A Unique Safety Signal: Social-Support Figures Enhance Rather Than Protect From Fear Extinction

Abstract

Although research has made significant advances in identifying treatments for fear-related disorders, these treatments are not entirely effective and relief from symptoms is often short-lived (Craske, 1999; McNally, 2007; Rachman, 1989). The research on which these treatments are based has largely focused on investigating processes by which fears are learned with an eye toward enhancing fear extinction. Less work, however, has examined safety stimuli (which denote the absence of threat) and whether specific types of safety stimuli have beneficial effects on fear extinction. One prevailing view is that safety signals are detrimental to the fear extinction process (Craske et al., 2008; Hermans, Craske, Mineka, & Lovibond, 2006), even though only a handful of studies using simplistic safety signals have tested these effects in humans (Lovibond, Davis, & O'Flaherty, 2000). Although there has been some discussion of the potential benefits of safety behaviors during exposure therapy (Rachman, Radomsky, & Shafran, 2008), protocols for the treatment of fear-related disorders generally warn against the presence of safety signals during therapy, including social-support figures even though their safety role had not been formally tested. However, recent findings suggest that this thinking may be misguided (Hornstein, Fanselow, & Eisenberger, 2016). Here, we examined whether one unique type of safety signal-social-support stimuli-can actually enhance fear extinction and whether these effects remain over time. The most common and effective method of treatment for maladaptive fears is exposure therapy, a procedure based on fear extinction processes. Yet fear extinction procedures in general, and exposure therapies in particular, are not always successful; fear reduction is often only temporary (

A Social Safety Net: Developing a Model of Social-Support Figures as Prepared Safety Stimuli

“…This suggests a powerful and lasting inhibitory effect of social-support figures on the fear response. This enhanced extinction effect was replicated immediately postextinction as well as 24 hr postextinction (Hornstein, Haltom, Shirole, & Eisenberger, 2017; Fig. 2b).…”

“…In both graphs, error bars indicate ±1 SE . Graphs were modified from (a) Hornstein and Eisenberger (2017) and (b) Hornstein, Haltom, Shirole, and Eisenberger (2017).…”

Social Support and Longevity: Meta-Analysis-Based Evidence and Psychobiological Mechanisms

“…Eisenberger et al ( 2011 ) recently investigated the face of an attachment figure as inhibitor of stress-related responses in studies on pain perception and fear learning (Hornstein et al, 2016 , 2018 ; Hornstein and Eisenberger, 2017 ). Using a passive picture viewing procedure within an fMRI scanner, female participants received painful thermal stimulation of two intensities (moderate and high) at regular intervals while viewing pictures of their romantic partner or of a stranger or object.…”

“…Studies by Eisenberger on social support figures during fear learning used a Pavlovian shock conditioning procedure to condition the skin conductance response to faces of social support figures (“ the two individuals that give you the most social support on a daily basis ”) in comparison to faces of strangers or known people or neutral objects. The results obtained demonstrate that in comparison to faces of strangers and neutral objects, social support faces, either presented alone or paired with control faces, act as safety signals with the following capacities: (a) to inhibit their own fear conditioning (Hornstein et al, 2016 ), (b) to inhibit the expression of fear toward previously conditioned stimuli (Hornstein et al, 2016 ), (c) to inhibit the fear conditioning of new stimuli (Hornstein and Eisenberger, 2017 ), and (d) to enhance the extinction of conditioned fear responses and prevent the return of fear after a fear reinstatement procedure with additional shocks (Hornstein et al, 2018 ). Based on this evidence, Eisenberger and colleagues suggested that social support figures have become biologically prepared safety stimuli, analogous to biologically prepared fear stimuli (Seligman, 1971 ; Öhman, 1986 ), because over the course of evolutionary history they have provided individuals with protection, care, and resources, which has ultimately promoted survival (Hornstein et al, 2016 , p. 1,051).…”

An Argument for Reconsidering the Role of Social Support in Treating Anxiety Disorders

“…Yet, surprisingly, recent work has demonstrated that while social support reminders do in fact inhibit fear responding [ 6 ] like safety signals, they have the additional effect of enhancing fear extinction [ 6 – 8 ], in contrast to safety signals. Indeed, while safety signals prevent any long-term reduction in fear responding, social support reminders lead to fear reduction that lasts longer than if fear extinction is conducted in the presence of images of neutral objects [ 6 ], images of strangers [ 6 , 7 ], or pretrained safety signals [ 8 ], with no return of fear following extinction procedures or even 24-hours-later following a test designed to reinstate fear (please see Figure 1 ). This distinct and never-before-seen combination of effects suggests that social support reminders are not engaging the same mechanisms as safety signals during fear learning processes and thus should not be assumed to belong in the safety category.…”