Instructed extinction in human fear conditioning: History, recent developments, and future directions

Persistence of extensively trained avoidance is not elevated in anxiety disorders in an outcome devaluation paradigm

BACKGROUND

A habitual avoidance component may enforce the persistence of maladaptive avoidance behavior in anxiety disorders. Whether habitual avoidance is acquired more strongly in anxiety disorders is unclear.

METHODS

Individuals with current social anxiety disorder, panic disorder and/or agoraphobia (n = 62) and healthy individuals (n = 62) completed a devaluation paradigm with extensive avoidance training, followed by the devaluation of the aversive outcome. In the subsequent test phase, habitual response tendencies were inferred from compatibility effects. Neutral control trials were added to assess general approach learning in the absence of previous extensive avoidance training.

RESULTS

The compatibility effects indicating habitual control did not differ between patients with anxiety disorders and healthy controls. Patients showed lower overall approach accuracy, but this effect was unrelated to the compatibility effects.

CONCLUSIONS

In this study, anxiety disorders were characterized by reduced approach but not stronger habitual avoidance. These results do not indicate a direct association between anxiety disorders and the acquisition of pervasive habitual avoidance in this devaluation paradigm.

Incidental learning of faces during threat: No evidence for enhanced physiological responses to former threat identities

Remembering an unfamiliar person and the contextual conditions of that encounter is important for adaptive future behavior, especially in a potentially dangerous situation. Initiating defensive behavior in the presence of former dangerous circumstances can be crucial. Recent studies showed selective electrocortical processing of faces that were previously seen in a threat context compared to a safety context, however, this was not reflected in conscious recognition performance. Here, we investigated whether previously seen threat-faces, that could not be remembered, were capable to activate defensive psychophysiological response systems. During an encoding phase, 50 participants with low to moderate levels of anxiety viewed 40 face pictures with neutral expressions (6 s each), without an explicit learning instruction (incidental learning task). Each half of the faces were presented with contextual background colors that signaled either threat-of-shock or safety. In the recognition phase, all old and additional new faces (total of 60) were presented intermixed without context information. Participants had to decide whether a face was new or had been presented previously in a threatening or a safe context. Results show moderate face recognition independent of context conditions. Startle reflex and skin conductance responses (SCR) were more pronounced for threat compared to safety during encoding. For SCR, this differentiation was enhanced with higher levels of depression and anxiety. There were no differential startle reflex or SCR effects during recognition. From a clinical perspective, these findings do not support the notion that perceptual biases and physiological arousal directly relate to threat-associated identity recognition deficits in healthy and clinical participants with anxiety and trauma-related disorders.

Conscious knowledge of CS-UCS contingency information affects extinction retrieval of conditioned disgust responses: Findings from an online de novo disgust conditioning task

Objective

The present study aimed to establish and develop an online de novo conditioning paradigm for the measurement of conditioned disgust responses. We further explored the effects of explicit instructions about the CS-UCS contingency on extinction learning and retrieval of conditioned disgust responses.

Method

The study included a sample of 115 healthy participants. Geometric figures served as conditioned stimuli (CS) and disgust-evoking pictures as unconditioned stimuli (UCS). During disgust conditioning, the CS+ was paired with the UCS (66% reinforcement) and the CS- remained unpaired; during extinction and retrieval, no UCS was presented. Half of the participants (n = 54) received instructions prior to the disgust extinction stating that the UCS will not be presented anymore. 1-2 days or 7-8 days later participants performed a retrieval test. CS-UCS contingency, disgust and valence ratings were used as dependent measures.

Results

Successful acquisition of conditioned disgust response was observed on the level of CS-UCS contingency, disgust and valence ratings. While some decline in valence and disgust ratings during the extinction stage was observed, contingency instructions did not significantly affect extinction performance. Retrieval one week later revealed that contingency instructions increased the discrimination of the CSs.

Conclusions

Extinction of conditioned disgust responses is not affected by explicit knowledge of the CS-UCS contingencies. However, contingency instructions prior to extinction seem to have a detrimental effect on long-term extinction retrieval.

Consensus design of a calibration experiment for human fear conditioning

Fear conditioning is a widely used laboratory model to investigate learning, memory, and psychopathology across species. The quantification of learning in this paradigm is heterogeneous in humans and psychometric properties of different quantification methods can be difficult to establish. To overcome this obstacle, calibration is a standard metrological procedure in which well-defined values of a latent variable are generated in an established experimental paradigm. These intended values then serve as validity criterion to rank methods. Here, we develop a calibration protocol for human fear conditioning. Based on a literature review, series of workshops, and survey of N = 96 experts, we propose a calibration experiment and settings for 25 design variables to calibrate the measurement of fear conditioning. Design variables were chosen to be as theory-free as possible and allow wide applicability in different experimental contexts. Besides establishing a specific calibration procedure, the general calibration process we outline may serve as a blueprint for calibration efforts in other subfields of behavioral neuroscience that need measurement refinement.

Threat shapes visual context sensitivity selectively through low-spatial-frequency channels

Threat has long been supposed to affect human cognitive processing including visual size perception. Whether such threat-related modulation effect varies as a function of spatial frequency is largely unexplored. Here we used low- or high-pass filtered threatening animal and fearful face images as primes and measured their effects on the processing of the Ebbinghaus illusion. Results showed that threatening-animal primes relative to neutral ones significantly decreased the illusion magnitude in low-spatial-frequency rather than in high-spatial-frequency ranges. However, fearful- and neutral-face primes had a comparable effect on the illusion magnitude in both spatial frequency ranges. Notably, when inhibitory transcranial magnetic stimulation was applied to the left temporo-parietal junction (TPJ), fearful-face primes significantly decreased the illusion magnitude in low-spatial-frequency rather than in high-spatial-frequency ranges. However, the opposite pattern of results was observed with right TPJ stimulation. The findings suggest that threat shapes basic aspects of visual perception in a spatial frequency-specific manner, possibly via magnocellular projections from both subcortical and cortical fear-processing systems to early visual cortex.

Laboratory models of post-traumatic stress disorder: The elusive bridge to translation

Post-traumatic stress disorder (PTSD) is a debilitating mental illness composed of a heterogeneous collection of symptom clusters. The unique nature of PTSD as arising from a precipitating traumatic event helps simplify cross-species translational research modeling the neurobehavioral effects of stress and fear. However, the neurobiological progress on these complex neural circuits informed by animal models has yet to produce novel, evidence-based clinical treatment for PTSD. Here, we provide a comprehensive overview of popular laboratory models of PTSD and provide concrete ideas for improving the validity and clinical translational value of basic research efforts in humans. We detail modifications to simplified animal paradigms to account for myriad cognitive factors affected in PTSD, which may contribute to abnormalities in regulating fear. We further describe new avenues for integrating different areas of psychological research underserved by animal models of PTSD. This includes incorporating emerging trends in the cognitive neuroscience of episodic memory, emotion regulation, social-emotional processes, and PTSD subtyping to provide a more comprehensive recapitulation of the human experience to trauma in laboratory research.

Conceptual generalisation in fear conditioning using single and multiple category exemplars as conditional stimuli - electrodermal responses and valence evaluations generalise to the broader category

Conceptual generalisation occurs when conditional responses generalise to novel stimuli from the same category. Past research demonstrates that physiological fear responses generalise across categories, however, conceptual generalisation of stimulus valence evaluations during fear conditioning has not been examined. We investigated whether conceptual generalisation, as indexed by electrodermal responses and stimulus evaluations, would occur, and differ after training with single or multiple conditional stimuli (CSs). Stimuli from two of four categories (vegetables, farm animals, clothing, and office supplies) were used as the CS+ (followed by an electric stimulus) or CS- (presented alone). Generalisation was assessed by presenting novel stimuli from the CS categories after acquisition, extinction, and reinstatement. One category exemplar was used as the CS+ and CS- in the single group, whereas three exemplars were used as the CS+ and CS- in the multiple group. Electrodermal responses generalised in acquisition and extinction but did not differ between groups. In the multiple group, CS evaluations generalised in acquisition and extinction, whereas generalisation was not evident in the single group. Training with multiple CSs also resulted in the extinction of stimulus valence. The current findings have implications for future research examining the generalisation of valence and for exposure-based treatments of anxiety.

Modulation of threat extinction by working memory load: An event-related potential study

Distraction is typically discouraged during exposure therapy for anxiety, because it is thought to interfere with extinction learning by diverting attention away from anxiety-provoking stimuli. Working memory load is one form of distraction that might interfere with extinction learning. Alternatively, working memory load might reduce threat responding and benefit extinction learning by engaging prefrontal brain regions that have a reciprocal relationship with brain circuits involved in threat detection and processing. Prior work examining the effect of working memory load on threat extinction has been limited and has found mixed results. Here, we used the late positive potential (LPP), an event-related potential that is larger for threatening compared to non-threatening stimuli to assess the effect of working memory load on threat extinction. After acquisition, 38 participants performed three blocks of an extinction task interspersed with low and high working memory load trials. Results showed that overall, the LPP was reduced under high compared to low working memory load, and that working memory load slowed extinction learning. Results provide empirical evidence in support of limiting distraction during exposure therapy in order to optimize extinction learning efficiency.

Specificity of spiders among fear- and disgust-eliciting arthropods: Spiders are special, but phobics not so much

To investigate a specificity of spiders as a prototypical fear- and disgust-eliciting stimuli, we conducted an online experiment. The respondents rated images of 25 spiders, 12 non-spider chelicerates, and 10 other arthropods on a fear and disgust 7-point scale. The evaluation of 968 Central European respondents confirmed the specificity of spiders among fear- and disgust-eliciting arthropods and supported the notion of spiders as a cognitive category. We delineated this category as covering extant spider species as well as some other chelicerates bearing a physical resemblance to spiders, mainly whip spiders and camel spiders. We suggested calling this category the spider-like cognitive category. We discussed evolutionary roots of the spider-like category and concluded that its roots should be sought in fear, with disgust being secondary of the two emotions. We suggested other chelicerates, e.g., scorpions, might have been important in formation and fixation of the spider-like category. Further, we investigated an effect of respondent's sensitivity to a specific fear of spiders on evaluation of the stimuli. We found that suspected phobic respondents were in their rating nearly identical to those with only high fear of spiders and similar to those with only moderate fear of spiders. We concluded that results based on healthy respondents with elevated fear should also be considered relevant for arachnophobia research.

The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research

Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.

Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory

Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them. We propose several adaptations that are expected to strengthen inhibitory learning and/or retrieval of the extinction memory, thus likely decreasing relapse. We summarize the limited, but emerging experimental data in the pain domain, and draw parallels with experimental evidence in the anxiety literature. Our reflections and suggestions pertain to the use of the fear hierarchy, reassurance, positive psychology interventions, exposure with a range of stimuli and within different contexts, and the use of safety behaviors during treatment, as well as associating the fear-inducing stimuli with novel outcomes. In addition, we reflect on the importance of specifically tackling (the return of) pain-related avoidance behavior with techniques such as disentangling fear from avoidance and reinforcing approach behaviors. Finally, we discuss challenges in the clinical application of exposure to improve functioning in chronic primary pain and possible avenues for future research. Perspectives: Inspired by recent advances in learning theory and its applications on the treatment of anxiety disorders, we reflect on the delivery of exposure treatment for chronic primary pain and propose strategies to improve its long-term outcomes.

Simulating the computational mechanisms of cognitive and behavioral psychotherapeutic interventions: insights from active inference

Cognitive-behavioral therapy (CBT) leverages interactions between thoughts, feelings, and behaviors. To deepen understanding of these interactions, we present a computational (active inference) model of CBT that allows formal simulations of interactions between cognitive interventions (i.e., cognitive restructuring) and behavioral interventions (i.e., exposure) in producing adaptive behavior change (i.e., reducing maladaptive avoidance behavior). Using spider phobia as a concrete example of maladaptive avoidance more generally, we show simulations indicating that when conscious beliefs about safety/danger have strong interactions with affective/behavioral outcomes, behavioral change during exposure therapy is mediated by changes in these beliefs, preventing generalization. In contrast, when these interactions are weakened, and cognitive restructuring only induces belief uncertainty (as opposed to strong safety beliefs), behavior change leads to generalized learning (i.e., "over-writing" the implicit beliefs about action-outcome mappings that directly produce avoidance). The individual is therefore equipped to face any new context, safe or dangerous, remaining in a content state without the need for avoidance behavior-increasing resilience from a CBT perspective. These results show how the same changes in behavior during CBT can be due to distinct underlying mechanisms; they predict lower rates of relapse when cognitive interventions focus on inducing uncertainty and on reducing the effects of automatic negative thoughts on behavior.

Human fear conditioning is moderated by stimulus contingency instructions

Recent research findings indicate that human fear conditioning is affected by instructions, particularly those concerning the contingency between the conditioned stimulus (CS) and the unconditioned stimulus (US). However, whether or not such instructions were provided to participants often remains unsaid in fear conditioning studies. In the current study (N = 102), we investigated whether conditioned fear acquisition depends on CS-US contingency instructions. Participants were randomly assigned to one of three groups. The first group was instructed about the precise CS-US contingency before conditioning. The second group was instructed to discover the CS-US contingency. The third group did not receive any contingency instructions. We found facilitated fear acquisition (using skin conductance and startle) and increased contingency awareness in the first and second group compared to the third group. Furthermore, contingency reversal instructions immediately reversed conditioned responses. Based on these results, we advise to systematically report the contingency instructions used in fear conditioning research.

Comparing neural correlates of conditioned inhibition between children with and without anxiety disorders - A preliminary study

Cognitive-behavioral therapy (CBT), a first-line treatment for pediatric anxiety disorders, is based on principles of threat learning and extinction. However, CBT does not work sufficiently for up to 40% of clinically anxious youth. The neural and behavioral correlates of conditioned inhibition might provide promising targets for attempts to improve CBT response. During conditioned inhibition, threat and safety cues appear together, forming a safety compound. Here, we test whether this safety compound elicits a reduced fear response compared to pairing the threat cue with a novel cue (novel compound). The current pilot study compares behavioral, physiological, and neural correlates of conditioned inhibition between children with (n = 17, M_age = 13.09, SD_age = 3.05) and without (n = 18, M_age = 14.49, SD_age = 2.38) anxiety disorders. Behavioral and physiological measures did not differ between children with and without anxiety disorders during fear acquisition. During testing, children with anxiety disorders showed overall higher skin conductance response and expected to hear the aversive sound following the novel compound more often than children without anxiety disorders. Children with anxiety disorders showed more activity in the right ventromedial prefrontal cortex (vmPFC) to the safety versus novel compound. Children without anxiety disorders showed the opposite pattern - more right vmPFC activity to the novel versus safety compound (F(1,31) = 5.40, p = 0.03). No group differences manifested within the amygdala, dorsal anterior cingulate cortex, or hippocampus. These pilot findings suggest a feasible approach for examining conditioned inhibition in pediatric anxiety disorders. If replicated in larger samples, findings may implicate perturbed conditioned inhibition in pediatric anxiety disorders and provide targets for CBT.

Behavioral and Physiological Evidence Challenges the Automatic Acquisition of Evaluations

Dual-learning theories of evaluations posit that evaluations can be automatically (i.e., efficiently, unconsciously, uncontrollably, and involuntarily) acquired. They also often assume the existence of evaluative-learning processes that are impervious to verbal information. In this article, we explain that recent research challenges both assertions for three categories of measures: explicit evaluative measures, implicit evaluative measures, and physiological measures of fear. In doing so, we also question the widespread assumption that implicit (i.e., typically behavioral and physiological) compared with explicit (i.e., self-reported) evaluative measures are indicative of the way evaluations are acquired. In the second part of the article, we discuss the practical implications of these recent findings.

Measuring unconditional stimulus expectancy during evaluative conditioning strengthens explicit conditional stimulus valence

During evaluative conditioning, a neutral conditional stimulus (CS) becomes pleasant or unpleasant after pairings with a positive/negative unconditional stimulus (US). Measures of US expectancy are commonly assessed during conditioning but it is unclear whether this affects evaluative learning. In Experiment 1, we examined whether the concurrent assessment of US expectancy alongside measures of CS valence would influence the acquisition, extinction, and reinstatement of explicit CS valence. Participants rated both valence and expectancy during conditioning (valence/expectancy group) or only CS valence (valence only group). Evaluative conditioning was acquired in both groups during acquisition, but its magnitude was enhanced in the valence/expectancy group. Measuring US expectancy did not influence the extinction or reinstatement of conditional valence. In Experiment 2, we confirmed the enhancement of evaluative conditioning due to concurrent measurement of US expectancy in an explicit measure, but did not find corresponding evidence in an implicit measure of conditional valence. In Experiment 3, we replicated the results using a different US expectancy scale and demonstrated that measuring CS valence multiple times throughout conditioning also strengthens conditional valence. Overall, the results suggest that the measurement of US expectancy and CS valence throughout conditioning draws attention to the contingencies and strengthens explicit evaluative learning.

Effects of verbal instructions and physical threat removal prior to extinction training on the return of conditioned fear

Instructions given prior to extinction training facilitate the extinction of conditioned skin conductance (SCRs) and fear-potentiated startle responses (FPSs) and serve as laboratory models for cognitive interventions implemented in exposure-based treatments of pathological anxiety. Here, we investigated how instructions given prior to extinction training, with or without the additional removal of the electrode used to deliver the unconditioned stimulus (US), affect the return of fear assessed 24 hours later. We replicated previous instruction effects on extinction and added that the additional removal of the US electrode slightly enhanced facilitating effects on the extinction of conditioned FPSs. In contrast, extinction instructions hardly affected the return of conditioned fear responses. These findings suggest that instruction effects observed during extinction training do not extent to tests of return of fear 24 hours later which serve as laboratory models of relapse and improvement stability of exposure-based treatments.

"Prepared" fear or socio-cultural learning? Fear conditioned to guns, snakes, and spiders is eliminated by instructed extinction in a within-participant differential fear conditioning paradigm

Across three experiments, we investigated whether electrodermal responses conditioned to ontogenetic fear-relevant (pointed guns) and phylogenetic fear-relevant stimuli (snakes and spiders) would resist instructed extinction in a within-participant differential fear conditioning paradigm. Instructed extinction involves informing participants before extinction that the unconditional stimulus (US) will no longer be presented. This manipulation has been shown to abolish fear conditioned to fear-irrelevant conditional stimuli, but is said to leave fear conditioned to images of snakes and spiders intact. The latter finding, however, has only been demonstrated when fear-relevance is manipulated between-groups. It is also not known whether instructed extinction affects fear conditioned to ontogenetic fear-relevant stimuli, such as pointed guns. In Experiment 1, we demonstrated that fear conditioned to images of pointed guns does not resist instructed extinction. In Experiment 2, we detected some evidence to suggest that fear conditioned to images of snakes and spiders survives instructed extinction but this evidence was not conclusive. In Experiment 3, we directly compared the effects of instructed extinction on fear conditioned to snakes and spiders and to guns and provide strong evidence that fear conditioned to both classes of stimuli is reduced after instructed extinction with no differences between ontogenetic and phylogenetic stimuli. The current results suggest that when fear relevance is manipulated within-participants fear conditioned to both phylogenetic and ontogenetic, fear-relevant stimuli responds to instructed extinction providing evidence in favor of a socio-cultural explanation for "preparedness" effects.

Reversing Threat to Safety: Incongruence of Facial Emotions and Instructed Threat Modulates Conscious Perception but Not Physiological Responding

Facial expressions inform about other peoples’ emotion and motivation and thus are central for social communication. However, the meaning of facial expressions may change depending on what we have learned about the related consequences. For instance, a smile might easily become threatening when displayed by a person who is known to be dangerous. The present study examined the malleability of emotional facial valence by means of social learning. To this end, facial expressions served as cues for verbally instructed threat-of-shock or safety (e.g., “happy faces cue shocks”). Moreover, reversal instructions tested the flexibility of threat/safety associations (e.g., “now happy faces cue safety”). Throughout the experiment, happy, neutral, and angry facial expressions were presented and auditory startle probes elicited defensive reflex activity. Results show that self-reported ratings and physiological reactions to threat/safety cues dissociate. Regarding threat and valence ratings, happy facial expressions tended to be more resistant becoming a threat cue, and angry faces remain threatening even when instructed as safety cue. For physiological response systems, however, we observed threat-potentiated startle reflex and enhanced skin conductance responses for threat compared to safety cues regardless of whether threat was cued by happy or angry faces. Thus, the incongruity of visual and verbal threat/safety information modulates conscious perception, but not the activation of physiological response systems. These results show that verbal instructions can readily overwrite the intrinsic meaning of facial emotions, with clear benefits for social communication as learning and anticipation of threat and safety readjusted to accurately track environmental changes.

Vagally mediated heart rate variability and safety learning: Effects of instructions and number of extinction trials

Extinction of conditioned fear serves as a laboratory model for the mechanism of action underlying exposure treatment with patients suffering from anxiety disorders. Thus, an enhanced understanding of individual differences in extinction learning may help to improve exposure procedures by tailoring treatment plans to the specific needs of the patient. Vagally mediated heart rate variability (vmHRV) is a promising candidate to investigate individual differences in extinction learning because vmHRV is influenced by an inhibitory prefrontal-amygdala network that is similarly implied in extinction learning. Moreover, low levels of vmHRV were previously associated with a higher prevalence of anxiety disorders and a deficit in safety learning. Here, we report on two studies (Study 1: N = 48; Study 2: N = 120) in which we investigated the boundary conditions of the observed association between vmHRV and safety learning as indexed by startle potentiation during instructed or uninstructed extinction training. In Study 1 (conditional discrimination task), we found that low vmHRV levels are associated with higher CS+ potentiation during instructed extinction. In Study 2 (differential cue conditional task), we observed an association between individual vmHRV levels and defensive responding during CS- presentations and, in later instructed extinction trials, during intertrial intervals. These findings indicate an overactive defensive system in individuals with low levels of vmHRV that interferes with their ability to recognize safety and thus is associated with a general perception of unsafety.

The effect of foreign language in fear acquisition

Emotions are at the core of human nature. There is evidence that emotional reactivity in foreign languages compared to native languages is reduced. We explore whether this emotional distance could modulate fear conditioning, an essential mechanism for the understanding and treatment of anxiety disorders. A group of participants was verbally informed (either in a foreign or in a native language) that two different stimuli could be either cueing the potential presence of a threat stimulus or its absence. We registered pupil size and electrodermal activity and calculated the difference in psychophysiological responses to conditioned and to unconditioned stimuli. Our findings provided evidence that verbal conditioning processes are affected by language context in this paradigm. We report the first experimental evidence regarding how the use of a foreign language may reduce fear conditioning. This observation opens the avenue to the potential use of a foreign language in clinical contexts.