Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany.
Department of Psychology, Humboldt University of Berlin, 10099, Berlin, Germany.
Transl Psychiatry. 2019 May 21;9(1):148. doi: 10.1038/s41398-019-0482-x.
Learning accounts of addiction and obesity emphasize the persistent power of Pavlovian reward cues to trigger craving and increase relapse risk. While extinction can reduce conditioned responding, Pavlovian relapse phenomena-the return of conditioned responding following successful extinction-challenge the long-term success of extinction-based treatments. Translational laboratory models of Pavlovian relapse could therefore represent a valuable tool to investigate the mechanisms mediating relapse, although so far human research has mostly focused on return of fear phenomena. To this end we developed an appetitive conditioning paradigm with liquid food rewards in combination with a 3-day design to investigate the return of appetitive Pavlovian responses and the involved neural structures in healthy subjects. Pavlovian conditioning (day 1) was assessed in 62 participants, and a subsample (n = 33) further completed extinction (day 2) and a reinstatement test (day 3). Conditioned responding was assessed on explicit (pleasantness ratings) and implicit measures (reaction time, skin conductance, heart rate, startle response) and reinstatement effects were further evaluated using fMRI. We observed a return of conditioned responding during the reinstatement test, evident by enhanced skin conductance responses, accompanied by enhanced BOLD responses in the amygdala. On an individual level, psychophysiological reinstatement intensity was significantly anticorrelated with ventromedial prefrontal cortex (vmPFC) activation, and marginally anticorrelated with enhanced amygdala-vmPFC connectivity during late reinstatement. Our results extend evidence from return of fear phenomena to the appetitive domain, and highlight the role of the vmPFC and its functional connection with the amygdala in regulating appetitive Pavlovian relapse.
学习成瘾和肥胖的相关内容强调了巴甫洛夫奖励线索的持久力量,这些线索会引发渴望并增加复发的风险。尽管消退可以减少条件反应,但巴甫洛夫式的复发现象——即在成功消退后条件反应的恢复——挑战了基于消退的治疗的长期成功。因此,巴甫洛夫式复发的转化实验室模型可以代表一种研究介导复发机制的有价值的工具,尽管到目前为止,人类研究主要集中在恐惧现象的恢复上。为此,我们开发了一种带有液体食物奖励的条件反射范式,并结合三天的设计,以研究健康受试者中食欲性巴甫洛夫反应的恢复以及涉及的神经结构。在 62 名参与者中评估了巴甫洛夫式条件反射(第 1 天),其中一个亚组(n=33)进一步完成了消退(第 2 天)和再激发测试(第 3 天)。在显性(愉悦度评分)和隐性测量(反应时间、皮肤电导、心率、惊跳反应)上评估了条件反应,并用 fMRI 进一步评估了再激发效应。我们观察到在再激发测试中出现了条件反应的恢复,这表现为皮肤电导反应增强,同时杏仁核的 BOLD 反应增强。在个体水平上,生理心理再激发强度与腹内侧前额叶皮层(vmPFC)的激活呈显著负相关,与再激发后期增强的杏仁核-vmPFC 连接呈边缘负相关。我们的研究结果从恐惧现象的恢复扩展到了食欲领域,并强调了 vmPFC 的作用及其与杏仁核的功能连接在调节食欲性巴甫洛夫式复发中的作用。
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