Åhs et al.'s (2018) Systematic review on biological preparedness and resistance to extinction: A commentary and reanalysis

Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation

OBJECTIVES

Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety.

METHODS

Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity.

RESULTS

Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety.

CONCLUSIONS

The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.

Spider vs. guns: expectancy and attention biases to phylogenetic threat do not extend to ontogenetic threat

Introduction

Attention bias plays an important role in specific fears and phobias. Previous studies revealed that a-priori expectancies affect attention toward neutral stimuli but not threatening stimuli. The aim of the current study was to test whether this selective influence of expectancies on attention is specific to phylogenetic threat (i.e., spiders) or whether it can be generalized to ontogenetic threat (i.e., guns). Correspondingly, we directly compared expectancy effects on attentional allocation to phylogenetically vs. ontogenetically threatening stimuli.

Method

Expectancies were manipulated by presenting a cue indicating the likelihood of the appearance of a deviant picture in a visual search array. The array included eight distractors and one neutral (phone/bird) or threatening (gun/spider) deviant picture. In a comprehensive design, we examined the effects of stimulus type (phylogenetic/ontogenetic) and visual background (white and sterile/complex and ecological). Individual differences such as intolerance of uncertainty and spider fear were also measured.

Results

Results showed that attention bias toward spiders does not extend to threatening ontogenetic stimuli (i.e., guns). Our previous findings on attention bias toward spiders were replicated and a small to medium positive correlation was found between reaction time to bird targets and pre-existing fear of spider levels. Cues were used to detect threatening as well as neutral targets on both background types, except for spider targets on a complex background, replicating previous results. A small to medium positive correlation was also found between fear of spiders and intolerance of uncertainty.

Discussion

Together, these results suggest that expectancy and attentional processes may differ between ontogenetic and phylogenetic threat. Importantly, the effects of expectancy on attentional allocation depend on an interaction between the type of threat (ontogenetic/phylogenetic), visual factors, and individual differences.

Angry and fearful compared to happy or neutral faces as conditional stimuli in human fear conditioning: A systematic review and meta-analysis

Some previous research has shown stronger acquisition and impaired extinction of fear conditioned to angry or fearful compared to happy or neutral face conditional stimuli (CS) - a difference attributed to biological 'preparedness'. A systematic review and meta-analysis of fear conditioning studies comparing face CSs of differing expressions identified thirty studies, eighteen of which were eligible for meta-analysis. Skin conductance responses were larger to angry or fearful faces compared to happy or neutral faces during habituation, acquisition and extinction. Significant differences in differential conditioning between angry, fearful, neutral, and happy face CSs were also found, but differences were more prominent between angry and neutral faces compared to angry/fearful and happy faces. This is likely due to lower arousal elicited by neutral compared to happy faces, which may be more salient as CSs. The findings suggest there are small to moderate differences in differential conditioning when angry or fearful compared to happy or neutral faces are used as CSs. These findings have implications for fear conditioning study design and the preparedness theory.

Why and how does early adversity influence development? Toward an integrated model of dimensions of environmental experience

Two extant frameworks - the harshness-unpredictability model and the threat-deprivation model - attempt to explain which dimensions of adversity have distinct influences on development. These models address, respectively, why, based on a history of natural selection, development operates the way it does across a range of environmental contexts, and how the neural mechanisms that underlie plasticity and learning in response to environmental experiences influence brain development. Building on these frameworks, we advance an integrated model of dimensions of environmental experience, focusing on threat-based forms of harshness, deprivation-based forms of harshness, and environmental unpredictability. This integrated model makes clear that the why and the how of development are inextricable and, together, essential to understanding which dimensions of the environment matter. Core integrative concepts include the directedness of learning, multiple levels of developmental adaptation to the environment, and tradeoffs between adaptive and maladaptive developmental responses to adversity. The integrated model proposes that proximal and distal cues to threat-based and deprivation-based forms of harshness, as well as unpredictability in those cues, calibrate development to both immediate rearing environments and broader ecological contexts, current and future. We highlight actionable directions for research needed to investigate the integrated model and advance understanding of dimensions of environmental experience.

A Current Learning Theory Approach to the Etiology and Course of Anxiety and Related Disorders

The authors describe how contemporary learning theory and research provide the basis for models of the etiology and maintenance of anxiety and related disorders. They argue that contemporary learning theory accounts for much of the complexity associated with individual differences in the development and course of these disorders. These insights from modern research on learning overcome the limitations of earlier behavioral approaches, which were overly simplistic and have been justifiably criticized. The authors show how considerations of early learning histories and temperamental vulnerabilities affect the short- and long-term likelihood that experiences with stressful events will lead to the development of anxiety disorders. They also discuss how contextual variables during and after stressful learning experiences influence the maintenance of anxiety disorder symptoms. Thus, contemporary learning models provide a rich and nuanced understanding of the etiology and course of anxiety and related disorders. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.