Elevated Fear Conditioning to Socially Relevant Unconditioned Stimuli in Social Anxiety Disorder

Abstract

Objective-Though conditioned fear has long been acknowledged as an important etiologic mechanism in social anxiety disorder, past psychophysiological experiments have found no differences in general conditionability among social anxiety patients using generally aversive but socially nonspecific unconditioned stimuli (e.g., unpleasant odors and painful pressure). The authors applied a novel fear conditioning paradigm consisting of socially relevant unconditioned stimuli of critical facial expressions and verbal feedback. This study represents the first effort to assess the conditioning correlates of social anxiety disorder within an ecologically enhanced paradigm.Method-Subjects with social anxiety disorder and age-and gender-matched healthy comparison subjects underwent differential classical conditioning. Conditioned stimuli included images of three neutral facial expressions, each of which was paired with one of three audiovisual unconditioned stimuli: negative insults with critical faces (US neg ), positive compliments with happy faces (US pos ), or neutral comments with neutral faces (US neu ). The conditioned response was measured as the fear-potentiation of the startle-blink reflex elicited during presentation of the conditioned stimuli.Results-Only social anxiety subjects demonstrated fear conditioning in response to facial expressions, as the startle-blink reflex was potentiated by the CS neg versus both CS neu and CS pos among those with the disorder, while healthy comparison subjects displayed no evidence of conditioned startle-potentiation. Such group differences in conditioning were independent of levels of anxiety to the unconditioned stimulus, implicating associative processes rather than increased unconditioned stimulus reactivity as the active mechanism underlying enhanced conditioned startlepotentiation among social anxiety subjects.Conclusions-Results support a conditioning contribution to social anxiety disorder and underscore the importance of disorder-relevant unconditioned stimuli when studying the conditioning correlates of pathologic anxiety.Fear conditioning, the associative learning process by which a neutral conditioned stimulus acquires the capacity to elicit fear following its repeated pairing with an aversive unconditioned stimulus, features prominently in etiologic accounts of social anxiety disorder (1-3). In this context, the unconditioned stimulus consists of a time-limited humiliating experience and the conditioned stimuli are those stimuli associatively linked to the unconditioned stimulus (i.e., Address correspondence and reprint requests to Dr. Lissek, NIMH, NIH, 15K North Dr., Rm. 200, Bethesda, MD 20892-2670; lisseks@mail.nih.gov (e-mail people, places, and things) (1). Conditioning is thought to contribute to the onset and course of social anxiety disorder by conferring anxiogenic valence to conditioned stimuli that are then capable of sustaining social anxiety beyond the presence of the time-limited unconditioned stimulus.Theories regarding conditioning and soci...

Relationship between social anxiety and perceived trustworthiness

“…Finally, three investigations reported findings that socially anxious participants judged neutral faces as more negative or less friendly (Amir et al, 2005;Stevens, Gerlach, & Rist, 2008;Yoon & Zinbarg, 2007). However, the majority of results did not suggest an interpretational bias in the judgment of facial expressions, as thirteen of the 26 studies did not find any group differences on valence ratings when negative, neutral, or positive facial expressions were evaluated by socially anxious and control participants (Coles & Heimberg, 2005;de Jong, Merckelbach, Bogels, & Kindt, 1998;Evans et al, 2008;Heuer, Rinck, & Becker, 2007;Lange et al, 2011;Lange, Keijsers, Becker, & Rinck, 2008;Lissek et al, 2008;Merckelbach, Vanhout, Vandenhout, & Mersch, 1989;Mühlberger et al, 2009;Stein, Goldin, Sareen, Zorrilla, & Brown, 2002;Vrana & Gross, 2004;Wieser, McTeague, & Keil, 2011;Wieser, Pauli, Weyers, Alpers, & Mühlberger, 2009). A summary of these patterns can be inspected in Table 1.…”

Oxytocin Facilitates Pavlovian Fear Learning in Males

“…This raised the possibility of OXT IN as a potential enhancer of psychotherapy for social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD) especially. Indeed, the prevailing pathomechanistic models of anxiety disorders have emphasized a key role of Pavlovian fear conditioning in the acquisition of avoidance behavior (Lissek et al, 2008;Rauch et al, 2006). This finding of increased fear extinction, however, seems to contradict further research showing that OXT IN facilitates bodily reactions to and episodic memory for aversive events , increases the perception of social stress in the absence of support (Eckstein et al, 2014a), and promotes defensive aggression towards competing outgroups (De Dreu et al, 2010).…”

Conditioned Fear Acquisition and Generalization in Generalized Anxiety Disorder

“…These processes include acquisition, within-session extinction, extinction recall, conditioned inhibition and conditioned fear-generalization. For example, an enhanced fear acquisition may be characteristic of social phobia (Lissek et al, 2008a), generalized anxiety disorder (GAD; Thayer, Friedman, Borkovec, Johnsen, & Molina, 2000), or post-traumatic stress disorder (PTSD; Orr et al, 2000;Peri, Ben-Shakhar, Orr, & Shalev, 2000). Impaired within-session fear extinction has been shown for individuals with panic disorder (PD; Michael, Blechert, Vriends, Margraf, & Wilhelm, 2007;Otto et al, 2014) or GAD (Pitman & Orr, 1986), whereas impaired extinction recall could be present in PTSD (Milad et al, 2008) or obsessive-compulsive disorder (OCD; Milad et al, 2013).…”