Time course of threat responding in panic disorder and depression

Abstract

Heightened sensitivity to threat is a characteristic feature of panic disorder (PD). It is also a factor that is considered to be central to PD but not major depressive disorder (MDD) – a related disorder that commonly co-occurs with PD. However, sensitivity to threat is a broad construct and it is unclear whether individuals with PD exhibit heightened initial threat reactivity, impairments in modulating their threat responding over time, or both. It is also unclear how these different facets of threat responding apply to predictable and/or unpredictable threat. The aim of the current study was to examine whether there are differences in initial threat reactivity and the time course of threat responding during predictable and unpredictable threat-of-shock in 186 adults with: 1) current PD and no history of depression (i.e., PD-only), 2) current MDD and no history of an anxiety disorder (i.e., MDD-only), 3) current comorbid PD and MDD, or 4) no lifetime history of psychopathology (i.e., controls). Threat responding was assessed using an electromyography startle paradigm. Relative to controls, individuals in the three psychopathology groups exhibited heightened initial threat reactivity to predictable and unpredictable threat and did not differ from each other. Multilevel mixed model analyses indicated that those with PD evidenced less of a decline over time in startle responding during unpredictable threat relative to those without PD. Those with MDD displayed a greater slope of decline in startle responding during predictable threat compared with those without MDD. The pattern of results suggests that there may be conceptual differences between measures of initial threat reactivity and time course of threat responding. Moreover, time course of threat responding, not initial threat reactivity, may differentiate PD from MDD.

Association between problematic alcohol use and reactivity to uncertain threat in two independent samples

“…Participants then completed the No-Predictable-Unpredictable (NPU) threat task which is modeled after the one developed by Schmitz and Grillon (2012) and has been previously used in our lab (Gorka et al, 2013, 2015; Shankman et al, 2013). The task includes three within-subject conditions – no shock (N), predictable shock (P), and unpredictable shock (U).…”

Exercise decreases defensive responses to unpredictable, but not predictable, threat

“…Fear and anxiety have been distinguished at the neural level in both humans (Herrmann, Beier, et al, 2016; Herrmann, Boehme, et al, 2016; Klahn et al, 2016, 2017) and animals (for reviews: Davis et al, 2010; Walker, Toufexis, & Davis, 2003). Additionally, a plethora of psychopharmacological (Bradford, Shapiro, & Curtin, 2013; Grillon, Baas, Pine, et al, 2006; Grillon et al, 2015; Grillon, Chavis, Covington, & Pine, 2009; Hogle, Kaye, & Curtin, 2010; Moberg & Curtin, 2009) and clinical (Bradford, Curtin, & Piper, 2015; Chamberlain et al, 2013; Gorka et al, 2013; Gorka et al, 2016; Gorka, Lieberman, Shankman, & Phan, 2017; Gorka, Liu, Sarapas, & Shankman, 2015; Grillon et al, 2008; Grillon, Pine, Lissek, et al, 2009; Grillon, Morgan, Davis, & Southwick, 1998; Hogle et al, 2010; Klahn et al, 2016, 2017; Moberg & Curtin, 2009; Schroijen et al, 2016) studies have advanced knowledge of mental health and treatment by comparing these two states. Indeed, fear and anxiety distinctly characterize psychiatric disorders (American Psychiatric Association, 2013) and constitute separate negative valence system constructs in the National Institutes of Health Research Domain Criteria (NIH RDoC).…”

“…Fear and anxiety have been explored experimentally using the Neutral-Predictable-Unpredictable (NPU) threat test (Bradford et al, 2013; Chamberlain et al, 2013; Gorka, Nelson, Sarapas, et al, 2013; Gorka, Nelson & Shankman, 2013; Gorka et al, 2015; Gorka et al, 2017; Gorka, Lieberman, Phan, & Shankman, 2016; Grillon et al, 1998; Grillon, Baas, Pine, et al, 2006; Grillon, Pine, Baas, et al, 2006; Grillon, Chavis, Covington, et al, 2009; Grillon, Pine, Lissek, et al, 2009 Grillon et al, 2008, 2011, 2015; Grillon, Cordova, Morgan, Charney, & Davis, 2004; Herrmann, Beier, et al, 2016; Herrmann, Boehme, et al, 2016; Hogle et al, 2010; Kaye, Bradford, & Curtin, 2016; Klahn et al, 2016, 2017; Klinkenberg et al, 2016; Moberg & Curtin, 2009; Nelson, Hodges, Hajcak, & Shankman, 2015; Schroijen et al, 2016). The NPU threat test consists of a neutral condition (N), and two threat conditions that involve administration of predictable (P) and unpredictable (U) shocks (Schmitz & Grillon, 2012).…”

“…With regard to internalizing disorders, the NPU threat test offers a valuable means to explore clinically relevant mechanisms (Ballard et al, 2014; Gorka, Nelson & Shankman, 2013; Gorka et al, 2015, 2017; Grillon et al, 1998, 2008; Grillon, Pine, Lissek, et al, 2009; Klahn et al, 2016, 2017). For example, individuals with posttraumatic stress (Grillon, Pine, Lissek, et al, 2009) and panic disorders (Gorka et al, 2013; Grillon et al, 2008; Nelson et al, 2013) display elevated anxiety-potentiated, but not fear-potentiated, startle.…”

“…Additionally, a plethora of psychopharmacological (Bradford, Shapiro, & Curtin, 2013;Grillon et al, 2015; TA B L E 1 Sample characteristics. Sex, age, heart rate, and fitness level (VO2-peak) of participants (means and SDs) Grillon et al, 2008;Grillon, Pine, Lissek, et al, 2009; Morgan, Davis, & Southwick, 1998;Hogle et al, 2010;Klahn et al, 2016Klahn et al, , 2017Moberg & Curtin, 2009;Schroijen et al, 2016) (Bradford et al, 2013;Chamberlain et al, 2013;Gorka, Nelson, Sarapas, et al, 2013;Gorka et al, 2015;Gorka et al, 2017;Grillon, Chavis, Covington, et al, 2009;Grillon, Pine, Lissek, et al, 2009Grillon et al, 2008, 2011Grillon, Cordova, Morgan, Charney, & Davis, 2004;Herrmann, Beier, et al, 2016;Herrmann, Boehme, et al, 2016;Hogle et al, 2010;Kaye, Bradford, & Curtin, 2016;Klahn et al, 2016Klahn et al, , 2017Klinkenberg et al, 2016;Moberg & Curtin, 2009;Nelson, Hodges, Hajcak, & Shankman, 2015;Schroijen et al, 2016). The NPU threat test consists of a neutral condition (N), and two threat conditions that involve administration of predictable (P) and unpredictable (U) shocks (Schmitz & Grillon, 2012).…”