct states that are hypothesized to play a prominent role in the etiology of panic disorder. The present study aimed to investigate whether fear- and anxiety-potentiated startle responses occur to predictable and unpredictable interoceptive threat, respectively. Therefore, we modified the NPU threat test (SchmitzGrillon, ) and replaced the aversive electrocutaneous stimulus with an aversive interoceptive stimulus (a breathing occlusion, making it briefly impossible to breathe). Healthy participants (N = 48) underwent three instructed conditions. A visual cue signaled the occlusion in the predictable condition (P), whereas another cue was unrelated to the occurrence of the occlusion in the unpredictable condition (U). The safe condition (N) also had a visual cue, but no occlusion. Both fear- and anxiety-potentiated startle blink responses were observed in response to predictable and unpredictable respiratory threat, respectively. The current study presents and validates the NPU respiratory threat test (NPUr) as an ecologically valid paradigm to study both anxiety and fear in response to a panic-relevant interoceptive threat. The paradigm allows future testing of contextual generalization, investigation of different clinical groups, and more explicit comparisons of defensive responding to interoceptive versus exteroceptive threats.

Despite the effectiveness of exposure therapy for treating anxiety disorders, a number of patients fail to benefi t or experience a return of fear after treatment. Research suggests that anxious individuals show defi cits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the effi cacy of expo- sure-based procedures. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a "fear habituation" approach and "belief disconfi rma- tion" approach within standard cognitive-behavior therapy. Exposure optimization strategies include 1) expectancy violation, 2) deepened extinction, 3) occasional reinforced extinction, 4) removal of safety signals, 5) variability, 6) retrieval cues, 7) multiple contexts, and 8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders.

Exposure therapy is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear after treatment. Research suggests that anxious individuals show deficits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure-based procedures. Although evidence supports an inhibitory learning model of extinction, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a 'fear habituation' approach and 'belief disconfirmation' approach within standard cognitive-behavior therapy. Exposure optimization strategies include (1) expectancy violation, (2) deepened extinction, (3) occasional reinforced extinction, (4) removal of safety signals, (5) variability, (6) retrieval cues, (7) multiple contexts, and (8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, specific phobia, and panic disorder. publisher: Elsevier articletitle: Maximizing exposure therapy: An inhibitory learning approach journaltitle: Behaviour Research and Therapy articlelink: http://dx.doi.org/10.1016/j.brat.2014.04.006 content_type: article copyright: Copyright © 2014 Elsevier Ltd. All rights reserved. ispartof: Behaviour Research and Therapy vol:58 pages:10-23 ispartof: location:England status: published

Fear generalization, in which conditioned fear responses generalize or spread to related stimuli, is a defining feature of anxiety disorders. The behavioral consequences of maladaptive fear generalization are that aversive experiences with one stimulus or event may lead one to regard other cues or situations as potential threats that should be avoided, despite variations in physical form. Theoretical and empirical interest in the generalization of conditioned learning dates to the earliest research on classical conditioning in nonhumans. Recently, there has been renewed focus on fear generalization in humans due in part to its explanatory power in characterizing disorders of fear and anxiety. Here, we review existing behavioral and neuroimaging empirical research on the perceptual and non-perceptual (conceptual and symbolic) generalization of fear and avoidance in healthy humans and patients with anxiety disorders. The clinical implications of this research for understanding the etiology and treatment of anxiety is considered and directions for future research described.

Adaptive anxiety relies on a balance between the generalization of fear acquisition and fear extinction. Research on fear (extinction) generalization has focused mostly on perceptual similarity, thereby ignoring the importance of conceptual stimulus relations in humans. The present study used a laboratory procedure to create de novo conceptual categories of arbitrary stimuli and investigated fear and extinction generalization among these stimuli. A matching-to-sample task produced two four-member categories of abstract figures. Next, a member from one category was coupled with an aversive electrical stimulation, while a member from the other category was presented alone. As expected, conditioned fear responses generalized to the other members of the first category (skin conductance and online shock-expectancy). Subsequent extinction of the conditioned member also generalized to the other members. However, extinguishing a non-conditioned member failed to reduce fear of the conditioned member itself. We conclude that fears generalize readily across conceptually related stimuli, but that the degree of extinction generalization depends on the stimulus subjected to extinction. ispartof: PLoS One vol:9 issue:5 ispartof: location:United States status: published

Background and Objectives: The degree of (over)generalization (to the self, over situations) is an important characteristic of depression and anxiety disorders. Little is known about cognitive mechanisms underlying this (over)generalization. In this context, the present study examined the effect of an abstract processing style (compared to a more concrete processing style) on generalization of angry faces to the self. An abstract processing style refers to thoughts about the meaning, causes and consequences of events or situations (‘Why’-thinking). Methods: To test the impact of an abstract processing experimentally, images of angry faces were paired with the name of the participant and happy faces were paired with another person’s name while participants adopted either an abstract (‘Why’) or a concrete (‘How’) processing style. A surprise recognition task, where participants were asked to indicate whether they had seen the faces before, served as a test of generalization of angry faces to the self. Results: Results indicated that participants who adopted an abstract processing style showed more generalization of angry faces to the self and a trend towards more generalization of happy faces to the other person, relative to participants who adopted a concrete processing style. Limitations: Our sample was a non-clinical student sample and thus conclusions about the generalizability to clinical samples should be done with caution. Conclusions: These results suggest that abstract thought may underlie the generalization of bad/failure/angry feelings toward the self (‘Everyone is always angry with me’) and of good feelings towards other people (‘Everyone is always nicer to other people’) that is often seen in depression and social anxiety disorder. publisher: Elsevier articletitle: “Why is everyone always angry with me?!”: When thinking ‘why’ leads to generalization journaltitle: Journal of Behavior Therapy and Experimental Psychiatry articlelink: http://dx.doi.org/10.1016/j.jbtep.2014.11.008 content_type: article copyright: Copyright © 2014 Elsevier Ltd. All rights reserved. ispartof: Journal of Behavior Therapy and Experimental Psychiatry vol:47 pages:34-41 ispartof: location:Netherlands status: published

Little is known about the role of discrete stimulus features in the regulation of fear. This study examined the effects of feature learning on the acquisition and extinction of fear conditioning. Human participants were fear conditioned to a yellow triangle (CS+) using an electrical shock. We manipulated feature learning through differential conditioning. The nonconditioned control stimulus (CS−) was a red triangle in one group (Color-Relevant), but a yellow circle in the other group (Shape-Relevant). Next, two generalization stimuli were tested that shared the shape- or color-feature with the CS+ (a blue triangle and a yellow square). Online shock-expectancy ratings and skin conductance responding showed that the CS− determined the pattern of fear generalization: the same-color stimulus elicited more fear in Group Color-Relevant, versus the same-shape stimulus in group Shape-Relevant. Furthermore, extinguishing these two generalization stimuli had no detectable effect on fear of the CS+. These results show that fear generalization is influenced by feature learning through differential conditioning, and that exposures to different features of a stimulus are not sufficient to extinguish fear of that stimulus as a whole.

Prevention is better than cure, but little is known about effective prevention of anxiety disorders. Individuals vulnerable for trauma-exposure would benefit from effective techniques to prevent the development of post-traumatic stress. One reason for the apparent standstill in this literature may be the exclusive focus on the development of fear, while pre-clinical anxiety treatment research has turned to impaired extinction of fear as the main mechanism underlying abnormal anxiety. Conditioning theories propose latent inhibition as a technique to prevent the development of fears, but the effects on fear extinction have not been examined in detail. I conducted two experiments to evaluate the effects of latent inhibition on extinction in a standard human fear conditioning paradigm, which serves as a model for post-traumatic stress disorder. Skin conductance reactivity and online expectancy ratings revealed slower rates of fear acquisition in the latent inhibition groups, as well as a speeded extinction effect early in extinction. However, extinction of expectancy ratings was less complete in the latent inhibition groups. The beneficial effects of the latent inhibition technique may be in promoting early success of self-exposures or exposure treatment and motivating the patient to continue on the exposure path

Individuals seem to differ in conditionability, i.e., the ease by which the contingent presentation of two stimuli will lead to a conditioned response. In contemporary learning theory, individual differences in the etiology and maintenance of anxiety disorders are, among others, explained by individual differences in temperamental variables (Mineka and Zinbarg, 2006). One such individual difference variable is how people process a learning experience when the conditioning stimuli are no longer present. Repeatedly thinking about the conditioning experience, as in worry or rumination, might prolong the initial (fear) reactions and as such, might leave certain individuals more vulnerable to developing an anxiety disorder. However, in human conditioning research, relatively little attention has been devoted to the processing of a memory trace after its initial acquisition, despite its potential influences on subsequent performance. Post-acquisition processing can be induced by mental reiteration of a conditioned stimulus-unconditioned stimulus (CS-US)-contingency. Using a human conditioned suppression paradigm, we investigated the effect of repeated activations of a CS-US-contingency memory on the level of conditioned responding at a later test. Results of three experiments showed more sustained responding to a "rehearsed" CS+ as compared to a "non-rehearsed" CS+. Moreover, the second experiment showed no effect of rehearsal when only the CS was rehearsed instead of the CS-US-contingency. The third experiment demonstrated that mental CS-US-rehearsal has the same effect regardless of whether it was cued by the CS and a verbal reference to the US or by a neutral signal, making the rehearsal "purely mental." In sum, it was demonstrated that post-acquisition activation of a CS-US-contingency memory can impact conditioned responding, underlining the importance of post-acquisition processes in conditioning. This might indicate that individuals who are more prone to mentally rehearse information condition more easily. ispartof: Frontiers in Psychology vol:4 issue:MAY pages:305-305 ispartof: location:Switzerland status: published

At the core of anxiety disorders is the inability to use contextual information to modulate behavioral responses to potentially threatening events. Models of the pathogenesis of anxiety disorders incorporate stress and concomitant stress hormones as important vulnerability factors, while others emphasize sex as an important factor. However, translational basic research has not yet investigated the effects of stress hormones and sex on the ability to use contextual information to modulate responses to threat. Therefore, the purpose of the present study was threefold: first, we aimed at developing an experimental paradigm specifically capable of capturing contextual modulation of the expression of fear. Second, we tested whether cortisol would alter the contextualization of fear expression. Third, we aimed at assessing whether alterations in contextualization due to cortisol were different for men and women. Healthy participants (n = 42) received placebo or hydrocortisone (20 mg) prior to undergoing a newly developed differential contextual fear-conditioning paradigm. The results indicated that people rapidly acquire differential contextual modulation of the expression of fear, as measured by fear potentiated startle (FPS) and skin conductance responses (SCR). In addition, cortisol impaired the contextualization of fear expression leading to increased fear generalization on FPS data in women. The opposite pattern was found in men. Finally, as assessed by SCR, cortisol impaired differential conditioning in men. The results are in line with models suggesting heightened vulnerability in women for developing anxiety disorders after stressful events. ispartof: Frontiers in behavioral neuroscience vol:6 issue:67 pages:1-14 ispartof: location:Switzerland status: published

Exposure-based interventions are core to the psychosocial treatment of anxiety disorders. Protocols utilizing these elements are associated with some of the highest effect sizes in the anxiety treatment literature (e.g., Hofmann & Smits, 2008). These interventions rely on the use of experience to aid the learning of safety in relation to the core fears underlying anxiety disorders; yet, the efficacy of these interventions may be limited by a number of contextual and procedural challenges. This chapter provides a review of studies of these procedures and parameters and provides a conceptual overview of a heuristic for guiding exposure interventions. Relative to this heuristic we attend to the stimulus properties, duration, spacing, gradation, and, particularly, context of exposure interventions.

Panic disorder is characterized by both specific, phased fear and generalized, chronic anxiety. Standard extinction procedures are efficient in reducing specific fear. However, methods based on human conditioning research - that are capable of reducing chronic anxiety have not yet been thoroughly investigated. This study evaluates a new way of reducing chronic anxiety by signaling aversive events (or by making them more predictable). Using an experimental approach with healthy participants, specific fear and chronic anxiety were operationalized in a within-subjects fear-potentiated startle paradigm by, respectively, conditioning to a cue by presenting predictable shocks and conditioning to a context induced by unpredictable shocks. The results clearly demonstrate that context conditioning is reduced when a discrete cue is added that predicts the onset of the aversive event. The data suggest that making unpredictable events, such as for example panic attacks, predictable, may reduce the generalized and sustained anxiety that often complicates exposure treatment.

Lesion studies in animals have identified a critical role of the hippocampus in context fear conditioning. To extend these findings to human volunteers, we used functional magnetic resonance imaging to investigate neural responses associated with context fear conditioning in humans. Our novel conditioning paradigm consisted of aversive electrical shocks ( unconditioned stimulus) that were delivered either cue or context related. Differential evoked responses, related to the conditioned stimulus (CS), were found in the anterior cingulate cortex and the bilateral insular cortices, regions that have been implicated in anticipatory anxiety. In case of context conditioning, a similar pattern was observed during the presentation of the entire context. In line with previous conditioning studies, differential responses in the amygdala showed a time by stimulus interaction, suggesting rapid adaptation of CS-specific responses. More importantly, a similar differential decay of activation was observed during context conditioning in the hippocampus, in agreement with a role of the hippocampus in the acquisition phase of human context fear conditioning. ispartof: Journal of Neuroscience vol:28 issue:36 pages:9030-9036 ispartof: location:United States status: published

The present study was set up to investigate cued and contextual fear in situations of (un)predictability in a human fear conditioning paradigm. Forty-nine participants were presented with two different contexts (switching on and off the central lighting of the experimental room). In the predictable context, a visual cue (CS I) was systematically followed by an electrocutaneous stimulus (US). In the unpredictable context, CS2 was presented explicitly unpaired with the US. Dependent variables were online US-expectancy ratings and fear-potentiated startle. First, in both measures, the results showed significantly more fear elicited by CS I than by CS2. Second, larger startle amplitudes during the intertrial intervals demonstrated more contextual fear in the unpredictable than in the predictable context. Hence, these findings illustrate that unpredictability increases contextual fear. Moreover, the US-expectancy ratings during the intertrial intervals were also higher in the unpredictable than in the predictable context. This last finding suggests that a chronic expectation of the threatening US is responsible for sustained levels of anxiety in unpredictable situations. (C) 2007 Elsevier B.V. All rights reserved. ispartof: Biological Psychology vol:77 issue:1 pages:39-46 ispartof: location:Netherlands status: published

In a treatment-analogue experiment, extinction of fear of spiders was investigated in a group of spider-anxious students. Two groups were created: in the single extinction group the extinction trials consisted of repeated presentations of a videotaped spider in one specific location of a house, whereas in the multiple extinction group the trials consisted of videotapes of the same spider in three different locations of a house. Also a control group was included that was exposed to videotapes of the location but without the spider. As reflected in skin conductance responses and self-report data, fear of spiders was significantly reduced in the two extinction groups compared to the control group. Moreover, when the extinction groups were confronted with the videotape of the spider in a new location, the single extinction group did not show generalisation of extinction, whereas the multiple extinction group did. These results corroborate the existing evidence for context dependence of extinction of fear and provide new evidence that the use of multiple contexts during extinction might improve the generalisability of extinction in humans. Implications for exposure therapy are discussed.