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Peyrot C, Provencher J, Duplessis Marcotte F, Cernik R, Marin MF. Using unconditioned responses to predict fear acquisition, fear extinction learning, and extinction retention patterns: Sex hormone status matters. Behav Brain Res 2024; 459:114802. [PMID: 38081517 DOI: 10.1016/j.bbr.2023.114802] [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: 08/16/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Following a traumatic event, fear dysregulation can increase the likelihood of developing post-traumatic stress disorder (PTSD). This psychopathology is twice as prevalent in women than in men. High physiological reactivity following trauma may be an early risk indicator for the development of PTSD. Elevated physiological reactivity and low estradiol levels have individually been associated with higher fear acquisition and/or lower extinction retention. Thus, sex hormone status may also modulate fear regulation abilities. However, it is unknown whether these two vulnerability factors interact to modulate fear learning and regulation. Using a fear conditioning and extinction protocol, we examined whether physiological reactivity to the aversive stimulus during fear acquisition training predicted fear responses during fear learning, extinction learning, and extinction retention. We verified whether these associations differed according to sex hormone status. Seventy-seven non-clinical participants were recruited including oral contraceptive users (n = 18), early follicular women (n = 20, [low estradiol]), mid-cycle women (n = 20, [high estradiol]), and men (n = 19). Participants underwent a three-day fear conditioning and extinction protocol (day 1: fear acquisition training; day 2: extinction training; day 3: retention test). Skin conductance responses were recorded. In early follicular women, physiological reactivity predicted conditioned and extinguished stimulus fear responses during all phases. For the remaining women, this effect was only present during fear learning and extinction learning. These findings highlight the importance of considering physiological reactivity and sex hormone status following a traumatic event. This knowledge could aid in the early identification of those at higher risk of developing PTSD.
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Affiliation(s)
- Clémence Peyrot
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, 2900 Édouard-Montpetit boulevard, Montréal, Québec H3T 1J4, Canada.
| | - Jessie Provencher
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
| | - Félix Duplessis Marcotte
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
| | - Rebecca Cernik
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
| | - Marie-France Marin
- Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, H1N 3J4 Montréal, Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, 2900 Édouard-Montpetit boulevard, Montréal, Québec H3T 1J4, Canada; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montréal, Québec H2X 2P3, Canada.
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Maslahati T, Schultebraucks K, Galve Gómez M, Hellmann-Regen J, Otte C, Wingenfeld K, Roepke S. Effects of oral contraceptives on intrusive memories: a secondary analysis of two studies using the trauma film paradigm in healthy women. Eur J Psychotraumatol 2023; 14:2282003. [PMID: 38039055 PMCID: PMC10990444 DOI: 10.1080/20008066.2023.2282003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background: Women are more likely to develop post-traumatic stress disorder (PTSD) than men. Recent research suggests an impact of oral contraceptive (OC) intake on PTSD and intrusive memories, a hallmark symptom of PTSD. Although a majority of women use OCs at some point in their lives, the effects on PTSD pathogenesis are only poorly understood.Objective: In the current paper, we aimed to investigate the impact of OC intake on the acquisition and consolidation of intrusive memories in healthy women after watching a trauma film paradigm.Methods: We performed a secondary analysis of a pooled dataset (N = 437) of two previously conducted and published studies investigating the effect of oxytocin on the development of intrusive memories.Results: Women taking OCs showed an attenuated decline of intrusive memories over time after having watched the trauma film compared to naturally cycling women (F(2.75, 1167) = 3.79, p = .03, η p 2 = .01).Conclusion: These findings indicate that the intake of OCs is associated with the development of intrusive memories after a trauma film paradigm. This indication emphasizes the need to further investigate the complex impact of OCs and gonadal hormones on fear learning processes and PTSD.
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Affiliation(s)
- Tolou Maslahati
- Clinic for Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Katharina Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, New York City, NY, USA
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York City, NY, USA
| | - Milagros Galve Gómez
- Clinic for Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Julian Hellmann-Regen
- Clinic for Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christian Otte
- Clinic for Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Germany
| | - Katja Wingenfeld
- Clinic for Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Germany
| | - Stefan Roepke
- Clinic for Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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3
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Wiseman M, Hinks M, Hallett D, Blundell J, Sweeney E, Thorpe CM, Walling SG, Swift-Gallant A. Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder. J Psychiatr Res 2023; 168:213-220. [PMID: 37918034 DOI: 10.1016/j.jpsychires.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow's Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis.
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Affiliation(s)
- Megan Wiseman
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Meagan Hinks
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Darcy Hallett
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ellen Sweeney
- Atlantic PATH, Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Christina M Thorpe
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Susan G Walling
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ashlyn Swift-Gallant
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada.
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Ziemka-Nalecz M, Pawelec P, Ziabska K, Zalewska T. Sex Differences in Brain Disorders. Int J Mol Sci 2023; 24:14571. [PMID: 37834018 PMCID: PMC10572175 DOI: 10.3390/ijms241914571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
A remarkable feature of the brain is its sexual dimorphism. Sexual dimorphism in brain structure and function is associated with clinical implications documented previously in healthy individuals but also in those who suffer from various brain disorders. Sex-based differences concerning some features such as the risk, prevalence, age of onset, and symptomatology have been confirmed in a range of neurological and neuropsychiatric diseases. The mechanisms responsible for the establishment of sex-based differences between men and women are not fully understood. The present paper provides up-to-date data on sex-related dissimilarities observed in brain disorders and highlights the most relevant features that differ between males and females. The topic is very important as the recognition of disparities between the sexes might allow for the identification of therapeutic targets and pharmacological approaches for intractable neurological and neuropsychiatric disorders.
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Affiliation(s)
| | | | | | - Teresa Zalewska
- NeuroRepair Department, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5, A. Pawinskiego Str., 02-106 Warsaw, Poland; (M.Z.-N.); (P.P.); (K.Z.)
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5
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Velasco ER, Florido A, Perez-Caballero L, Marin I, Andero R. The Impacts of Sex Differences and Sex Hormones on Fear Extinction. Curr Top Behav Neurosci 2023; 64:105-132. [PMID: 37528309 DOI: 10.1007/7854_2023_426] [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] [Indexed: 08/03/2023]
Abstract
Fear extinction memories are strongly modulated by sex and hormonal status, but the exact mechanisms are still being discovered. In humans, there are some basal and task-related features in which male and female individuals differ in fear conditioning paradigms. However, analyses considering the effects of sex hormones demonstrate a role for estradiol in fear extinction memory consolidation. Translational studies are taking advantage of the convergent findings between species to understand the brain structures implicated. Nevertheless, the human brain is complex and the transfer of these findings into the clinics remains a challenge. The promising advances in the field together with the standardization of fear extinction methodologies in humans will benefit the design of new personalized therapies.
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Affiliation(s)
- Eric Raul Velasco
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Florido
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Perez-Caballero
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignacio Marin
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raul Andero
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
- Unitat de Neurociència Traslacional, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- ICREA, Pg. Lluís Companys 23, Barcelona, Spain.
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6
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Bauer EP. Sex differences in fear responses: Neural circuits. Neuropharmacology 2023; 222:109298. [PMID: 36328063 PMCID: PMC11267399 DOI: 10.1016/j.neuropharm.2022.109298] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Women have increased vulnerability to PTSD and anxiety disorders compared to men. Understanding the neurobiological underpinnings of these disorders is critical for identifying risk factors and developing appropriate sex-specific interventions. Despite the clear clinical relevance of an examination of sex differences in fear responses, the vast majority of pre-clinical research on fear learning and memory formation has exclusively used male animals. This review highlights sex differences in context and cued fear conditioning, fear extinction and fear generalization with a focus on the neural circuits underlying these behaviors in rodents. There are mixed reports of behavioral sex differences in context and cued fear conditioning paradigms, which can depend upon the behavioral indices of fear. However, there is greater evidence of differential activation of the hippocampus, amygdalar nuclei and the prefrontal cortical regions in male and female rodents during context and cued fear conditioning. The bed nucleus of the stria terminalis (BNST), a sexually dimorphic structure, is of particular interest as it differentially contributes to fear responses in males and females. In addition, while the influence of the estrous cycle on different phases of fear conditioning is delineated, the clearest modulatory effect of estrogen is on fear extinction processes. Examining the variability in neural responses and behavior in both sexes should increase our understanding of how that variability contributes to the neurobiology of affective disorders. This article is part of the Special Issue on 'Fear, anxiety and PTSD'.
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Affiliation(s)
- Elizabeth P Bauer
- Departments of Biology and Neuroscience & Behavior, Barnard College of Columbia University, 3009 Broadway, New York, NY, 10027, United States.
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7
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Merz CJ. How Different Factors in Combination Change Fear Extinction Learning: The Case of Sex and Stress Hormones. Curr Top Behav Neurosci 2023; 64:179-191. [PMID: 37455303 DOI: 10.1007/7854_2023_427] [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] [Indexed: 07/18/2023]
Abstract
Effects of a specific factor on fear extinction or exposure therapy have revealed promising results, for example how sex or stress hormones exert the capability to critically change extinction learning and consolidation processes. However, we must acknowledge that in real life these factors do not operate in isolation, they go hand in hand. In this chapter, the available evidence regarding interactions of sex and stress hormones on extinction processes and exposure therapy will be integrated and discussed. First hints exist that these factors in combination critically target extinction learning and consolidation processes, calling for more detailed research on the exact underlying mechanisms. In addition to experiments with high sample sizes, we must aim for a collaborative effort of laboratories across the whole world to be able to identify critical combinations of factors associated with improved, but also impaired extinction processes and exposure therapy success. We expect that the revelation of further relevant factors will not only be limited to the interplay between sex and stress hormones but will include factors such as sleep and exercise as well. In the long run, uncovering the most important interaction effects will give us critical hints for differential treatment options to be realized in the sense of a personalized medicine approach.
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Affiliation(s)
- Christian J Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany.
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8
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Schenker MT, Ince S, Ney LJ, Hsu CMK, Zuj DV, Jordan AS, Nicholas CL, Felmingham KL. Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity. Behav Res Ther 2022; 159:104222. [PMID: 36327524 DOI: 10.1016/j.brat.2022.104222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, and sleep disturbances are linked to many mental disorders including post-traumatic stress disorder (PTSD). Previous studies examining associations between sleep and fear or extinction processes primarily focused on objectively measured sleep architecture. Little research has so far focused on subjective sleep measures and particularly in clinical populations, which often experience subjectively poor sleep, including PTSD. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity (n = 248). Overall, we did not find that subjective sleep was associated with fear conditioning or extinction processes. However, exploratory analyses examining the moderating effect of sex found that shorter sleep onset latency and greater sleep efficiency were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective in highly symptomatic women against the commonly observed impaired extinction recall in PTSD. More studies are needed to explore sex-specific effects further.
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Affiliation(s)
- Maya T Schenker
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Sevil Ince
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Luke J Ney
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Chia-Ming K Hsu
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
| | - Daniel V Zuj
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia; School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
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9
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Graham BM. The impact of hormonal contraceptives on anxiety treatments: From preclinical models to clinical settings. Front Neuroendocrinol 2022; 67:101030. [PMID: 35995079 DOI: 10.1016/j.yfrne.2022.101030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/10/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022]
Abstract
Exposure therapy is a central component of the first-line treatment for anxiety disorders, a common mental health condition that is twice as prevalent in women relative to men. A key underlying mechanism of exposure therapy is fear extinction, which is an active learning process supported by a neural circuitry that is highly regulated by ovarian hormones. This review synthesises research examining the impact of hormonal contraceptives on laboratory fear extinction tasks in female rats and women, and on exposure therapy in women with anxiety disorders. The evidence indicates that hormonal contraceptives have a detrimental impact on fear extinction and exposure therapy that is consistent across species, and from laboratory to clinical settings. Candidate pathways by which hormonal contraceptives impede fear extinction and exposure therapy include suppression of endogenous ovarian hormones and glucocorticoids, and downregulation of signalling pathways that support extinction learning. Key areas of focus for future research are discussed.
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Affiliation(s)
- Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, Australia.
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10
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Tronson NC, Schuh KM. Hormonal contraceptives, stress, and the brain: The critical need for animal models. Front Neuroendocrinol 2022; 67:101035. [PMID: 36075276 DOI: 10.1016/j.yfrne.2022.101035] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/26/2022] [Accepted: 09/01/2022] [Indexed: 01/10/2023]
Abstract
Hormonal contraceptives are among the most important health and economic developments in the 20thCentury, providing unprecedented reproductive control and a range of health benefits including decreased premenstrual symptoms and protections against various cancers. Hormonal contraceptives modulate neural function and stress responsivity. These changes are usually innocuous or even beneficial, including their effects onmood. However, in approximately 4-10% of users, or up to 30 million people at any given time, hormonal contraceptives trigger depression or anxiety symptoms. How hormonal contraceptives contribute to these responses and who is at risk for adverse outcomes remain unknown. In this paper, we discussstudies of hormonal contraceptive use in humans and describe the ways in which laboratory animal models of contraceptive hormone exposure will be an essential tool for expanding findings to understand the precise mechanisms by which hormonal contraceptives influence the brain, stress responses, and depression risk.
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Affiliation(s)
- Natalie C Tronson
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Kristen M Schuh
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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11
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Bufo MR, Guidotti M, De Faria C, Mofid Y, Bonnet-Brilhault F, Wardak C, Aguillon-Hernandez N. Autonomic tone in children and adults: Pupillary, electrodermal and cardiac activity at rest. Int J Psychophysiol 2022; 180:68-78. [PMID: 35914548 DOI: 10.1016/j.ijpsycho.2022.07.009] [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: 03/14/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Considering the suspected involvement of the autonomic nervous system (ANS) in several neurodevelopmental disorders, a description of its tonus in typical populations and of its maturation between childhood and adulthood is necessary. We aimed to arrive at a better understanding of the maturation of the sympathetic (SNS) and parasympathetic (PNS) tonus by comparing children and adults at rest, via recordings of multiple ANS indices. We recorded simultaneously pupil diameter, electrodermal activity (EDA) and cardiac activity (RR interval and HRV: heart rate variability) in 29 children (6-12 years old) and 30 adults (20-42 years old) during a 5-min rest period. Children exhibited lower RR intervals, higher LF peak frequencies, and lower LF/HF (low frequency/high frequency) ratios compared to adults. Children also produced more spontaneous EDA peaks, reflected in a larger EDA AUC (area under the curve), in comparison with adults. Finally, children displayed a larger median pupil diameter and a higher pupillary hippus frequency than adults. Our results converged towards higher SNS and PNS tones in children compared to adults. Childhood would thus be characterized by a high autonomic tone, possibly reflecting a physiological state compatible with developmental acquisitions.
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Affiliation(s)
- Maria Rosa Bufo
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Marco Guidotti
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre universitaire de pédopsychiatrie, CHRU de Tours, Tours, France; Centre Hospitalier du Chinonais, Saint-Benoît-la-Forêt, France
| | - Cindie De Faria
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Yassine Mofid
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Frédérique Bonnet-Brilhault
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre universitaire de pédopsychiatrie, CHRU de Tours, Tours, France
| | - Claire Wardak
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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12
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Kredlow MA, de Voogd LD, Phelps EA. A Case for Translation From the Clinic to the Laboratory. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1120-1149. [PMID: 35245166 PMCID: PMC9271534 DOI: 10.1177/17456916211039852] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments for emotional disorders and identifying strategies to make treatments more effective. This research has often focused on translation from the laboratory to the clinic. Although this approach has notable successes, it has not been seamless. There are many examples of strategies that work in the laboratory that fail to lead to improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is a failure to focus on translation from the clinic to the laboratory. Here, we discuss potential benefits of translation from the clinic to the laboratory and provide examples of how this might be implemented. We first consider two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that are missing from these analogues, and propose variations to better capture the clinical process. Second, we discuss two clinical procedures that have more recently been brought into the laboratory (eye-movement desensitization and reprocessing and imagery rescripting). We conclude by highlighting potential implications of this proposed shift in focus for translational research.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychology, Tufts University
- Department of Psychology, Harvard University
| | - Lycia D de Voogd
- Donders Institute for Brain, Cognition, and Behavior, Radboud University and Radboud University Medical Center
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13
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Ney LJ, Laing PAF, Steward T, Zuj DV, Dymond S, Harrison B, Graham B, Felmingham KL. Methodological implications of sample size and extinction gradient on the robustness of fear conditioning across different analytic strategies. PLoS One 2022; 17:e0268814. [PMID: 35609058 PMCID: PMC9128987 DOI: 10.1371/journal.pone.0268814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Fear conditioning paradigms are critical to understanding anxiety-related disorders, but studies use an inconsistent array of methods to quantify the same underlying learning process. We previously demonstrated that selection of trials from different stages of experimental phases and inconsistent use of average compared to trial-by-trial analysis can deliver significantly divergent outcomes, regardless of whether the data is analysed with extinction as a single effect, as a learning process over the course of the experiment, or in relation to acquisition learning. Since small sample sizes are attributed as sources of poor replicability in psychological science, in this study we aimed to investigate if changes in sample size influences the divergences that occur when different kinds of fear conditioning analyses are used. We analysed a large data set of fear acquisition and extinction learning (N = 379), measured via skin conductance responses (SCRs), which was resampled with replacement to create a wide range of bootstrapped databases (N = 30, N = 60, N = 120, N = 180, N = 240, N = 360, N = 480, N = 600, N = 720, N = 840, N = 960, N = 1080, N = 1200, N = 1500, N = 1750, N = 2000) and tested whether use of different analyses continued to produce deviating outcomes. We found that sample size did not significantly influence the effects of inconsistent analytic strategy when no group-level effect was included but found strategy-dependent effects when group-level effects were simulated. These findings suggest that confounds incurred by inconsistent analyses remain stable in the face of sample size variation, but only under specific circumstances with overall robustness strongly hinging on the relationship between experimental design and choice of analyses. This supports the view that such variations reflect a more fundamental confound in psychological science-the measurement of a single process by multiple methods.
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Affiliation(s)
- Luke J. Ney
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Patrick A. F. Laing
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Trevor Steward
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Daniel V. Zuj
- School of Psychology, Swansea University, Wales, United Kingdom
| | - Simon Dymond
- School of Psychology, Swansea University, Wales, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Ben Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Bronwyn Graham
- School of Psychology, University of New South Wales, New South Wales, Australia
| | - Kim L. Felmingham
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
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Effects of circulating estradiol on physiological, behavioural, and subjective correlates of anxiety: A double-blind, randomized, placebo-controlled trial. Psychoneuroendocrinology 2022; 138:105682. [PMID: 35123210 DOI: 10.1016/j.psyneuen.2022.105682] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/17/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
Anxiety-related behaviours as well as the prevalence of anxiety disorders show a large sex difference in humans. Clinical studies in humans as well as behavioural studies in rodents suggest that estradiol may have anxiolytic properties. In line with this, anxiety symptoms fluctuate with estradiol levels along the menstrual cycle. However, the influence of estradiol on subjective, behavioural, as well as physiological correlates of anxiety has never been systematically addressed in humans. We ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of estradiol on anxiety in men and women. In healthy volunteers, circulating estradiol levels were elevated through estradiol administration over two consecutive days to simulate the rise in estradiol levels around ovulation. Subjective, behavioral, as well as, physiological correlates of anxiety were assessed using a virtual reality elevated plus-maze (EPM). Estradiol treatment reduced the physiological stress response with blunted heart rate response and lower cortisol levels compared to placebo treatment in both sexes. In contrast, respiration frequency was only reduced in women after estradiol treatment. Behavioural measures of anxiety as well as subjective anxiety on the EPM were not affected by estradiol treatment. In general, women showed more avoidance and less approach behavior and reported higher subjective anxiety levels on the EPM than men. These results highlight the limited anxiolytic properties of circulating levels of estradiol in humans, which influence physiological markers of anxiety but not approach and avoidance behaviour or subjective anxiety levels.
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15
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Kitamura H, Strodl E, Johnston P, Johnson LR. The influence of dispositional cognitive reappraisal and expressive suppression on post-retrieval and standard extinction. Psychophysiology 2022; 59:e14048. [PMID: 35324013 DOI: 10.1111/psyp.14048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Individual differences in the ability to habitually regulate emotion may impact the efficacy of fear memory extinction. The aim of this study was to assess the relationship between dispositional cognitive reappraisal and expressive suppression with post-retrieval and standard extinction. Fear memory and extinction were measured with the recovery of skin conductance responses. We also examined the relationship between a temporal feature of electrodermal responding (half-recovery time) and each of the emotion regulation strategies. University students (N = 80) underwent a three-day fear conditioning procedure using a within-subject design consisting of acquisition on day one, post-retrieval extinction and standard extinction on day two, and recovery test on day three. Individual difference data on self-reported levels of cognitive reappraisal, expressive suppression, trait anxiety, and depression were collected. We did not detect a relationship between the two emotion regulation strategies measured in this study and acquisition or extinction. We found, however, that increased dispositional use of cognitive reappraisal was associated with lower spontaneous recovery to both the post-retrieval extinction and standard extinction stimulus after controlling for age, trait anxiety, and depression. There were no associations between expressive suppression and conditioned responses. We also observed patterns of faster dissipation of arousal for reappraisal and slower for suppression to the conditioned stimulus during extinction training, which may represent the unique influence of each emotion strategy on the regulation of fear. We conclude greater daily use of cognitive reappraisal, but not expressive suppression, associates with extinction retention after receiving both standard and post-retrieval extinction.
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Affiliation(s)
- Haruka Kitamura
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Patrick Johnston
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Luke R Johnson
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia.,Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
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16
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Pestana JE, McCutcheon TB, Harmon-Jones SK, Richardson R, Graham BM. Maternal Experience Does Not Predict Fear Extinction and Anxiety-Like Behaviour in Primiparous Rats Post-weaning. Front Glob Womens Health 2022; 2:742337. [PMID: 34977862 PMCID: PMC8718406 DOI: 10.3389/fgwh.2021.742337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Reproductive experience leads to long-lasting changes in anxiety-like behaviour and fear extinction, the laboratory model of exposure therapy for anxiety disorders. For example, fear extinction is influenced by estrous cycle in nulliparous (no reproductive experience) female rats, but this effect is abolished in primiparous (one reproductive experience) females. It is unclear whether such changes are driven by pregnancy, maternal experience of caring for offspring during the postpartum period, or a combination of both experiences. The present study sought to determine the influence of maternal experience (i.e., exposure to pups and mother-pup interactions) on fear extinction in primiparous rats. In Experiment 1, we tested whether pup exposure is necessary to mitigate estrous effects on fear extinction in primiparous rats. Age-matched nulliparous rats, primiparous rats, and primiparous rats who experienced pregnancy but not pup exposure, underwent fear conditioning on day 1 (2 months post-parturition), extinction training during proestrus (high sex hormones) or metestrus (low sex hormones) on day 2, and extinction recall on day 3. Replicating past research, nulliparous rats showed impaired extinction recall when they were extinguished during metestrus compared to proestrus. In contrast, primiparous rats with and without pup exposure showed comparable extinction recall irrespective of estrous phase. In Experiment 2, we assessed whether naturally-occurring variation in mother-pup interactions predict future fear extinction performance and anxiety-like behaviour. During the first week of lactation, primiparous rats were measured for maternal behaviours toward pups. Primiparous rats were then tested on the light-dark box and elevated plus maze to measure anxiety-like behaviour and underwent a fear extinction protocol 1 month post-weaning. We found no significant correlations between maternal behaviour and fear extinction outcomes or anxiety-like behaviour. Our findings suggest that pregnancy, not maternal experience, mitigates the impact of estrous cycle on fear extinction. In addition, natural variation in maternal experience does not appear to contribute to variability in future fear extinction outcomes or anxiety-like behaviour in primiparous rats.
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Affiliation(s)
- Jodie E Pestana
- School of Psychology, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Tayla B McCutcheon
- School of Psychology, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Sylvia K Harmon-Jones
- School of Psychology, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rick Richardson
- School of Psychology, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Bronwyn M Graham
- School of Psychology, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
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17
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Using Translational Models of Fear Conditioning to Uncover Sex-Linked Factors Related to PTSD Risk. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220010. [PMID: 36506701 PMCID: PMC9731144 DOI: 10.20900/jpbs.20220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating neuropsychiatric disorder that follows exposure to a traumatic event; however, not every person who experiences trauma will develop PTSD. Women are more likely to be diagnosed with PTSD than men even when controlling for type and amount of trauma exposure. Circulating levels of gonadal hormones such as estradiol, progesterone, and testosterone may contribute to differential risk for developing PTSD. In this review, we briefly consider the influence of gonadal hormones on fear conditioning processes including fear acquisition, fear inhibition, extinction learning, and extinction recall within translational neuroscience models. We discuss findings from human studies incorporating samples from both community and traumatized clinical populations to further understand how these hormones might interact with exposure to trauma. Additionally, we propose that special attention should be paid to the specific measure used to examine fear conditioning processes as there is evidence that common psychophysiological indices such as skin conductance response and fear-potentiated startle can reveal quite different results and thus necessitate nuanced interpretations. Continued research to understand the influence of gonadal hormones in fear learning and extinction processes will provide further insight into the increased risk women have of developing PTSD and provide new targets for the treatment and prevention of this disorder.
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Hsu CMK, Ney LJ, Honan C, Felmingham KL. Gonadal steroid hormones and emotional memory consolidation: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 130:529-542. [PMID: 34517034 DOI: 10.1016/j.neubiorev.2021.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
Anxiety and stress-related disorders are more prevalent in women and associated with negative emotional memory consolidation as well as impaired fear extinction recall. Recent research has identified a role of gonadal steroid hormones in influencing emotional memories and fear extinction, however most individual studies have small samples and employed various protocols. A systematic review and meta-analysis were conducted on studies that examined sex hormones (estrogen, progesterone, testosterone, allopregnanolone, dehydroepiandrosterone) on four aspects of memory, namely, intentional recall (k = 13), recognition memory (k = 7), intrusive memories (k = 9), and extinction recall (k = 11). The meta-analysis on natural cycling women revealed that progesterone level was positively associated with negative recall and negative intrusive memories, and this effect on intentional recall was enhanced under stress induction. Estradiol level was positively associated with extinction recall. This study reveals an important role of progesterone and estradiol in influencing emotional memory consolidation. It highlights the need to control for these hormonal effects and examine progesterone and estradiol concurrently across all menstrual phases in future emotional memory paradigms.
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Affiliation(s)
- Chia-Ming K Hsu
- School of Psychological Sciences, University of Tasmania, Australia.
| | - Luke J Ney
- School of Psychological Sciences, University of Tasmania, Australia
| | - Cynthia Honan
- School of Psychological Sciences, University of Tasmania, Australia
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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Ney LJ, Laing PA, Steward T, Zuj DV, Dymond S, Felmingham KL. Inconsistent analytic strategies reduce robustness in fear extinction via skin conductance response. Psychophysiology 2020; 57:e13650. [DOI: 10.1111/psyp.13650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Luke John Ney
- School of Psychology University of Tasmania Hobart TAS Australia
| | - Patrick A.F. Laing
- Melbourne Neuropsychiatry Centre Department of Psychiatry University of Melbourne & Melbourne Health Carlton VIC Australia
| | - Trevor Steward
- School of Psychological Sciences University of Melbourne Carlton VIC Australia
| | - Daniel V. Zuj
- Department of Psychology Swansea University Swansea UK
| | - Simon Dymond
- Department of Psychology Swansea University Swansea UK
- Department of Psychology Reykjavik University Reykjavik Iceland
| | - Kim L. Felmingham
- School of Psychological Sciences University of Melbourne Carlton VIC Australia
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20
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Day HLL, Stevenson CW. The neurobiological basis of sex differences in learned fear and its inhibition. Eur J Neurosci 2020; 52:2466-2486. [PMID: 31631413 PMCID: PMC7496972 DOI: 10.1111/ejn.14602] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022]
Abstract
Learning that certain cues or environments predict threat enhances survival by promoting appropriate fear and the resulting defensive responses. Adapting to changing stimulus contingencies by learning that such cues no longer predict threat, or distinguishing between these threat-related and other innocuous stimuli, also enhances survival by limiting fear responding in an appropriate manner to conserve resources. Importantly, a failure to inhibit fear in response to harmless stimuli is a feature of certain anxiety and trauma-related disorders, which are also associated with dysfunction of the neural circuitry underlying learned fear and its inhibition. Interestingly, these disorders are up to twice as common in women, compared to men. Despite this striking sex difference in disease prevalence, the neurobiological factors involved remain poorly understood. This is due in part to the majority of relevant preclinical studies having neglected to include female subjects alongside males, which has greatly hindered progress in this field. However, more recent studies have begun to redress this imbalance and emerging evidence indicates that there are significant sex differences in the inhibition of learned fear and associated neural circuit function. This paper provides a narrative review on sex differences in learned fear and its inhibition through extinction and discrimination, along with the key gonadal hormone and brain mechanisms involved. Understanding the endocrine and neural basis of sex differences in learned fear inhibition may lead to novel insights on the neurobiological mechanisms underlying the enhanced vulnerability to develop anxiety-related disorders that are observed in women.
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Affiliation(s)
- Harriet L. L. Day
- School of BiosciencesUniversity of NottinghamLoughboroughUK
- Present address:
RenaSci LtdBioCity, Pennyfoot StreetNottinghamNG1 1GFUK
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21
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Li SH, Graham BM. Progesterone levels predict reductions in behavioral avoidance following cognitive restructuring in women with spider phobia. J Affect Disord 2020; 270:1-8. [PMID: 32275214 DOI: 10.1016/j.jad.2020.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ovarian hormones have been implicated as a potential source of variability in the effectiveness of exposure therapy for anxiety disorders in women. Additionally, preclinical studies in healthy women indicate that ovarian hormones are related to cognitive modes of emotion regulation, like cognitive restructuring. The purpose of the current study was to determine whether a relationship exists between endogenous ovarian hormones and the outcomes of cognitive restructuring in clinically anxious women. METHODS Ninety women with spider phobia received training in cognitive restructuring or a control task and provided a blood sample for the measurement of serum estradiol and progesterone levels. Behavioral avoidance, using a behavioral approach task with a live spider, and self-reported fear of spiders were measured at baseline and 1-week post-treatment. RESULTS The results indicated that heightened levels of progesterone, but not estradiol, at the time of cognitive restructuring predicted greater post-treatment reductions in behavioral avoidance, but not self-reported fear, amongst women who received cognitive restructuring but not those in the control group. LIMITATIONS As menstrual cycle phase was not assessed; the present study provides information regarding how the benefits of cognitive therapy are predicted by between-person individual differences in absolute hormone levels, but does not examine the relationship between within-person fluctuations in hormone levels and outcomes. CONCLUSIONS These results suggest the effectiveness of cognitive therapy for anxiety disorders in women may differ depending on endogenous levels of progesterone, and raise the possibility that progesterone could be a useful pharmacological adjunct to cognitive therapy.
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Affiliation(s)
- Sophie H Li
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia.
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia
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22
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Tang S, Graham BM. Hormonal, reproductive, and behavioural predictors of fear extinction recall in female rats. Horm Behav 2020; 121:104693. [PMID: 31981581 DOI: 10.1016/j.yhbeh.2020.104693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 01/09/2023]
Abstract
The prevalence, severity and chronicity of anxiety disorders is significantly higher in women compared to men. Exposure therapy, the gold-standard treatment for anxiety disorders, can be modelled in the laboratory through Pavlovian fear extinction. Understanding the factors that influence fear extinction in females may aid in optimising the treatment of anxiety disorders in this population. The aim of the current study was therefore to explore the hormonal, reproductive and behavioural predictors of fear extinction recall in female rats by analysing data from nine published experiments that examined fear extinction in female rats. A hierarchical multiple regression analysis revealed that estrous cycle effects on extinction recall may be modulated by reproductive status. While the estrous phase in which nulliparous (virgin) rats undergo extinction training was predictive of extinction recall, no relationship between estrous phase and extinction recall was found among primiparous (one prior reproductive experience) rats. Moreover, estrous cycle predicted the relationship between early extinction and extinction recall in nulliparous rats, but not primiparous rats. Although reproductive status did not predict extinction recall, primiparous rats exhibited poor extinction recall relative to nulliparous rats extinguished during proestrus, and better extinction recall than nulliparous rats extinguished during metestrus. A faster rate of extinction, and lower fear responses at the end of extinction training were predictive of lower levels of CS-elicited fear during extinction recall in both nulliparous and primiparous female rats, while the length of extinction training was not predictive of extinction recall. The potential theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Samantha Tang
- School of Psychology, UNSW Sydney, NSW 2052, Australia.
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23
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Estradiol Modulates Neural and Behavioral Arousal in Women With Posttraumatic Stress Disorder During a Fear Learning and Extinction Task. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:1114-1122. [PMID: 32563699 DOI: 10.1016/j.bpsc.2020.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/18/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fear responding in posttraumatic stress disorder (PTSD) is sexually heterogeneous and varies with hormonal fluctuations throughout the menstrual cycle. While research suggests that estrogen levels affect PTSD symptoms among women, there is a dearth of research on modulatory effects of estrogen on fear responding among women with PTSD, and neural outcome measures are lacking. METHODS A sample of 42 women with PTSD underwent 2 consecutive alternating blocks of fear conditioning and extinction training, during which a CS+ conditioned stimulus, but not a CS-, predicted the occurrence of an electric shock in an acquisition context but not in an extinction context. Assayed saliva determined estradiol levels. Skin conductance response and whole-brain voxelwise activity during functional magnetic resonance imaging were outcome variables in linear mixed-effects models, with estradiol level, PTSD severity, and task contrasts as predictors. RESULTS Skin conductance response exhibited a significant estradiol × PTSD severity × habituation interaction (t = 3.180, p = .002), such that PTSD severity was correlated with increased arousal responding between training blocks among women with lower estradiol (t = -3.985, p < .001) but not higher estradiol (t = 0.550, p = .583). Voxelwise activity also demonstrated an identical three-way interaction within dorsomedial prefrontal cortex and anterior insula clusters. The skin conductance response and imaging interactions between PTSD severity and estradiol were not specific to conditioned stimulus type or context. CONCLUSIONS Estradiol moderated the relationship between PTSD severity and arousal response habituation between fear conditioning and extinction training sessions, such that high estradiol protected against the negative impact of severe PTSD symptoms on fear habituation. These findings suggest that estrogen enhances habituation among women with severe PTSD, potentially influencing the efficacy of extinction-based therapies.
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Peyrot C, Brouillard A, Morand-Beaulieu S, Marin MF. A review on how stress modulates fear conditioning: Let's not forget the role of sex and sex hormones. Behav Res Ther 2020; 129:103615. [PMID: 32334278 DOI: 10.1016/j.brat.2020.103615] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
Stress and fear are two fields of research that have evolved simultaneously. It was not until the eighties that these domains converged in order to better characterize the impact of stress on fear memory formation. Here, we reviewed the effects of stress occurring before fear acquisition on the main phases of fear conditioning protocols (acquisition training, extinction training, extinction retention test), with a specific focus on sex and sex hormones. We also paid close attention to methodological aspects in order to better understand and characterize discrepant findings across studies. In men, stress appears to potentiate fear acquisition at a physiological level but induces lower activations of fear-related brain regions. In women, results are inconsistent. Although some studies have shown that stress lowers physiological fear responses and heightens brain activations in women during fear acquisition, many studies report no significant effects. Irrespective of sex, pre-acquisition stress seems to induce fear extinction learning resistance. Overall, few studies have taken into account sex hormones, despite their impact on both the fear and stress brain networks. As methodological variability makes it complex to draw strong conclusions, several methodological aspects are discussed with the aim of orienting future research.
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Affiliation(s)
- Clémence Peyrot
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychiatry and Addictology, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec, Canada, H3T 1J4.
| | - Alexandra Brouillard
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montreal, Quebec, Canada, H2X 2P3.
| | - Simon Morand-Beaulieu
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Neuroscience, Université de Montréal, 2960 de la Tour Rd, Montreal, Quebec, Canada, H3T 1J4; Currently with the Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT, 06519, USA.
| | - Marie-France Marin
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychiatry and Addictology, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec, Canada, H3T 1J4; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montreal, Quebec, Canada, H2X 2P3.
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The Effect of Age, Gender, and Job on Skin Conductance Response among Smartphone Users Who are Prohibited from Using Their Smartphone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072313. [PMID: 32235441 PMCID: PMC7177482 DOI: 10.3390/ijerph17072313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/17/2022]
Abstract
The smartphone is a widely used and rapidly growing phenomenon worldwide, and problematic smartphone use is common in our society. This study's objective was to examine the gender difference of baseline and post-intervention skin conductance response (SCR) among smartphone users and explore the relationships among problematic smartphone use level, anxiety level, and SCR changes by evaluating SCR, the Zung Self-Rating Anxiety Scale score, and the Chinese version of the Smartphone Addiction Inventory (SPAI) score in a one-group baseline and post-test design. Sixty participants were recruited from two communities, and data were collected from April to June 2017. There was a significant difference in terms of SCR changes between young males and old males and between young females and old females. Additionally, the SCR changes in young females were significantly greater than those in young males with twofold mean difference. This study provides strong evidence supporting the effectiveness of SCR measurement for assessing problematic smartphone use (PSU) anxiety when users are in a withdrawal-like state. The SCR measurement can help healthcare providers identify cases with risk factors of PSU for early intervention.
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The Role of Hormonal and Reproductive Status in the Treatment of Anxiety Disorders in Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32002944 DOI: 10.1007/978-981-32-9705-0_26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Exposure therapy, a key treatment for anxiety disorders, can be modelled in the laboratory using Pavlovian fear extinction. Understanding the hormonal and neurobiological mechanisms underlying fear extinction in females, who are twice more likely than males to present with anxiety disorders, may aid in optimising exposure therapy outcomes in this population. This chapter will begin by discussing the role of the sex hormones, estradiol and progesterone, in fear extinction in females. We will also propose potential mechanisms by which these hormones may modulate fear extinction. The second half of this chapter will discuss the long-term hormonal, neurological and behavioural changes that arise from pregnancy and motherhood and how these changes may alter the features of fear extinction in females. Finally, we will discuss implications of this research for the treatment of anxiety disorders in women with and without prior reproductive experience.
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An alternative theory for hormone effects on sex differences in PTSD: The role of heightened sex hormones during trauma. Psychoneuroendocrinology 2019; 109:104416. [PMID: 31472433 DOI: 10.1016/j.psyneuen.2019.104416] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 08/22/2019] [Indexed: 02/08/2023]
Abstract
Women are at least twice as susceptible to developing post-traumatic stress disorder (PTSD) compared to men. Although most research seeking to explain this discrepancy has focussed on the role of oestradiol during fear extinction learning, the role of progesterone has been overlooked, despite relatively consistent findings being reported concerning the role of progesterone during consolidation of emotional and intrusive memories. In this review article, we outline literature supporting the role of progesterone on memory formation, with particular emphasis on potential memory-enhancing properties of progesterone when subjects are placed under stress. It is possible that progesterone directly and indirectly exerts memory-enhancing effects at the time of trauma, which is an effect that may not be necessarily captured during non-stressful paradigms. We propose a model whereby progesterone's steroidogenic relationship to cortisol and brain-derived neurotrophic factor in combination with elevated oestradiol may enhance emotional memory consolidation during trauma and therefore present a specific vulnerability to PTSD formation in women, particularly during the mid-luteal phase of the menstrual cycle.
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Gogos A, Ney LJ, Seymour N, Van Rheenen TE, Felmingham KL. Sex differences in schizophrenia, bipolar disorder, and post-traumatic stress disorder: Are gonadal hormones the link? Br J Pharmacol 2019; 176:4119-4135. [PMID: 30658014 PMCID: PMC6877792 DOI: 10.1111/bph.14584] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/30/2022] Open
Abstract
In this review, we describe the sex differences in prevalence, onset, symptom profiles, and disease outcome that are evident in schizophrenia, bipolar disorder, and post-traumatic stress disorder. Women with schizophrenia tend to exhibit less disease impairment than men. By contrast, women with post-traumatic stress disorder are more affected than men. The most likely candidates to explain these sex differences are gonadal hormones. This review details the clinical evidence that oestradiol and progesterone are dysregulated in these psychiatric disorders. Notably, existing data on oestradiol, and to a lesser extent, progesterone, suggest that low levels of these hormones may increase the risk of disease development and worsen symptom severity. We argue that future studies require a more inclusive, considered analysis of gonadal steroid hormones and the intricacies of the interactions between them, with methodological rigour applied, to enhance our understanding of the roles of steroid hormones in psychiatric disorders. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
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Affiliation(s)
- Andrea Gogos
- Hormones in Psychiatry LaboratoryFlorey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Luke J. Ney
- School of Medicine (Psychology)University of TasmaniaSandy BayTasmaniaAustralia
| | - Natasha Seymour
- Hormones in Psychiatry LaboratoryFlorey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of PsychiatryUniversity of MelbourneParkvilleVictoriaAustralia
- Centre for Mental Health, School of Health Sciences, Faculty of Health, Arts and DesignSwinburne UniversityMelbourneVictoriaAustralia
| | - Kim L. Felmingham
- School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
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Impacts of sex and the estrous cycle on associations between post-fear conditioning sleep and fear memory recall. Behav Brain Res 2019; 378:112156. [PMID: 31593790 DOI: 10.1016/j.bbr.2019.112156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/17/2019] [Indexed: 01/18/2023]
Abstract
Women are at greater risk than men for developing posttraumatic stress disorder (PTSD) after trauma exposure. Sleep, especially rapid-eye-movement sleep (REMS), has been considered a contributing factor to the development of PTSD symptoms through its effects on the processing of emotional memories. However, it remains unknown if sex and sex hormones play a role in the hypothesized impact of sleep on the development of PTSD. Animal models have methodological advantages over human studies in investigating this research question; however, animal models of sleep in PTSD have been tested only with males. C57BL/6 mice (7 males and 15 females) were exposed to 15 footshocks in a footshock chamber, and 5 min after the last footshock, were returned to their home cages for telemetric electroencephalographic sleep recording. Nine to thirteen days later, mice were returned to the footshock chamber for 10 min without footshocks. Fear recall rates were computed by comparing freezing behaviors in the footshock chamber immediately after the footshocks to those during fear context reexposure. Males had significantly lower recall rates compared to metestrous females (that received footshocks on metestrus). Overall, males slept more than both proestrous females (that received footshocks on proestrus) and metestrous females during the dark period. Regression analyses revealed that average REMS episode durations after footshocks were differentially associated with recall rates across groups, such that the association was positive in males, but negative in proestrous females. Results suggest that both sex and the estrous cycle modulate the associations between REMS continuity and fear memory consolidation.
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Ravi M, Stevens JS, Michopoulos V. Neuroendocrine pathways underlying risk and resilience to PTSD in women. Front Neuroendocrinol 2019; 55:100790. [PMID: 31542288 PMCID: PMC6876844 DOI: 10.1016/j.yfrne.2019.100790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/26/2019] [Accepted: 09/18/2019] [Indexed: 01/23/2023]
Abstract
Women are twice as likely than men to suffer from posttraumatic stress disorder (PTSD). While women have increased exposure to traumatic events of many types and have greater prevalence of comorbid psychiatric disorders compared to men, these differences do not account for the overall sex difference in the prevalence of PTSD. The current review summarizes significant findings that implicate the role of estradiol, progesterone, and allopregnanolone in female risk for PTSD symptoms and dysregulation of fear psychophysiology that is cardinal to PTSD. We also discuss how these steroid hormones influence the stress axis and neural substrates critical for the regulation of fear responses. Understanding the role of ovarian steroid hormones in risk and resilience for trauma-related adverse mental health outcomes across the lifespan in women has important translational, clinical, and intergenerational implications for mitigating the consequences of trauma exposure.
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Affiliation(s)
- Meghna Ravi
- Emory University Graduate Program in Neuroscience, Atlanta, GA, United States
| | - Jennifer S Stevens
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States; Yerkes National Primate Research Center, Atlanta, GA, United States.
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Tang S, Graham BM. d-Cycloserine and estradiol enhance fear extinction in nulliparous but not primiparous female rats. Neurobiol Learn Mem 2019; 166:107088. [PMID: 31513850 DOI: 10.1016/j.nlm.2019.107088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 01/16/2023]
Abstract
Female reproductive experience has been shown to alter the hormonal, neurobiological and behavioural features of fear extinction, which is the laboratory basis of exposure therapy. This raises uncertainties as to whether pharmacological agents that enhance fear extinction in reproductively inexperienced females are equally effective in reproductively experienced females. The aim of the current study was therefore to compare the effects of two pharmacological enhancers of fear extinction, d-cycloserine (DCS) and estradiol, between nulliparous (virgin) and primiparous (reproductively experienced) female rats. In Experiment 1, nulliparous and primiparous females received systemic administration of either DCS or saline immediately after extinction training, and were tested for extinction recall the following day. DCS enhanced extinction recall in nulliparous females that showed low levels of freezing at the end of extinction training, but not among those that showed high levels of freezing at the end of extinction training. DCS did not enhance fear extinction in primiparous females, regardless of their level of freezing at the end of extinction training. In Experiment 2, nulliparous and primiparous female rats received systemic administration of either estradiol or vehicle prior to extinction training. Estradiol enhanced extinction recall among nulliparous females, but not primiparous females. Increasing the dose of estradiol administered prior to extinction training did not alter the outcomes in primiparous females (Experiment 3). Together, these findings suggest that reproductive status may be an important individual difference factor associated with the response to pharmacological modulators of extinction in rats. The implications of these findings for the pharmacological augmentation of exposure therapy in clinical populations are discussed.
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Affiliation(s)
- Samantha Tang
- School of Psychology, UNSW Sydney, NSW 2052, Australia.
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Wang W, Zhornitsky S, Le TM, Dhingra I, Zhang S, Krystal JH, Li CSR. Cue-elicited craving, thalamic activity, and physiological arousal in adult non-dependent drinkers. J Psychiatr Res 2019; 116:74-82. [PMID: 31202048 PMCID: PMC6606341 DOI: 10.1016/j.jpsychires.2019.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
Changes in physiological arousal frequently accompany cognitive and affective challenges. Many studies employed cue exposure paradigms to investigate the neural processes underlying cue-elicited drug and alcohol craving. However, whether cue-elicited craving relates to changes in physiological arousal and the neural bases underlying the potential relationship remain unclear. Here we examined cerebral cue-related activations in relation to differences in skin conductance responses (SCR) recorded during alcohol vs. neutral cue blocks in 61 non-dependent alcohol drinkers (30 men). Imaging and skin conductance data were collected and processed with published routines. Mediation analyses were conducted to examine the inter-relationship between regional activities, cue-elicited craving, and SCR. The results showed higher SCR during alcohol than during neutral cue exposure. Despite no differences in drinking characteristics, men as compared to women demonstrated higher craving rating, and men but not women demonstrated a positive correlation between alcohol (vs. neutral) cue-evoked craving and SCR. Further, across subjects, thalamic cue activity was positively correlated with differences in SCR between alcohol and neutral cue blocks in men but not in women. Mediation analyses suggested that thalamic activity mediated the correlation between craving and SCR across men and women, and in men but not women alone. These findings substantiate physiological and neural correlates of alcohol cue response and suggest important sex differences in the physiological and neural processes of cue evoked craving. Centered on the intralaminar and mediodorsal subregions, the thalamic correlate may represent a neural target for behavioral or pharmacological therapy to decrease cue-elicited arousal and craving.
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Affiliation(s)
- Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520
| | - Thang M. Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520
| | - Isha Dhingra
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520
| | - John H. Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520,Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520,Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520
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Lonsdorf TB, Merz CJ, Fullana MA. Fear Extinction Retention: Is It What We Think It Is? Biol Psychiatry 2019; 85:1074-1082. [PMID: 31005240 DOI: 10.1016/j.biopsych.2019.02.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 12/22/2022]
Abstract
There has been an explosion of research on fear extinction in humans in the past 2 decades. This has not only generated major insights, but also brought a new goal into focus: how to maintain extinction memory over time (i.e., extinction retention). We argue that there are still important conceptual and procedural challenges in human fear extinction research that hamper advancement in the field. We use extinction retention and the extinction retention index to exemplarily illustrate these challenges. Our systematic literature search identified 16 different operationalizations of the extinction retention index. Correlation coefficients among these different operationalizations as well as among measures of fear/anxiety show a wide range of variability in four independent datasets, with similar findings across datasets. Our results suggest that there is an urgent need for standardization in the field. We discuss the conceptual and empirical implications of these results and provide specific recommendations for future work.
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Affiliation(s)
- Tina B Lonsdorf
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian J Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany
| | - Miquel A Fullana
- Institute of Neurosciences, Hospital Clínic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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Tang S, Graham BM. Reproductive experience alters the involvement of N-methyl-D-aspartate receptors in fear extinction, but not fear conditioning, in female Sprague Dawley rats. Psychopharmacology (Berl) 2019; 236:251-264. [PMID: 29959460 DOI: 10.1007/s00213-018-4956-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/19/2018] [Indexed: 01/05/2023]
Abstract
Recently, evidence has emerged showing that the behavioural and hormonal features of fear extinction are altered as a result of reproductive experience in both rats and humans. The current set of experiments sought to determine whether reproductive experience also alters the molecular features of fear extinction. In adult male rats, it has been widely demonstrated that the activation of N-methyl-D-aspartate receptors (NMDAR) is essential for fear extinction. We therefore compared the involvement of NMDAR in fear extinction between nulliparous (virgin) and primiparous (reproductively experienced) female rats. Nulliparous and primiparous females received systemic administrations of either MK-801 (a non-competitive NMDAR antagonist) or saline prior to extinction training. MK-801 was found to impair extinction recall in nulliparous females, but not primiparous females. When the same dose of MK-801 was administered prior to conditioning, both groups of rats showed impaired recall of conditioning the following day. The results of these experiments indicate that the extinction, but not the acquisition of fear, may become NMDAR-independent following reproductive experience.
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Affiliation(s)
- Samantha Tang
- School of Psychology, UNSW, Sydney, NSW, 2052, Australia.
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35
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White EC, Graham BM. Low estradiol is linked to increased skin conductance, but not subjective anxiety or affect, in response to an impromptu speech task. Psychoneuroendocrinology 2018; 98:30-38. [PMID: 30092497 DOI: 10.1016/j.psyneuen.2018.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 01/04/2023]
Abstract
Low estradiol is associated with impaired extinction of conditioned physiological fear responses (e.g. skin conductance) in females. As fear extinction is the laboratory basis of exposure therapy for anxiety disorders, it has been speculated that estradiol may be related to the effectiveness of treatment for anxiety. The present study extended past research by examining whether estradiol is related to physiological and subjective fear responses during the impromptu speech task, where participants perform a surprise speech to camera. This task elicits psychosocial fear, and thus has relevance for social anxiety disorder (SAD). We used a quasi-experimental design with two groups of women: 39 naturally cycling women, and 19 women taking hormonal contraceptives. Based on the measured serum levels, naturally cycling women were further divided into women with higher- vs. lower estradiol levels. Compared to those with higher estradiol, women with lower estradiol, and those using hormonal contraceptives (chronically suppressed estradiol) displayed higher speech-elicited skin conductance yet reported no differences in subjective anxiety or affect. Conversely, irrespective of estradiol status, compared to those with low self-reported social anxiety, participants with higher social anxiety exhibited greater subjective anxiety and affect, yet no differences in skin conductance. These results demonstrate that the relationship between estradiol and physiological fear responses extends to psychosocial tasks. However, the dissociations between physiological and subjective measures highlight the need to consider the relevance of different response outputs so that the potential impact of estradiol on the treatment of anxiety disorders can be better understood.
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Affiliation(s)
- Emily C White
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Bronwyn M Graham
- School of Psychology, University of New South Wales, Sydney, Australia.
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36
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Estrogen, progesterone, and the menstrual cycle: A systematic review of fear learning, intrusive memories, and PTSD. Clin Psychol Rev 2018; 66:80-96. [DOI: 10.1016/j.cpr.2018.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 05/16/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022]
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37
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Modulation of the endocannabinoid system by sex hormones: Implications for posttraumatic stress disorder. Neurosci Biobehav Rev 2018; 94:302-320. [DOI: 10.1016/j.neubiorev.2018.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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38
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Merz CJ, Kinner VL, Wolf OT. Let's talk about sex … differences in human fear conditioning. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.01.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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39
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Graham BM, Shin G. Estradiol moderates the relationship between state-trait anxiety and attentional bias to threat in women. Psychoneuroendocrinology 2018; 93:82-89. [PMID: 29705576 DOI: 10.1016/j.psyneuen.2018.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/11/2018] [Accepted: 04/18/2018] [Indexed: 01/09/2023]
Abstract
Anxiety disorders are characterized by impaired fear extinction and heightened attentional allocation to threatening stimuli. The sex hormones estradiol and progesterone modulate fear extinction in female rats and women; whether these hormones are similarly related to attentional biases to threat has not been examined. In the present study 74 women (53 cycling, 21 using hormonal contraception), and a comparison group of 30 men, completed standard assessments of state-trait anxiety, as well symptoms of depression, anxiety and stress, followed by a computerized assessment of attentional bias, the dot-probe task. Women's endogenous estradiol and progesterone levels were ascertained by a blood sample. No differences in attentional bias were found dependent on sex or hormonal contraceptive use. Estradiol was the only variable measured that was independently positively correlated with attentional bias to threat. Regression analyses revealed a bi-directional relationship between state-trait anxiety, symptoms of anxiety and stress, and attentional bias that was moderated by estradiol, such that a positive relationship was observed amongst women with higher estradiol, and a negative relationship was observed amongst women with lower estradiol. Together, these results indicate that under conditions of anxiety and stress, women may attend to threat differently depending on endogenous estradiol levels, being avoidant when estradiol is lower, and vigilant when estradiol is higher. A more nuanced understanding of the role for attention in anxiety disorders amongst women may be developed by taking hormonal status into consideration.
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Affiliation(s)
- Bronwyn M Graham
- School of Psychology, University of New South Wales, Sydney, Australia.
| | - Geena Shin
- School of Psychology, University of New South Wales, Sydney, Australia
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40
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The association between estradiol levels, hormonal contraceptive use, and responsiveness to one-session-treatment for spider phobia in women. Psychoneuroendocrinology 2018; 90:134-140. [PMID: 29482136 DOI: 10.1016/j.psyneuen.2018.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/14/2018] [Accepted: 02/19/2018] [Indexed: 01/18/2023]
Abstract
Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one-session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treatment, greater behavioral avoidance at post-treatment and follow-up, and fewer self-initiated post-treatment exposure tasks, relative to both groups of cycling women, who did not differ. No group differences in self-reported fear were evident. Correlational analyses revealed that across the whole sample, lower estradiol levels were associated with slower rates of improvement across treatment, and greater self-reported fear and behavioral avoidance at post-treatment, but not follow-up. These results provide the first evidence of an association between endogenous estradiol, hormonal contraceptive use, and exposure therapy outcomes in spider phobic women. Hormonal profile may partly account for variability in responsiveness to psychological treatments for anxiety and trauma disorders in women.
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Miedl SF, Wegerer M, Kerschbaum H, Blechert J, Wilhelm FH. Neural activity during traumatic film viewing is linked to endogenous estradiol and hormonal contraception. Psychoneuroendocrinology 2018; 87:20-26. [PMID: 29032323 DOI: 10.1016/j.psyneuen.2017.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 11/18/2022]
Abstract
Women are at higher risk for Posttraumatic Stress Disorder (PTSD) and recent research has highlighted a modulating role of female sex hormones for cognitive and emotional processes potentially underlying PTSD symptoms. However, studies combining fMRI recordings of brain activity during trauma film viewing with assessment of female sex hormones are missing. The trauma film paradigm - a widely used experimental analogue for trauma exposure - confronts healthy participants with traumatic film clips and thus allows studying peritraumatic processing under laboratory conditions. Following this paradigm, the current fMRI study examined the role of endogenous estradiol and synthetic sex hormones for the neural processing of traumatic (i.e., depicting interpersonal violence) vs. neutral films in 53 healthy women (mean age 22.3 years; 23 using hormonal contraception, HC). As predicted, traumatic films strongly activated areas of the fear processing network, such as amygdala, insula, and dorsal anterior cingulate cortex. Estradiol levels in women not using HC were positively correlated with ventromedial prefrontal activity. Furthermore, women using HC as compared to women without HC demonstrated heightened insula and dorsal anterior cingulate cortex activity during traumatic film viewing. These experimental results highlight the effects of both gonadal hormone status and HC intake on peritraumatic processing in neural regions relevant for emotion generation and regulation that have been found to be abnormal in PTSD.
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Affiliation(s)
- Stephan F Miedl
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, & Clinical Stress and Emotion Lab, University of Salzburg, Austria.
| | - Melanie Wegerer
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, & Clinical Stress and Emotion Lab, University of Salzburg, Austria; University Clinic of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | | | - Jens Blechert
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, & Clinical Stress and Emotion Lab, University of Salzburg, Austria; Centre for Cognitive Neuroscience, University of Salzburg, Austria
| | - Frank H Wilhelm
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, & Clinical Stress and Emotion Lab, University of Salzburg, Austria
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42
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Graham BM, Scott E. Effects of systemic estradiol on fear extinction in female rats are dependent on interactions between dose, estrous phase, and endogenous estradiol levels. Horm Behav 2018; 97:67-74. [PMID: 29079442 DOI: 10.1016/j.yhbeh.2017.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022]
Abstract
Administering estradiol to females during periods of low endogenous estradiol enhances their ability to extinguish fear, the laboratory basis of exposure therapy for anxiety disorders. It has therefore been proposed that estradiol could be a useful adjunct to enhance exposure therapy outcomes. The present study aimed to clarify the boundary conditions under which estradiol could be used for this purpose, by assessing whether the impact of estradiol, administered systemically prior to extinction training, differs depending on dose and estrous phase in adult female rats. Results demonstrated that in rats extinguished during metestrus (naturally low estradiol), a low dose of estradiol reduced freezing during extinction training and augmented extinction recall the following day, whereas a high dose of estradiol had no effect on either extinction training or recall. In rats extinguished during proestrus (naturally high estradiol), a high dose of estradiol impaired extinction recall, whereas a low dose of estradiol had no effect, or impairing effects, on extinction recall in different experiments. A subsequent analysis revealed that estradiol-treated proestrus rats that exhibited impaired extinction recall had significantly higher pre-treatment serum estradiol levels than those that exhibited good extinction recall. Together, these results indicate that systemically administered estradiol interacts with endogenous estradiol to produce an inverted U shaped dose effect on fear extinction, where low and high estradiol levels lead to poor extinction recall, and moderate estradiol levels lead to good extinction recall. These results highlight potential limitations to the use of estradiol as an adjunct to exposure therapy in clinical settings.
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Affiliation(s)
- Bronwyn M Graham
- School of Psychology, University of New South Wales, Sydney, Australia.
| | - Elliot Scott
- School of Psychology, University of New South Wales, Sydney, Australia
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43
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Abstract
PURPOSE OF REVIEW This review examines the recent literature on biological factors that influence sex differences in posttraumatic stress disorder (PTSD) during childhood and adolescence, focusing on neurobiological, hormonal, and genetic factors that may increase risk in girls. RECENT FINDINGS More than 60% of children and adolescents are exposed to traumatic events, and many develop PTSD. There is increasing recognition of gender differences in PTSD, with women having double the rates of the disorder compared to men. These gender differences in symptoms and their underlying neurobiology appear to emerge during adolescence, although it is still unclear which biological mechanisms may play key roles in the development of sex difference. The literature on gender effects in children and adolescents is still in the early stages, and more prospective and longitudinal work is needed; however, estrogen appears to play a key role in increasing risk for PTSD in girls, which emerges in adolescence.
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Affiliation(s)
- Kristie Garza
- Neuroscience Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Neuroscience Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr Dr NE, Suite 331, Atlanta, GA, 30303, USA.
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More than just noise: Inter-individual differences in fear acquisition, extinction and return of fear in humans - Biological, experiential, temperamental factors, and methodological pitfalls. Neurosci Biobehav Rev 2017; 80:703-728. [DOI: 10.1016/j.neubiorev.2017.07.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/12/2017] [Accepted: 07/20/2017] [Indexed: 01/07/2023]
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High endogenous estradiol is associated with enhanced cognitive emotion regulation of physiological conditioned fear responses in women. Psychoneuroendocrinology 2017; 80:7-14. [PMID: 28292685 DOI: 10.1016/j.psyneuen.2017.02.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 01/30/2023]
Abstract
The sex hormone estradiol has a modifying role in the underlying neurobiology of cognitive emotion regulation, although whether estradiol is associated with outcomes of techniques like cognitive restructuring is unknown. In the present study 34 women with regular menstrual cycles participated in a one-day differential fear conditioning procedure. Women then received cognitive restructuring training, involving the reappraisal of their initial thoughts about the conditioning procedure to reduce their emotional responses, before repeating the conditioning procedure. Endogenous estradiol levels (ascertained by a blood sample) were not associated with subjective or physiological indices of conditioned fear during the first conditioning session. Following cognitive restructuring, however, women with high estradiol exhibited significantly reduced physiological arousal in the presence of the conditioned stimulus, relative to women with low estradiol. No group differences were observed in subjective fear ratings obtained after the second conditioning procedure, although those obtained during the second habitation phase (taking place immediately following cognitive restructuring) were lower amongst high estradiol women. Progesterone was not associated with any outcomes measures. Together, these results suggest that the outcomes of cognitive emotion regulation may be enhanced during periods of naturally high estradiol.
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