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Generalisation of fear in PTSD related to prolonged childhood maltreatment: an experimental study

Published online by Cambridge University Press:  28 December 2017

Janine Thome ,
Sophie Hauschild ,
Georgia Koppe ,
Lisa Liebke ,
Sophie Rausch ,
Julia I. Herzog ,
Meike Müller-Engelmann ,
Regina Steil ,
Kathlen Priebe  and
Dirk Hermans
...Show all authors
Janine Thome*
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Sophie Hauschild
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Georgia Koppe
Affiliation:
Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Lisa Liebke
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Sophie Rausch
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Julia I. Herzog
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Meike Müller-Engelmann
Affiliation:
Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
Regina Steil
Affiliation:
Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
Kathlen Priebe
Affiliation:
Department of Psychology, Faculty of Life Sciences, Humboldt University Berlin, Berlin, Germany
Dirk Hermans
Affiliation:
Faculty of Psychology and Educational Sciences, Leuven University, Leuven, Belgium
Christian Schmahl
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Martin Bohus
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Faculty of Health, Antwerp University, Antwerp, Belgium
Stefanie Lis
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
*
Author for correspondence: Janine Thome, E-mail: janine.thome@zi-mannheim.de
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Abstract

Background

Fear responses are particularly intense and persistent in post-traumatic stress disorder (PTSD), and can be evoked by unspecific cues that resemble the original traumatic event. Overgeneralisation of fear might be one of the underlying mechanisms. We investigated the generalisation and discrimination of fear in individuals with and without PTSD related to prolonged childhood maltreatment.

Methods

Sixty trauma-exposed women with (N = 30) and without (N = 30) PTSD and 30 healthy control participants (HC) underwent a fear conditioning and generalisation paradigm. In a contingency learning procedure, one of two circles of different sizes was associated with an electrical shock (danger cue), while the other circle represented a safety cue. During generalisation testing, online risk ratings, reaction times and fear-potentiated startle were measured in response to safety and danger cues as well as to eight generalisation stimuli, i.e. circles of parametrically varying size creating a continuum of similarity between the danger and safety cue.

Results

The increase in reaction times from the safety cue across the different generalisation classes to the danger cue was less pronounced in PTSD compared with HC. Moreover, PTSD participants expected higher risk of an aversive event independent of stimulus types and task.

Conclusions

Alterations in generalisation constitute one part of fear memory alterations in PTSD. Neither the accuracy of a risk judgement nor the strength of the induced fear was affected. Instead, processing times as an index of uncertainty during risk judgements suggested a reduced differentiation between safety and threat in PTSD.

Keywords

classical conditioningearly life maltreatmentfear generalisationfear-potentiated startleinterpersonal violencepost-traumatic stress disordersafety signals
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 13 , October 2018 , pp. 2223 - 2234
Copyright
Copyright © Cambridge University Press 2017 

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References

Acheson, DT, Geyer, MA, Baker, DG, Nievergelt, CM, Yurgil, K and Risbrough, VB (2015). Conditioned fear and extinction learning performance and its association with psychiatric symptoms in active duty Marines. Psychoneuroendocrinology 51, 495–505.Google Scholar
Ahrens, LM, Pauli, P, Reif, A, Muhlberger, A, Langs, G, Aalderink, T et al. (2016). Fear conditioning and stimulus generalization in patients with social anxiety disorder. Journal of Anxiety Disorders 44, 36–46.Google Scholar
Armony, JL, Servan-Schreiber, D, Romanski, LM, Cohen, JD and LeDoux, JE (1997). Stimulus generalization of fear responses: effects of auditory cortex lesions in a computational model and in rats. Cerebral Cortex 7, 157–165.Google Scholar
Arnone, D, Horder, J, Cowen, PJ, and Harmer, CJ (2009). Early effects of mirtazapine on emotional processing. Psychopharmacology 203, 685–691.Google Scholar
Bernstein, DP and Fink, L (1998). Childhood Trauma Questionnaire: A Retrospective Self-Report: Manual. San Antonio, TX: Psychological Corparation.Google Scholar
Blechert, J, Michael, T, Vriends, N, Margraf, J and Wilhelm, FH (2007). Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses. Behavior Research and Therapy 45, 2019–2033.Google Scholar
Bradley, MM and Lang, PJ (1994). Measuring emotion: the self-assessment manikin and the semantic differential. Journal of Behavior Therapy and Experimental Psychiatry 25, 49–59.Google Scholar
Bremner, JD, Vermetten, E, Schmahl, C, Vaccarino, V, Vythilingam, M, Afzal, N et al. (2005). Positron emission tomographic imaging of neural correlates of a fear acquisition and extinction paradigm in women with childhood sexual-abuse-related post-traumatic stress disorder. Psychological Medicine 35, 791–806.Google Scholar
Davidson, JR, Book, SW, Colket, JT, Tupler, LA, Roth, S, David, D et al. (1997). Assessment of a new self-rating scale for post-traumatic stress disorder. Psychological Medicine 27, 153–160.Google Scholar
Davis, M (2006). Neural systems involved in fear and anxiety measured with fear-potentiated startle. The American Psychologist 61, 741–756.Google Scholar
Davis, TA, Jovanovic, T, Norrholm, SD, Glover, EM, Swanson, M, Spann, S et al. (2013). Substance use attenuates physiological responses associated with PTSD among individuals with co-morbid PTSD and SUDs. Journal of Psychology and Psychotherapy (Suppl 7) 006, 1–18.Google Scholar
Ebner-Priemer, UW, Badeck, S, Beckmann, C, Wagner, A, Feige, B, Weiss, I et al. (2005). Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. Journal of Psychiatry Research 39, 85–92.Google Scholar
Ehlers, A and Clark, DM (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy 38, 319–345.Google Scholar
Gamwell, K, Nylocks, M, Cross, D, Bradley, B, Norrholm, SD and Jovanovic, T (2015). Fear conditioned responses and PTSD symptoms in children: sex differences in fear-related symptoms. Developmental Psychobiology 57, 799–808.Google Scholar
Gray, MJ, Litz, BT, Hsu, JL and Lombardo, TW (2004). Psychometric properties of the life events checklist. Assessment 11, 330–341.Google Scholar
Greenberg, T, Carlson, JM, Cha, J, Hajcak, G and Mujica-Parodi, LR (2013). Ventromedial prefrontal cortex reactivity is altered in generalized anxiety disorder during fear generalization. Depression and Anxiety 30, 242–250.Google Scholar
Grillon, C and Morgan, CA (1999). Fear-potentiated startle conditioning to explicit and contextual cues in Gulf War veterans with posttraumatic stress disorder. Journal of Abnormal Psychology 108, 134–142.Google Scholar
Hautzinger, M, Kuehner, C, Buerger, C and Keller, F (2003). Manual für das BDI-II. Bern: Huber.Google Scholar
Hayes, JP, Hayes, SM and Mikedis, AM (2012). Quantitative meta-analysis of neural activity in posttraumatic stress disorder. Biology of Mood and Anxiety Disorders 2, 1–13.Google Scholar
Hermans, D, Baeyens, F and Vervliet, B (2013). Generalization of acquired emotional responses. In Robinson, MD, Watkins, E and Harmon-Jones, E (eds). Handbook of Cognition and Emotion. New York: The Guilford Press, pp. 117–134.Google Scholar
Hoddes, E, Zarcone, V, Smythe, H, Phillips, R and Dement, WC (1973). Quantification of sleepiness: a new approach. Psychophysiology 10, 431–436.Google Scholar
Hyland, P, Murphy, J, Shevlin, M, Vallieres, F, McElroy, E, Elklit, A et al. (2017). Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Social Psychiatry and Psychiatric Epidemiology 52, 727–736.Google Scholar
Jovanovic, T, Blanding, NQ, Norrholm, SD, Duncan, E, Bradley, B and Ressler, KJ (2009). Childhood abuse is associated with increased startle reactivity in adulthood. Depression and Anxiety 26, 1018–1026.Google Scholar
Jovanovic, T, Ely, T, Fani, N, Glover, EM, Gutman, D, Tone, EB et al. (2013). Reduced neural activation during an inhibition task is associated with impaired fear inhibition in a traumatized civilian sample. Cortex 49, 1884–1891.Google Scholar
Jovanovic, T, Norrholm, SD, Blanding, NQ, Davis, M, Duncan, E, Bradley, B et al. (2010). Impaired fear inhibition is a biomarker of PTSD but not depression. Depression and Anxiety 27, 244–251.Google Scholar
Kaczkurkin, AN, Burton, PC, Chazin, SM, Manbeck, AB, Espensen-Sturges, T, Cooper, SE et al. (2016). Neural substrates of overgeneralized conditioned fear in PTSD. The American Journal of Psychiatry 174, 125–134.Google Scholar
Keane, TM and Barlow, DH (2002). Posttraumatic stress disorder. In Barlow, DH (ed.). Anxiety and Its Disorders. New York: Guilford Press. pp. 418–453.Google Scholar
Koenen, KC, Ratanatharathorn, A, Ng, L, McLaughlin, KA, Bromet, EJ, Stein, DJ et al. (2017). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine 47, 1–15.Google Scholar
Lang, PJ (1985). Fear, anxiety and panic: context, cognition and visceral arousal. In Rachman, S and Maser, JD (ed.). Panic: Psychological Perspectives. Hillsdale, NJ: Erlbaum, pp. 219–236.Google Scholar
Lang, PJ, McTeague, LM and Bradley, MM (2016). RDoc, DSM, and the reflex physiology of fear: a biodimensional analysis of the anxiety disorders spectrum. Psychophysiology 53, 336–347.Google Scholar
Laux, L, Glanzmann, P, Schaffner, P and Spielberger, CD (1981). Das State-Trait-Angstinventar. Theoretische Grundlagen und Handanweisung. Weinheim: Beltz.Google Scholar
Lissek, S, Biggs, AL, Rabin, SJ, Cornwell, BR, Alvarez, RP, Pine, DS et al. (2008). Generalization of conditioned fear-potentiated startle in humans: experimental validation and clinical relevance. Behavior Research and Therapy 46, 678–687.Google Scholar
Lissek, S, Kaczkurkin, AN, Rabin, S, Geraci, M, Pine, DS and Grillon, C (2014). Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biological Psychiatry 75, 909–915.Google Scholar
Lissek, S, Rabin, S, Heller, RE, Lukenbaugh, D, Geraci, M, Pine, DS et al. (2010). Overgeneralization of conditioned fear as a pathogenic marker of panic disorder. The American Journal of Psychiatry 167, 47–55.Google Scholar
Lissek, S and van Meurs, B (2015). Learning models of PTSD: theoretical accounts and psychobiological evidence. International Journal of Psychophysiology 98, 594–605.Google Scholar
Maercker, A, Brewin, CR, Bryant, RA, Cloitre, M, Reed, GM, van Ommeren, M et al. (2013). Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 381, 1683–1685.Google Scholar
Maier, SF and Watkins, LR (2005). Stressor controllability and learned helplessness: the roles of the dorsal raphe nucleus, serotonin, and corticotropin-releasing factor. Neuroscience and Biobehavioral Reviews 29, 829–841.Google Scholar
Marks, I and Tobena, A (1990). Learning and unlearning fear: a clinical and evolutionary perspective. Neuroscience and Biobehavioral Reviews 14, 365–384.Google Scholar
McLaughlin, KA, Sheridan, MA, Gold, AL, Duys, A, Lambert, HK, Peverill, M et al. (2015). Maltreatment exposure, brain structure, and fear conditioning in children and adolescents. Neuropsychopharmacology 41, 1956–1964.Google Scholar
McTeague, LM and Lang, PJ (2012). The anxiety spectrum and the reflex physiology of defense: from circumscribed fear to broad distress. Depression and Anxiety 29, 264–281.Google Scholar
McTeague, LM, Lang, PJ, Laplante, MC, Cuthbert, BN, Shumen, JR and Bradley, MM (2010). Aversive imagery in posttraumatic stress disorder: trauma recurrence, comorbidity, and physiological reactivity. Biological Psychiatry 67, 346–356.Google Scholar
Molnar, BE, Buka, SL and Kessler, RC (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753–760.Google Scholar
Morey, RA, Dunsmoor, JE, Haswell, CC, Brown, VM, Vora, A, Weiner, J et al. (2015). Fear learning circuitry is biased toward generalization of fear associations in posttraumatic stress disorder. Translational Psychiatry 5, e700.Google Scholar
Parsons, RG and Ressler, KJ (2013). Implications of memory modulation for post-traumatic stress and fear disorders. Nature Neuroscience 16, 146–153.Google Scholar
Pole, N (2007). The psychophysiology of posttraumatic stress disorder: a meta-analysis. Psychological Bulletin 133, 725–746.Google Scholar
Rausch, S, Herzog, J, Thome, J, Ludascher, P, Muller-Engelmann, M, Steil, R et al. (2016). Women with exposure to childhood interpersonal violence without psychiatric diagnoses show no signs of impairment in general functioning, quality of life and sexuality. Borderline Personality Disorder and Emotion Dysregulation 3, 1–13.Google Scholar
Shevlin, M, Hyland, P, Karatzias, T, Fyvie, C, Roberts, N, Bisson, JI et al. (2017). Alternative models of disorders of traumatic stress based on the new ICD-11 proposals. Acta Psychiatrica Scandinavica 135, 419–428.Google Scholar
Steiger, F, Nees, F, Wicking, M, Lang, S and Flor, H (2015). Behavioral and central correlates of contextual fear learning and contextual modulation of cued fear in posttraumatic stress disorder. International Journal of Psychophysiology 98, 584–593.Google Scholar
Steuwe, C, Lanius, RA and Frewen, PA (2012). Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depression and Anxiety 29, 689–700.Google Scholar
Teicher, MH and Samson, JA (2016). Annual research review: enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry 57, 241–266.Google Scholar
Tinoco-Gonzalez, D, Fullana, MA, Torrents-Rodas, D, Bonillo, A, Vervliet, B, Blasco, MJ et al. (2015). Conditioned fear acquisition and generalization in generalized anxiety disorder. Behavioral Therapy 46, 627–639.Google Scholar
Watson, JB and Rayner, R (1920). Conditioned emotional reaction. Journal of Experimental Psychology 3, 1–14.Google Scholar
Wessa, M and Flor, H (2007). Failure of extinction of fear responses in posttraumatic stress disorder: evidence from second-order conditioning. The American Journal of Psychiatry 164, 1684–1692.Google Scholar
Wittchen, HU, Wunderlich, U, Gruschwitz, S and Zaudig, M (1997). SKID I Strukturiertes Klinisches Interview für DSM-IV Achse I: Psychische Störungen Interviewheft und Beurteilungsheft Eine deutschsprachige, erweiterte Bearbeitung der amerikanischen Originalversion des SCID I. Göttingen: Hogrefe.Google Scholar
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