Fear-relevant selective associations and covariation bias

Uncertainty cues amplify late positive potential responses to aversive emotional stimuli

Uncertainty is unavoidable, and maladaptive responses to uncertainty may underlie the etiology and maintenance of psychopathology. A general tendency to associate uncertainty with aversive consequences, a type of covariation bias, can amplify aversive emotional experiences. To address questions about uncertainty during emotion regulation, we examined the Late Positive Potential (LPP) - an electrocortical marker of attention to and appraisal of motivationally relevant emotional stimuli - during a task designed to measure the effect of covariation bias and its emotional response consequences. Event-related potentials (ERPs) were recorded while participants (N = 52) were presented with a pre-stimulus cue that either conveyed information about the valence of an upcoming emotional image, or left them in ambiguity. We replicated findings that demonstrate expectancy biases in a priori and online expectancies of emotion-eliciting images, as well as in a posteriori estimates for concurrence of uncertainty cues and aversive images. Moreover, we demonstrate a novel finding that uncertainty cues amplify the LPP in response to subsequent aversive emotional stimuli. These findings advance research by conjoining existing emotion regulation research on the LPP with study of the effects of uncertainty on emotional appraisal and highlight the importance of accounting for stimulus uncertainty in emotion regulation research.

Predictors of fear control related to COVID-19 among older population: an investigation on COVID-19 risk perception and health related quality of life during the pandemic

BACKGROUND

The aim of this study was to examine the role of demographic characteristics, general health and health related quality of life on the fear control. Also, the aim of study was to explore how older people percept the COVID-19 pandemic by using the component of the expanded parallel process model (EPPM), and how the possible perception may contribute to probable behavior responses to prevention and control of COVID-19.

METHODS

The present study is a cross-sectional study that was conducted in Tabriz, a city in north of Iran from February to April 2021, the period that correspond with the fourth wave of COVID-19. To collect information, the Covid-19 risk perception questionnaire (based on EPPM model including efficacy, defensive responses, and perceived threat) and health related quality of life (HQOL) Short Form-36 questionnaire were used. Discriminate value was calculated to estimate fear control and danger control. Univariate and multivariable logistic regression were calculated to examine the effect of demographic characteristics, general health and health-related quality of life on the fear control.

RESULTS

The mean age of the 350 participants was 67.9 (6.4) years. A total of 83.1% of participants were engaged in danger control processes and 16.9% in fear control processes. According to the multivariable results, significant predictors for fear control were: gender 1.57 (95% CI 1.05-2.34, 0.025), education 7.38 (1.42-38.35, p = 0.017), economic status 1.31 (0.4-0.63, p = 0.029), and significant protective factors for fear control were: body pain 0.97 (0.94-0.99, p = 0.041), general health 0.96 (0.93-0.98, p = 0.032), physical health 0.94 (0.90-0.98) and total quality of life 0.024 (0.89-0.98).

CONCLUSIONS

Strong associations of fear control were found with being female, being illiterate, and having a good economic status and also body pain, general health, physical health and total HQOL were significantly associated with danger control. Since, most of elderly populations have adequately higher perceptions of efficacy to counteract their threat perceptions to continue motivating these older people to engage in COVID-19 self-protective behaviors, it is necessary to emphasis on the susceptibility of target population and the severity of the COVID-19 threats.

Associations Between Fear of COVID-19, Affective Symptoms and Risk Perception Among Community-Dwelling Older Adults During a COVID-19 Lockdown

Fear is a common and potentially distressful psychological response to the current COVID-19 pandemic. The factors associated with such fear remains relatively unstudied among older adults. We investigated if fear of COVID-19 could be associated with a combination of psychological factors such as anxiety and depressive symptoms, and risk perception of COVID-19, and demographic factors in a community sample of older adults. Older adults (N = 413, M age = 69.09 years, SD = 5.45) completed measures of fear of COVID-19, anxiety and depressive symptoms, and risk perception of COVID-19, during a COVID-19 lockdown. These variables, together with demographics, were fitted to a structural equation model. Anxiety and depressive symptoms were highly correlated with each other and were combined into the higher order latent variable of affective symptoms for analyses. The final model revealed that fear of COVID-19 was positively associated with psychological factors of affective symptoms and risk perception. Older age was associated with greater fear of COVID-19. Our findings showed that fear of COVID-19 can be a projection of pre-existing affective symptoms and inflated risk perceptions and highlighted the need to address the incorrect risk perceptions of COVID-19 and socio-affective issues among older adults in the community.

Neural Pattern Similarity Unveils the Integration of Social Information and Aversive Learning

Attributing intentions to others' actions is important for learning to avoid their potentially harmful consequences. Here, we used functional magnetic resonance imaging multivariate pattern analysis to investigate how the brain integrates information about others' intentions with the aversive outcome of their actions. In an interactive aversive learning task, participants (n = 33) were scanned while watching two alleged coparticipants (confederates)-one making choices intentionally and the other unintentionally-leading to aversive (a mild shock) or safe (no shock) outcomes to the participant. We assessed the trial-by-trial changes in participants' neural activation patterns related to observing the coparticipants and experiencing the outcome of their choices. Participants reported a higher number of shocks, more discomfort, and more anger to shocks given by the intentional player. Intentionality enhanced responses to aversive actions in the insula, anterior cingulate cortex, inferior frontal gyrus, dorsal medial prefrontal cortex, and the anterior superior temporal sulcus. Our findings indicate that neural pattern similarities index the integration of social and threat information across the cortex.

Cue Valence Influences the Effects of Cue Uncertainty on ERP Responses to Emotional Events

Individuals often predict consequences, particularly emotional consequences, according to emotional or non-emotional signals conveyed by environmental cues (i.e., emotional and non-emotional cues, respectively). Some of these cues signify the consequences with certainty (i.e., certain cues), whereas others do not (i.e., uncertain cues). Several event-related potential (ERP) studies regarding non-emotional cues have suggested that the effects of cue uncertainty on attention to emotional events occur in both perception and evaluation processes. However, due to the limitations of previous studies, it is unclear what the effects of cue uncertainty would be in an emotional cue condition. Moreover, it is uncertain whether the effects of cue uncertainty are affected by cue valence (i.e., emotional and non-emotional cues). To address these questions, we asked participants to view cues and then to view emotional (positive or negative) pictures. The cues either did or did not indicate the emotional content of the picture. In the emotional cue condition, happy and fearful faces were used as certain cues indicating upcoming positive and negative pictures, respectively, and neutral faces were used as uncertain cues. In the non-emotional cue condition, scrambled faces outlined in red and blue indicated upcoming positive and negative pictures, respectively, and scrambled faces outlined in green served as uncertain cues. The results showed that for negative pictures, ERP responses in a time range between 60 and 1,000 ms were shifted to a more negative direction in a certain condition than in the uncertain condition when the cues were emotional. However, the effect was the reverse for positive pictures. This effect of cue uncertainty was similar in the non-emotional cue—negative condition. In contrast, there was no effect of cue uncertainty in the non-emotional cue—positive condition. Therefore, the findings indicate that cue uncertainty modulates attention toward emotional events when the events are signified by emotional cues. The findings may also suggest that cue valence modulates the effects of cue uncertainty on attention to emotional events.

Acute stress reduces out-group related safety signaling during fear reinstatement in women

When using in-group and out-group faces as conditional stimuli (CS) in fear conditioning designs, extinction learning is selectively impaired for out-group faces. Additionally, stress seems to inhibit extinction retrieval leading to a higher return of fear, which might be especially the case for out-group faces. To test this hypothesis, 51 healthy women underwent fear acquisition training, consisting of repeated presentations of two in-group and two out-group faces. One of each (CS+) was paired with an electrical stimulation (unconditional stimulus, UCS), whereas the other was not coupled with the UCS (CS-). During immediate extinction training, all CS were presented again. On the next day, a retrieval and reinstatement test took place after a stress or a control procedure. Confirming previous research, impaired extinction learning occurred for out-group relative to in-group faces. During the reinstatement test, stress specifically increased responding towards the out-group CS-, thus reducing its safety signaling properties. So, stress seems to reduce the ability to adequately distinguish threat and safety cues after aversive experiences mimicked by reinstatement shocks.

Covariation bias in depression - a predictor of treatment response?

Covariation bias, defined as an overestimation of the relationship between fear-relevant stimuli and aversive consequences, is a well-investigated cognitive bias in anxiety disorders. As patients with affective disorders also show biased information processing, the aim of the present study was to investigate whether depressed patients also display a covariation bias between negative stimuli and aversive consequences. Covariation estimates of 62 inpatients with a current severe depressive episode were assessed at admission (n = 31) or after 6 weeks of treatment (n = 31) and were compared in a between-group design with 31 age- and sex-matched healthy controls. All participants showed a covariation bias for the relationship between negative stimuli and aversive consequences. Moreover, covariation bias at admission was significantly associated with various clinician- and self-reported dimensional measures of treatment response assessed 6 weeks later (Global Assessment of Functioning, Clinical Global Impression Scale, and Beck Depression Inventory), i.e., patients with a stronger bias showed greater impairment after 6 weeks of treatment. Categorical analyses revealed that overall, treatment non-responders-but not responders-were characterized by a covariation bias. The naturalistic study design without standardized pharmacological and psychotherapeutic treatments is a central limitation. We conclude that the covariation bias may constitute a possible marker in the field of emotional information processing in the search for effective predictors of therapy outcome.

What's the Risk? Fearful Individuals Generally Overestimate Negative Outcomes and They Dread Outcomes of Specific Events

Although it is an adaptive mechanism that danger usually elicits fear, it seems that fearful individuals overestimate the danger associated with their feared objects or situations. Previous research has not systematically distinguished between the estimated risk of an encounter with fear-relevant stimuli and the expected unpleasant outcomes of such encounters. Furthermore, it is not clear if biased risk perception is specific to an individual's fear or generalized to all negative events. In an online-survey (N = 630) we assessed the estimated risk to encounter fear-relevant stimuli and the expectations of negative outcomes of such encounters. Items contained three domains (spiders, snakes, and everyday fear triggers). In regression analyses we examined the specific associations between fear and risk estimations. In addition, we compared subgroups with specific fears and low fearful individuals. While an individual's fear score was not related to the estimated risk of an encounter with fear-specific stimuli, it was related to an overestimation of negative outcomes in all domains. The perceived risk of aversive outcomes was most pronounced for an individual's specific fear. Furthermore, an individual's specific fear was most predictive of the estimated risk of a negative fear-relevant outcome. Highly fearful individuals overestimate the risk of negative outcomes of fear-relevant encounters. Specifically, they dread outcomes of encounters with their feared object. Differentiating fear-relevant components of risk perception provides insights into the cognitions which may motivate maladaptive avoidance behavior.

Anticipation of Uncertain Threat Modulates Subsequent Affective Responses and Covariation Bias

Uncertainty contributes to stress and anxiety-like behaviors by impairing the ability of participants to objectively estimate threat. Our study used the cue-picture paradigm in conjunction with the event-related potential (ERP) technique to explore the temporal dynamics of anticipation for and response to uncertain threat in healthy individuals. This task used two types of cue. While ‘certain’ cues precisely forecasted the valence of the subsequent pictures (negative or neutral), the valence of pictures following ‘uncertain’ cues was not predictable. ERP data showed that, during anticipation, uncertain cues elicited similar Stimulus-Preceding Negativity (SPN) to certain-negative cues, while both of them elicited larger SPN than certain-neutral cues. During affective processing, uncertainty enlarged the mean amplitude of late positive potential (LPP) for both negative and neutral pictures. Behavioral data showed that participants reported more negative mood ratings of uncertain-neutral pictures relative to certain-neutral pictures and overestimated the probability of negative pictures following uncertain cues. Importantly, the enlarged anticipatory activity evoked by uncertain cues relative to that evoked by certain-neutral cues positively modulated the more negative mood ratings of uncertain-neutral pictures relative to certain-neutral pictures. Further, this more negative mood ratings and the general arousal anticipation during anticipatory stage contributed to the covariation bias. These results can provide a novel insight into understanding the neural mechanism and pathological basis of anxiety.

Cognitive mechanisms of disgust in the development and maintenance of psychopathology: A qualitative review and synthesis

A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many disorders is robust, the mechanisms that may explain this role are unclear. Cutting-edge research in cognitive science has the potential to elucidate such mechanisms and consequently improve our understanding of how disgust contributes to the etiology and maintenance of psychopathology. In this qualitative review, we systematically assess cognitive bias mechanisms that have been linked to disgust and its disorders. This review suggests that disgust-related biases may be observed in memory, interpretation, judgment of expectancies, and attention, as well as at implicit levels. Of these cognitive domains, the most robust bias appears to be observed at the level of attention. However, reliable moderators of attentional biases for disgust have not yet been identified, and this bias has not been systematically linked to other levels of analysis. Despite these limitations, the available research indicates that attentional avoidance rather than orienting or maintenance may be the most characteristic of disgust. Attentional avoidance of disgust may have important implications for etiological and treatment models of disorders characterized by excessive disgust reactions. The implications for advancing such models are discussed in the context of a combined cognitive bias hypothesis.

Cognitive Biases and the Emotional Disorders

Four types of cognitive bias involving selective processing of emotion-relevant information are discussed vis-à-vis their relevance for understanding emotion-cognition interactions and for understanding the etiology and maintenance of the emotional disorders. Anxiety, but not depression, appears to be associated with an attentional bias for threatening material. Depression, but not anxiety, appears to be associated with a memory bias for negative mood-congruent material. Phobias, anxiety, and depression all appear to be associated with mood-congruent judgmental biases. Finally, selective associations in fear conditioning are a form of associative bias implicated in the origins of fears and phobias.

The Paranoid Optimist: An Integrative Evolutionary Model of Cognitive Biases

Human cognition is often biased, from judgments of the time of impact of approaching objects all the way through to estimations of social outcomes in the future. We propose these effects and a host of others may all be understood from an evolutionary psychological perspective. In this article, we elaborate error management theory (EMT; Haselton & Buss, 2000). EMT predicts that if judgments are made under uncertainty, and the costs of false positive and false negative errors have been asymmetric over evolutionary history, selection should have favored a bias toward making the least costly error. This perspective integrates a diverse array of effects under a single explanatory umbrella, and it yields new content-specific predictions.

How fear-relevant illusory correlations might develop and persist in anxiety disorders: A model of contributing factors

Fear-relevant illusory correlations (ICs) are defined as the overestimation of the relationship between a fear-relevant stimulus and aversive consequences. ICs reflect biased cognitions affecting the learning and unlearning of fear in anxiety disorders, and a deeper understanding might help to improve treatment. A model for the maintenance of ICs is proposed that highlights the importance of amplified aversiveness and salience of fear-relevant outcomes, impaired executive contingency monitoring and an availability heuristic. The model explains why ICs are enhanced in high fearful individuals and allows for some implications that might be applied to augment the effectiveness of cognitive behavior therapy, such as emotion regulation and the direction of attention to non-aversive experiences. Finally, we suggest possible future research directions and an alternative measure of ICs.

Threat expectancy bias and treatment outcome in patients with panic disorder and agoraphobia

BACKGROUND AND OBJECTIVES

Previous studies suggest that patients with panic disorder and agoraphobia (PD/A) tend to overestimate the associations between fear-relevant stimuli and threat. This so-called threat expectancy bias is thought to play a role in the development and treatment of anxiety disorders. The current study tested 1) whether patients with PD/A (N = 71) show increased threat expectancy ratings to fear-relevant and fear-irrelevant stimuli relative to a comparison group without an axis I disorder (N=65), and 2) whether threat expectancy bias before treatment predicts treatment outcome in a subset of these patients (n = 51).

METHODS

In a computerized task, participants saw a series of panic-related and neutral words and rated for each word the likelihood that it would be followed by a loud, aversive sound.

RESULTS

Results showed higher threat expectancy ratings to both panic-related and neutral words in patients with PD/A compared to the comparison group. Threat expectancy ratings did not predict treatment outcome.

LIMITATIONS

This study only used expectancy ratings and did not include physiological measures. Furthermore, no post-treatment expectancy bias task was added to shed further light on the possibility that expectancy bias might be attenuated by treatment.

CONCLUSIONS

Patients show higher expectancies of aversive outcome following both fear-relevant and fear-irrelevant stimuli relative to the comparison group, but this does not predict treatment outcome.

The Legacy of Seligman's "Phobias and Preparedness" (1971)

Seligman's (1971) classic article, "Phobias and Preparedness," marked a break from traditional conditioning theories of the etiology of phobias, inspiring a line of research integrating evolutionary theory with learning theory. In this article, I briefly sketch the context motivating the preparedness theory of phobias before summarizing the initial wave of laboratory conditioning experiments pioneered by Öhman and conducted by his team and by others to test predictions derived from Seligman's theory. Finally, I review the legacy of Seligman's article, including theoretical developments embodied in Öhman and Mineka's fear module approach as well as alternatives for explaining "preparedness" phenomena, including the selective sensitization, expectancy, and nonassociative theories. Although Seligman himself soon moved on to other topics, his seminal article in Behavior Therapy continues to inspire research more than four decades later that has deepened our understanding of the etiology of phobias.

Fear-relevant illusory correlations in different fears and anxiety disorders: A review of the literature

Fearful individuals often overestimate the relationship between fear-relevant stimuli and aversive consequences. Such fear-relevant illusory correlations (ICs) might be involved in the maintenance of anxiety disorders. In this literature review, we found clear evidence that ICs are present and enhanced in fear of animals. We also revealed some evidence for ICs related to fear of flying, social anxiety, contamination fear, panic disorder, and post-traumatic stress disorder, but with considerably less clarity. Fear-relevant ICs seem to be best explained by both a priori expectancies and biased encoding of the experienced associations. Studies to date suggest that one important biased encoding process is the enhanced aversiveness/salience of fear-relevant outcomes. Future studies may improve insight by developing more reliable IC measures and testing the effect of encoding processes on treatment outcomes.

Processes Contributing to the Maintenance of Flying Phobia: A Narrative Review

Flying phobia is a highly prevalent anxiety disorder, which causes sufferers significant distress and life interference. The processes which maintain flying phobia remain poorly understood. A systematic search of the literature was performed to identify what research has been conducted into the processes which may be involved in the fear of flying and whether processes which are believed to maintain other anxiety disorder diagnoses have been investigated in flying phobia. The results of the literature review are presented and related to existing cognitive behavioral theory and research. The results indicate that little research has been conducted into a number of areas considered important in the wider cognitive behavioral literature on anxiety disorders: namely attention, mental imagery, memory, worry, and safety-seeking behaviors. The review proposes a hypothetical model, derived from cognitive behavioral theory, for the processes which may be involved in maintaining flying phobia, and considers a number of areas for future research.

Racial stereotypes impair flexibility of emotional learning

Flexibility of associative learning can be revealed by establishing and then reversing cue-outcome discriminations. Here, we used functional MRI to examine whether neurobehavioral correlates of reversal-learning are impaired in White and Asian volunteers when initial learning involves fear-conditioning to a racial out-group. For one group, the picture of a Black male was initially paired with shock (threat) and a White male was unpaired (safe). For another group, the White male was a threat and the Black male was safe. These associations reversed midway through the task. Both groups initially discriminated threat from safety, as expressed through skin conductance responses (SCR) and activity in the insula, thalamus, midbrain and striatum. After reversal, the group initially conditioned to a Black male exhibited impaired reversal of SCRs to the new threat stimulus (White male), and impaired reversals in the striatum, anterior cingulate cortex, midbrain and thalamus. In contrast, the group initially conditioned to a White male showed successful reversal of SCRs and successful reversal in these brain regions toward the new threat. These findings provide new evidence that an aversive experience with a racial out-group member impairs the ability to flexibly and appropriately adjust fear expression towards a new threat in the environment.

Neural correlates of individual differences in anxiety sensitivity: an fMRI study using semantic priming

Individuals with high anxiety sensitivity (AS) have an increased risk of developing anxiety disorders and are more biased in how they process fear-related stimuli. This study investigates the neural correlates of fear-related words and word associations in high- and low-AS individuals. We used a semantic priming paradigm during functional magnetic resonance imaging in which three types of target words (fear symptoms, e.g. 'dizziness'; neutral, e.g. 'drink'; and pseudowords, e.g. 'salkom') were preceded by two types of prime words (fear-triggers, e.g. 'elevator'; and neutral, e.g. 'bottle'). Subjects with high AS rated fear-symptom words (vs neutral words) as more unpleasant than low-AS individuals; they also related these words more strongly to fear-triggers and showed prolonged reaction times. During the processing of fear-symptom words, greater activation in the left anterior insula was observed in high-AS subjects than in low-AS subjects. Lower activation in the left inferior frontal gyrus, angular gyrus, fusiform gyrus and bilateral amygdalae was found in high-AS subjects when fear-symptom words were preceded by fear-trigger words. The findings suggest that cognitive biases and the anterior insula play a crucial role in high-AS individuals. Furthermore, semantic processes may contribute to high AS and the risk of developing anxiety disorders.

Covariation bias in women with a negative body evaluation: How is it expressed and can it be diminished?

BACKGROUND AND OBJECTIVES

Women with a negative body evaluation display covariation bias: They overestimate the relation between their own body and negative social feedback. This study aimed to develop a more fine-grained understanding of this covariation bias and to determine whether it could be diminished.

METHODS

Seventy women completed a computer task wherein three categories of stimuli--pictures of their own body, a control woman's body, and a neutral object--were followed by (nonverbal) negative social feedback or nothing. Participants' estimates of the relation between each stimulus category and negative social feedback were assessed throughout the task.

RESULTS

Before starting the task, women with a more negative state body evaluation expected their body to be followed by more negative social feedback (demonstrating a priori covariation bias). During the task, when the relation between stimulus category and negative social feedback was random, women with a more negative trait and state body evaluation perceived at the present moment (online covariation bias) and retrospectively (a posteriori covariation bias) that their body was followed by more negative social feedback. When contingencies were manipulated so that women's own body was rarely followed by negative social feedback, covariation bias was temporarily diminished; this coincided with improvements in state body evaluation.

LIMITATIONS

The task did not incorporate neutral or positive social feedback and focused only on undergraduate women.

CONCLUSIONS

Covariation bias exists preexperimentally and occurs when situational information is ambiguous. It is possible to (temporarily) diminish covariation bias. This might be a technique for improving body evaluation.

Intolerance of Uncertainty Is Associated With Increased Threat Appraisal and Negative Affect Under Ambiguity but Not Uncertainty

Intolerance of Uncertainty (IU) has gained increasing interest as a vulnerability factor for worry in Generalized Anxiety Disorder and other emotional disorders. We extended the procedure of Grupe and Nitschke (2011) to compare threat processing in High IU (n=29) and Low IU (n=26) participants. Participants viewed four cues: two reference cues that preceded aversive pictures on 100% or 0% of trials, and a target cue that preceded aversive pictures on 50% of trials (Uncertain condition). Participants were instructed about these probabilities in advance. In addition, we surprised participants with a second target cue that also preceded aversive pictures on 50% of trials but that had not been mentioned in the instructions (Ambiguous condition). Results provided preliminary evidence that High IU participants showed greater online threat expectancy, postexperimental covariation estimates and negative mood for the target cues compared to the reference cues. The results also suggest that among high IU individuals, ambiguity, rather than uncertainty per se, may be a particularly powerful trigger for biased threat appraisal and negative affect. Clinically, the results suggest that patients with high IU may benefit from interventions to help them calibrate the degree of risk in situations involving ambiguous threat.

Expectancy biases in fear and anxiety and their link to biases in attention

Healthy individuals often exhibit prioritized processing of aversive information, as manifested in enhanced orientation of attention to threatening stimuli compared with neutral items. In contrast to this adaptive behavior, anxious, fearful, and phobic individuals show exaggerated attention biases to threat. In addition, they overestimate the likelihood of encountering their feared stimulus and the severity of the consequences; both are examples of expectancy biases. The co-occurrence of attention and expectancy biases in fear and anxiety raises the question about causal influences. Herein, we summarize findings related to expectancy biases in fear and anxiety, and their association with attention biases. We suggest that evidence calls for more comprehensive research strategies in the investigation of mutual influences between expectancy and attention biases, as well as their combined effects on fear and anxiety. Moreover, both types of bias need to be related to other types of distorted information processing commonly observed in fear and anxiety (e.g., memory and interpretation biases). Finally, we propose new research directions that may be worth considering in developing more effective treatments for anxiety disorders.

The scientific legacy of Little Hans and Little Albert: future directions for research on specific phobias in youth

We review issues associated with the phenomenology, etiology, assessment, and treatment of specific phobias in children and adolescents and provide suggestions for future research and clinical practice. In doing so, we highlight the early case studies of Little Hans and Little Albert and the advances that have been made following the publication of these seminal cases. In recent years, we have witnessed a deeper understanding of the etiology of specific phobias and developed a rich array of evidence-based assessments and treatments with which to address specific phobias in youth. Although much has been accomplished in this area of inquiry, we also note that much remains to be done before we can advance more fully our understanding, assessment, and treatment of specific phobias in youth. It will be important for future work to build more firmly on these developments and to better determine the moderators and mediators of change with our evidence-based treatments and to more vigorously pursue their dissemination in real-word settings.

Influences of Age and Emotion on Source Guessing: Are Older Adults More Likely to Show Fear-Relevant Illusory Correlations?

OBJECTIVES

The present study investigates age differences in the vulnerability to illusory correlations between fear-relevant stimuli and threatening information.

METHOD

Younger and older adults saw pictures of threatening snakes and nonthreatening fish, paired with threatening and nonthreatening context information ("poisonous" and "nonpoisonous") with a null contingency between animal type and poisonousness. In a source monitoring test, participants were required to remember whether an animal was associated with poisonousness or nonpoisonousness. Illusory correlations were implicitly measured via a multinomial model. One advantage of this approach is that memory and guessing processes can be assessed independently. An illusory correlation would be reflected in a higher probability of guessing that a snake rather than a fish was poisonous if the poisonousness of the animal was not remembered.

RESULTS

Older adults showed evidence of illusory correlations in source guessing while younger adults did not; instead they showed evidence of probability matching. Moreover, snake fear was associated with increased vulnerability to illusory correlations in older adults.

DISCUSSION

The findings confirm that older adults are more susceptible to fear-relevant illusory correlations than younger adults.

Brain activity associated with illusory correlations in animal phobia

Anxiety disorder patients were repeatedly found to overestimate the association between disorder-relevant stimuli and aversive outcomes despite random contingencies. Such an illusory correlation (IC) might play an important role in the return of fear after extinction learning; yet, little is known about how this cognitive bias emerges in the brain. In a functional magnetic resonance imaging study, 18 female patients with spider phobia and 18 healthy controls were exposed to pictures of spiders, mushrooms and puppies followed randomly by either a painful electrical shock or nothing. In advance, both patients and healthy controls expected more shocks after spider pictures. Importantly, only patients with spider phobia continued to overestimate this association after the experiment. The strength of this IC was predicted by increased outcome aversiveness ratings and primary sensory motor cortex activity in response to the shock after spider pictures. Moreover, increased activation of the left dorsolateral prefrontal cortex (dlPFC) to spider pictures predicted the IC. These results support the theory that phobia-relevant stimuli amplify unpleasantness and sensory motor representations of aversive stimuli, which in turn may promote their overestimation. Hyper-activity in dlPFC possibly reflects a pre-occupation of executive resources with phobia-relevant stimuli, thus complicating the accurate monitoring of objective contingencies and the unlearning of fear.

Equal pain-Unequal fear response: enhanced susceptibility of tooth pain to fear conditioning

Experimental fear conditioning in humans is widely used as a model to investigate the neural basis of fear learning and to unravel the pathogenesis of anxiety disorders. It has been observed that fear conditioning depends on stimulus salience and subject vulnerability to fear. It is further known that the prevalence of dental-related fear and phobia is exceedingly high in the population. Dental phobia is unique as no other body part is associated with a specific phobia. Therefore, we hypothesized that painful dental stimuli exhibit an enhanced susceptibility to fear conditioning when comparing to equal perceived stimuli applied to other body sites. Differential susceptibility to pain-related fear was investigated by analyzing responses to an unconditioned stimulus (UCS) applied to the right maxillary canine (UCS-c) vs. the right tibia (UCS-t). For fear conditioning, UCS-c and USC-t consisted of painful electric stimuli, carefully matched at both application sites for equal intensity and quality perception. UCSs were paired to simple geometrical forms which served as conditioned stimuli (CS+). Unpaired CS+ were presented for eliciting and analyzing conditioned fear responses. Outcome parameter were (1) skin conductance changes and (2) time-dependent brain activity (BOLD responses) in fear-related brain regions such as the amygdala, anterior cingulate cortex, insula, thalamus, orbitofrontal cortex, and medial prefrontal cortex. A preferential susceptibility of dental pain to fear conditioning was observed, reflected by heightened skin conductance responses and enhanced time-dependent brain activity (BOLD responses) in the fear network. For the first time, this study demonstrates fear-related neurobiological mechanisms that point toward a superior conditionability of tooth pain. Beside traumatic dental experiences our results offer novel evidence that might explain the high prevalence of dental-related fears in the population.

Seeing ghosts: negative body evaluation predicts overestimation of negative social feedback

The current study investigated whether negative body evaluation predicts women's overestimation of negative social feedback related to their own body (i.e., covariation bias). Sixty-five female university students completed a computer task where photos of their own body, of a control woman's body, and of a neutral object, were followed by nonverbal social feedback (i.e., facial crowds with equal numbers of negative, positive, and neutral faces). Afterward, women estimated the percentage of negative, positive, and neutral social feedback that followed their own body, the control woman's body, and the neutral object. The findings provided evidence for a covariation bias: negative body evaluation predicted higher estimates of negative social feedback for women's own body, but not for the other stimuli. Additionally, the covariation bias was not explained by differences in how women interpreted the social feedback (the facial stimuli). Clinical implications of the covariation bias to body image are discussed.

Maladaptive cognitive appraisals in children with high-functioning autism: associations with fear, anxiety and theory of mind

Despite the well-documented success of cognitive restructuring techniques in the treatment of anxiety disorders, there is still little clarity on which cognitions underpin fear and anxiety in children with high-functioning autism spectrum disorder. This study examined whether certain cognitive appraisals, known to be associated with fear and anxiety in typically developing groups, may help explain these emotions in children with high-functioning autism spectrum disorder. It also investigated relations between these cognitive appraisals and theory of mind. Appraisals, fear and anxiety were assessed using a vignette approach in 22 children with high-functioning autism spectrum disorders and 22 typically developing children. The two groups differed significantly on all four appraisal types. Anxiety was negatively correlated with future expectancy and positively with problem-focused coping potential in the high-functioning autism spectrum disorder group but was not correlated with appraisals in the typically developing group. The two appraisals associated with fear were emotion-focused coping potential (in the high-functioning autism spectrum disorder group only) and self-accountability (in the typically developing group only). Linear regression analysis found that appraisals of emotion-focused coping potential, problem-focused coping potential and future expectancy were significant predictors of theory-of-mind ability in the high-functioning autism spectrum disorders group. These findings indicate that specific, problematic patterns of appraisal may characterise children with high-functioning autism spectrum disorders.

Of hissing snakes and angry voices: human infants are differentially responsive to evolutionary fear-relevant sounds

Adult humans demonstrate differential processing of stimuli that were recurrent threats to safety and survival throughout evolutionary history. Recent studies suggest that differential processing of evolutionarily ancient threats occurs in human infants, leading to the proposal of an inborn mechanism for rapid identification of, and response to, evolutionary fear-relevant stimuli. The current study provides novel data in support of this proposal, showing for the first time that human infants differentially process evolutionary threats presented in the auditory modality. Sixty-one 9-month-olds listened to evolutionary fear-relevant, modern fear-relevant, and pleasant sounds, while their heart rate, startle, and visual orienting behaviours were measured. Infants demonstrated significantly enhanced heart rate deceleration, larger eye-blinks, and more visual orienting when listening to evolutionary fear-relevant sounds compared to sounds from the other two categories. These results support the proposal that human infants possess evolved mechanisms for the differential processing of a range of ancient environmental threats.

In the face of fear: anxiety sensitizes defensive responses to fearful faces

Fearful faces readily activate the amygdala. Yet, whether fearful faces evoke fear is unclear. Startle studies show no potentiation of startle by fearful faces, suggesting that such stimuli do not activate defense mechanisms. However, the response to biologically relevant stimuli may be sensitized by anxiety. The present study tested the hypothesis that startle would not be potentiated by fearful faces in a safe context, but that startle would be larger during fearful faces compared to neutral faces in a threat-of-shock context. Subjects viewed fearful and neutral faces in alternating periods of safety and threat of shock. Acoustic startle stimuli were presented in the presence and absence of the faces. Startle was transiently potentiated by fearful faces compared to neutral faces in the threat periods. This suggests that although fearful faces do not prompt behavioral mobilization in an innocuous context, they can do so in an anxiogenic one.

Evidence for an encounter expectancy bias in fear of spiders

Whereas research has demonstrated that phobic or fearful individuals overestimate the likelihood of incurring aversive consequences from an encounter with feared stimuli, it has not yet been systematically investigated whether these individuals also overestimate the likelihood (i.e., the frequency) of such encounters. In the current study, spider-fearful and control participants were presented with background information that allowed them to estimate the overall likelihood that different kinds of animals (spiders, snakes, or birds) would be encountered. Spider-fearful participants systematically overestimated the likelihood of encountering a spider with respect to the likelihood of encountering a snake or a bird. No such expectancy bias was observed in control participants. The results thus strengthen our idea that there indeed exist two different types of expectancy bias in high fear and phobia that can be related to different components of the fear response. A conscientious distinction and examination of these two types of expectancy bias are of potential interest for therapeutic applications.

Uncertainty is associated with biased expectancies and heightened responses to aversion

Uncertainty is an omnipresent force in peoples' lives that has been shown to amplify the negative impact of aversive events. This amplified aversiveness, together with the negative attitudes that individuals can have toward uncertainty, suggests that a cue indicating uncertainty about future events might be associated with biased expectancies of negative outcomes or biased contingency estimates, similar to biases that have been observed for traditional fear-relevant cues, such as snakes or spiders. Participants in this study saw three different cues: one that indicated with certainty that an aversive picture would follow, one that indicated with certainty that a neutral picture would follow, and one that indicated uncertainty about whether an aversive or neutral picture would follow. Online self-report data revealed negatively biased expectancies of aversion after uncertain cues. The degree of this online expectancy bias predicted participants' estimates, at the conclusion of the experiment, of the relationship between uncertain cues and aversive pictures. Aversive pictures after the uncertain cue (relative to those after the certain cue) were accompanied by increased skin conductance responses and self-reported negative mood. These findings that uncertainty is accompanied by biased expectancies of aversion and heightened responses to aversion warrant extensions of this research in anxiety disorders, given evidence for intolerance of uncertainty and anticipatory dysfunction in the pathology of such disorders.

The role of verbal threat information in the development of childhood fear. "Beware the Jabberwock!"

Rachman's (Behaviour Research and Therapy 15:372-387, 1977; Clinical Psychology Review 11:155-173, 1991) three pathways theory proposed that childhood fears not only arise as a consequence of direct learning experiences, but can also be elicited by means of threat information transmission. This review looks at the scientific evidence for this idea, which has accumulated during the past three decades. We review research on the influences of media exposure on children's fears, retrospective parent and child reports on the role of threat information in fear acquisition, and experimental studies that explored the causal effects of threat information on childhood fears. We also discuss possible mechanisms by which threat information exerts its influence and the processes relevant to understand the role of this type of learning experience in the origins of fear. Finally, implications for the prevention and intervention of childhood fears are briefly explored, and potential leads for future research will be highlighted.

Fear- and disgust-related covariation bias and eating disorders symptoms in healthy young women

Covariation bias refers to the phenomenon of overestimating the contingency between certain stimuli and negative outcomes, which is considered as a heuristic playing a role in the maintenance of certain types of psychopathology. In the present study, an attempt was made to investigate covariation bias within the context of eating pathology. In a sample of 61 female undergraduates, a priori and a posteriori contingencies were measured between pictures of obese and slim bodies, on the one hand, and fear- or disgust-relevant outcomes, on the other hand. Results indicated that participants in general displayed an a priori and an a posteriori covariation bias reflecting an overestimation of the link between obese bodies and disgust-relevant outcomes. However, this bias was not related to eating disorder symptomatology. Meanwhile, eating pathology was positively associated with a priori covariation biases referring to the associations between obese bodies and fear-relevant outcomes, and between slim bodies and disgust-relevant outcomes. All in all, these findings suggest that covariation bias plays a role in eating pathology.

Neurobehavioral mechanisms of human fear generalization

While much research has elucidated the neurobiology of fear learning, the neural systems supporting the generalization of learned fear are unknown. Using functional magnetic resonance imaging (fMRI), we show that regions involved in the acquisition of fear support the generalization of fear to stimuli that are similar to a learned threat, but vary in fear intensity value. Behaviorally, subjects retrospectively misidentified a learned threat as a more intense stimulus and expressed greater skin conductance responses (SCR) to generalized stimuli of high intensity. Brain activity related to intensity-based fear generalization was observed in the striatum, insula, thalamus/periacqueductal gray, and subgenual cingulate cortex. The psychophysiological expression of generalized fear correlated with amygdala activity, and connectivity between the amygdala and extrastriate visual cortex was correlated with individual differences in trait anxiety. These findings reveal the brain regions and functional networks involved in flexibly responding to stimuli that resemble a learned threat. These regions may comprise an intensity-based fear generalization circuit that underlies retrospective biases in threat value estimation and overgeneralization of fear in anxiety disorders.

Evaluative Conditioning and Conscious Knowledge of Contingencies: A Correlational Investigation with Large Samples

Evaluative conditioning (EC) is a change in the valence of a stimulus that results from pairing the stimulus with an affective stimulus. Two high-powered studies (total N = 1,161) investigated the nature of the relationship between EC and contingency awareness measured as contingency memory. Stronger EC occurred among people with more accurate and more confident memory of the pairings. Awareness was a necessary condition for EC, but EC was not necessary for awareness. Supporting a propositional account of EC, we found evidence for intentional reliance on the contingency for the evaluation of stimuli. We also found evidence that contingency memory was based both on the actual contingency and on preexisting attitudes.

Cognitive Processing of Weight and Emotional Information in Disordered Eating

Numerous theories propose a role for cognitive processing in disordered eating, but clinical scientists have yet to capitalize fully on the wealth of approaches developed by quantitative cognitive scientists when evaluating such theories. This article describes research that uses well-established and theoretically rich cognitive science approaches to demonstrate that women who struggle with disordered eating, relative to their peers, exhibit differential processing of other women’s emotional and weight information presented in photo stimuli. More generally, this work illustrates the portability of cognitive science approaches to the study of clinically relevant individual differences in complex, socially relevant processing.