Wurst Catherina, Schiele Miriam A, Stonawski Saskia, Weiß Carolin, Nitschke Felix, Hommers Leif, Domschke Katharina, Herrmann Martin J, Pauli Paul, Deckert Jürgen, Menke Andreas
Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany; Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany; Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstr. 5, 79104, Freiburg, Germany.
J Psychiatr Res. 2021 Mar;135:294-301. doi: 10.1016/j.jpsychires.2021.01.034. Epub 2021 Jan 21.
Fear conditioning and generalization are well-known mechanisms in the pathogenesis of anxiety disorders. Extinction of conditioned fear responses is crucial for the psychotherapeutic treatment of these diseases. Anxious depression as a subtype of major depression shares characteristics with anxiety disorders. We therefore aimed to compare fear learning mechanisms in patients with anxious versus non-anxious depression. Fear learning mechanisms in patients with major depression (n = 79; for subgroup analyses n = 41 patients with anxious depression and n = 38 patients with non-anxious depression) were compared to 48 healthy participants. We used a well-established differential fear conditioning paradigm investigating acquisition, generalization, and extinction. Ratings of valence, arousal and probability of expected threat were assessed as well as skin conductance response as an objective psychophysiological measure. Patients with major depression showed impaired acquisition of conditioned fear. In addition, depressed patients showed impaired extinction of conditioned fear responses after successful fear conditioning. Generalization was not affected. However, there was no difference between patients with anxious and non-anxious depression. Results differed between objective and subjective measures. Our findings show altered fear acquisition and extinction in major depression as compared to healthy controls, but they do not favor differential fear learning and extinction mechanisms in the pathogenesis of anxious versus non-anxious depression. The results of impaired extinction warrant future studies addressing extinction learning elements in the treatment of depression.
恐惧条件作用和泛化是焦虑症发病机制中众所周知的机制。条件性恐惧反应的消退对于这些疾病的心理治疗至关重要。作为重度抑郁症亚型的焦虑性抑郁症与焦虑症有共同特征。因此，我们旨在比较焦虑性抑郁症患者与非焦虑性抑郁症患者的恐惧学习机制。将重度抑郁症患者（n = 79；亚组分析中，n = 41例焦虑性抑郁症患者和n = 38例非焦虑性抑郁症患者）的恐惧学习机制与48名健康参与者进行比较。我们使用了一种成熟的差异恐惧条件作用范式来研究习得、泛化和消退。评估了效价、唤醒度和预期威胁概率的评分，以及作为客观心理生理指标的皮肤电反应。重度抑郁症患者表现出条件性恐惧习得受损。此外，抑郁症患者在成功进行恐惧条件作用后，条件性恐惧反应的消退也受损。泛化未受影响。然而，焦虑性抑郁症患者与非焦虑性抑郁症患者之间没有差异。客观测量和主观测量的结果有所不同。我们的研究结果表明，与健康对照组相比，重度抑郁症患者的恐惧习得和消退发生了改变，但它们并不支持焦虑性抑郁症与非焦虑性抑郁症发病机制中存在差异的恐惧学习和消退机制。消退受损的结果值得未来研究探讨抑郁症治疗中的消退学习要素。
