Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Twin City Campus, United States of America.
Section on Neurobiology of Fear and Anxiety, DIRP, NIMH, United States of America.
Compr Psychiatry. 2018 Aug;85:84-93. doi: 10.1016/j.comppsych.2018.07.001. Epub 2018 Jul 4.
Fear conditioning is implicated as a central psychopathological mechanism of anxiety disorders. People with anxiety disorders typically demonstrate reduced affective discrimination between conditioned danger and safety cues. Here, affective discrimination refers to the ability to selectively display fear to dangerous but not safe situations. Though both generalized anxiety disorder (GAD) and panic disorder (PD) are linked to impaired affective discrimination, the clinical phenomenology of these disorders suggests that people with GAD versus PD might be less able to overcome such deficits. It is unclear how this potential difference would manifest during lab-based conditioning.
We used a classical fear conditioning paradigm over two discrimination training sessions to examine whether those with GAD, but not PD, would display persistent discrimination deficits. Sixty-seven participants (21 GAD, 19 PD, 27 Healthy Controls) completed a task in which conditioned fear was measured psychophysiologically (fear-potentiated startle), behaviorally, and via self-report.
Although similar levels of impaired discrimination were found for both GAD and PD groups during initial training, such impairments tended to persist across a subsequent training session only for patients with GAD when compared with Controls.
Our results provide a foundation for additional research of discrimination deficits in specific anxiety disorders, with an ultimate goal of improved customization of psychological treatments.
恐惧条件作用被认为是焦虑障碍的核心心理病理机制。焦虑障碍患者通常表现出对条件性危险和安全线索的情感辨别力降低。这里的情感辨别力是指对危险但不安全的情况选择性地表现出恐惧的能力。尽管广泛性焦虑障碍(GAD)和惊恐障碍(PD)都与情感辨别力受损有关,但这些疾病的临床表型表明,GAD 患者比 PD 患者可能更难以克服这些缺陷。目前尚不清楚这种潜在差异在基于实验室的条件作用中会如何表现。
我们使用经典的恐惧条件作用范式进行了两次辨别训练,以检验 GAD 患者而非 PD 患者是否会表现出持续的辨别缺陷。67 名参与者(21 名 GAD、19 名 PD、27 名健康对照)完成了一项任务,通过生理(恐惧增强的惊跳反应)、行为和自我报告来测量条件性恐惧。
尽管在最初的训练中,GAD 和 PD 组都发现了类似程度的辨别障碍,但与对照组相比,只有 GAD 患者在随后的训练中,这种障碍倾向于持续存在。
我们的研究结果为特定焦虑障碍中辨别缺陷的进一步研究提供了基础,最终目标是改善心理治疗的个性化。