Natural Course of Posttraumatic Stress Disorder

Karamustafalıoğlu, Oğuz; Zohar, Joseph; Güveli, Mustafa; Gal, Gilad; Bakım, Bahadır; Fostick, Leah; Karamustafalıoğlu, Nesrin; Sasson, Yehuda

doi:10.4088/jcp.v67n0604

Cited by 71 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Avoidant tendencies may be particularly important in differentiating individuals likely to develop PTSD following exposure to a traumatic event from those who display resilience in the face of trauma. Avoidance or escape behaviors have been identified as a significant predictor of PTSD (Charlton and Thompson, 1996; Marmar, 1996; Chang et al., 2003; Gil and Caspi, 2006) as well as distinguishing between those at risk and not at risk for development of PTSD or anxiety disorders (North et al., 1999; Barlow, 2002; Karamustafalioglu et al., 2006; Marshall et al., 2006; O’Donnell et al., 2007). Specifically, avoidance only occurs in less than half of trauma-exposed individuals (Maes et al., 1998; Breslau et al., 1999), but individuals who report avoidance symptoms following a trauma have an increased likelihood of developing PTSD (North et al., 1999).…”

Section: Diathesis Modelsmentioning

confidence: 99%

“…Specifically, avoidance only occurs in less than half of trauma-exposed individuals (Maes et al., 1998; Breslau et al., 1999), but individuals who report avoidance symptoms following a trauma have an increased likelihood of developing PTSD (North et al., 1999). In addition, the consistency and intensity of avoidance symptoms (Solomon et al., 2009) may be related to the persistence (Maes et al., 1998) and full expression of PTSD (North et al., 2004; Karamustafalioglu et al., 2006; Kashdan et al., 2006; O’Donnell et al., 2007). Thus, the acquisition, expression, and retention of avoidance may represent an endophenotype (Gould and Gottesman, 2006) for PTSD and be the final common pathway to PTSD.…”

Section: Diathesis Modelsmentioning

confidence: 99%

See 1 more Smart Citation

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

et al. 2019

View full text Add to dashboard Cite

Although many individuals who experience a trauma go on to develop post-traumatic stress disorder (PTSD), the rate of PTSD following trauma is only about 15–24%. There must be some pre-existing conditions that impart increased vulnerability to some individuals and not others. Diathesis models of PTSD theorize that pre-existing vulnerabilities interact with traumatic experiences to produce psychopathology. Recent work has indicated that personality factors such as behavioral inhibition (BI), harm avoidance (HA), and distressed (Type D) personality are vulnerability factors for the development of PTSD and anxiety disorders. These personality temperaments produce enhanced acquisition or maintenance of associations, especially avoidance, which is a criterion symptom of PTSD. In this review, we highlight the evidence for a relationship between these personality types and enhanced avoidance and associative learning, which may increase risk for the development of PTSD. First, we provide the evidence confirming a relationship among BI, HA, distressed (Type D) personality, and PTSD. Second, we present recent findings that BI is associated with enhanced avoidance learning in both humans and animal models. Third, we will review evidence that BI is also associated with enhanced eyeblink conditioning in both humans and animal models. Overall, data from both humans and animals suggest that these personality traits promote enhanced avoidance and associative learning, as well as slowing of extinction in some training protocols, which all support the learning diathesis model. These findings of enhanced learning in vulnerable individuals can be used to develop objective behavioral measures to pre-identify individuals who are more at risk for development of PTSD following traumatic events, allowing for early (possibly preventative) intervention, as well as suggesting possible therapies for PTSD targeted on remediating avoidance or associative learning. Future work should explore the neural substrates of enhanced avoidance and associative learning for behaviorally inhibited individuals in both the animal model and human participants.

show abstract

Section: Diathesis Modelsmentioning

confidence: 99%

Section: Diathesis Modelsmentioning

confidence: 99%

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Although normally an adaptive behavior that protects one from harm, avoidance can be over-expressed and become pathological. Indeed, exaggerated avoidance behavior is a predominant symptom in all anxiety disorders (e.g., American Psychiatric Association, 2000) and its severity often parallels the overall growth and persistence of the disorders (Karamustafalioglu et al, 2006). Much of our current understanding of avoidance behavior is based on animal literature.…”

Section: Introductionmentioning

confidence: 99%

Acquisition and Extinction of Human Avoidance Behavior: Attenuating Effect of Safety Signals and Associations with Anxiety Vulnerabilities

Sheynin

Beck

Servatius

et al. 2014

Front. Behav. Neurosci.

View full text Add to dashboard Cite

While avoidance behavior is often an adaptive strategy, exaggerated avoidance can be detrimental and result in the development of psychopathologies, such as anxiety disorders. A large animal literature shows that the acquisition and extinction of avoidance behavior in rodents depends on individual differences (e.g., sex, strain) and might be modulated by the presence of environmental cues. However, there is a dearth of such reports in human literature, mainly due to the lack of adequate experimental paradigms. In the current study, we employed a computer-based task, where participants control a spaceship and attempt to gain points by shooting an enemy spaceship that appears on the screen. Warning signals predict on-screen aversive events; the participants can learn a protective response to escape or avoid these events. This task has been recently used to reveal facilitated acquisition of avoidance behavior in individuals with anxiety vulnerability due to female sex or inhibited personality. Here, we extended the task to include an extinction phase, and tested the effect of signals that appeared during “safe” periods. Healthy young adults (n = 122) were randomly assigned to a testing condition with or without such signals. Results showed that the addition of safety signals during the acquisition phase impaired acquisition (in females) and facilitated extinction of the avoidance behavior. We also replicated our recent finding of an association between female sex and longer avoidance duration and further showed that females continued to demonstrate more avoidance behavior even on extinction trials when the aversive events no longer occurred. This study is the first to show sex differences on the acquisition and extinction of human avoidance behavior and to demonstrate the role of safety signals in such behavior, highlighting the potential relevance of safety signals for cognitive therapies that focus on extinction learning to treat anxiety symptoms.

show abstract

“…Although each subtype (e.g., generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and social phobia) has unique features, a core symptom of all anxiety disorders is excessive avoidance. Avoidance is also a defining symptom for posttraumatic stress disorder (PTSD), and the growth of avoidance behaviors traces the full expression of PTSD (North et al, 2004; Karamustafalioglu et al, 2006; O’Donnell et al, 2007; Kashdan et al, 2009). Given this prominent position, acquisition and maintenance of avoidance behaviors may represent an endophenotype for a variety of anxiety- and stress-related mental disorders (Gould and Gottesman, 2006).…”

mentioning

confidence: 99%

Absence of â€œWarm-Upâ€ during Active Avoidance Learning in a Rat Model of Anxiety Vulnerability: Insights from Computational Modeling

Myers¹,

Smith²,

Servatius³

et al. 2014

Front. Behav. Neurosci.

View full text Add to dashboard Cite

Avoidance behaviors, in which a learned response causes omission of an upcoming punisher, are a core feature of many psychiatric disorders. While reinforcement learning (RL) models have been widely used to study the development of appetitive behaviors, less attention has been paid to avoidance. Here, we present a RL model of lever-press avoidance learning in Sprague-Dawley (SD) rats and in the inbred Wistar Kyoto (WKY) rat, which has been proposed as a model of anxiety vulnerability. We focus on “warm-up,” transiently decreased avoidance responding at the start of a testing session, which is shown by SD but not WKY rats. We first show that a RL model can correctly simulate key aspects of acquisition, extinction, and warm-up in SD rats; we then show that WKY behavior can be simulated by altering three model parameters, which respectively govern the tendency to explore new behaviors vs. exploit previously reinforced ones, the tendency to repeat previous behaviors regardless of reinforcement, and the learning rate for predicting future outcomes. This suggests that several, dissociable mechanisms may contribute independently to strain differences in behavior. The model predicts that, if the “standard” inter-session interval is shortened from 48 to 24 h, SD rats (but not WKY) will continue to show warm-up; we confirm this prediction in an empirical study with SD and WKY rats. The model further predicts that SD rats will continue to show warm-up with inter-session intervals as short as a few minutes, while WKY rats will not show warm-up, even with inter-session intervals as long as a month. Together, the modeling and empirical data indicate that strain differences in warm-up are qualitative rather than just the result of differential sensitivity to task variables. Understanding the mechanisms that govern expression of warm-up behavior in avoidance may lead to better understanding of pathological avoidance, and potential pathways to modify these processes.

show abstract

Natural Course of Posttraumatic Stress Disorder

Cited by 71 publications

References 0 publications

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

Acquisition and Extinction of Human Avoidance Behavior: Attenuating Effect of Safety Signals and Associations with Anxiety Vulnerabilities

Absence of â€œWarm-Upâ€ during Active Avoidance Learning in a Rat Model of Anxiety Vulnerability: Insights from Computational Modeling

Contact Info

Product

Resources

About

Natural Course of Posttraumatic Stress Disorder

Cited by 71 publications

References 0 publications

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

Acquisition and Extinction of Human Avoidance Behavior: Attenuating Effect of Safety Signals and Associations with Anxiety Vulnerabilities

Absence of â€œWarm-Upâ€ during Active Avoidance Learning in a Rat Model of Anxiety Vulnerability: Insights from Computational Modeling

Contact Info

Product

Resources

About

Absence of â€œWarm-Upâ€ during Active Avoidance Learning in a Rat Model of Anxiety Vulnerability: Insights from Computational Modeling