Norrholm Seth D, Laymon Jenna L, Szewczuk Michelle, Weingast Leah T, Innocente Brittney P, Heymann Jillian, George Renie, Riser Manessa, Woodford Jessica, Noetzel John J, Jovanovic Tanja, Acierno Ron, Davis Lori L
Neuroscience Center for Anxiety, Stress, and Trauma, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA; Atlanta VA Healthcare System, Decatur, GA 30033, USA; Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, CO, USA.
Neuroscience Center for Anxiety, Stress, and Trauma, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
Behav Res Ther. 2025 Sep;192:104803. doi: 10.1016/j.brat.2025.104803. Epub 2025 Jun 13.
Two decades of conditioned fear studies reveal impaired extinction in traumatized military and civilian populations with posttraumatic stress disorder (PTSD). We aimed to test fear extinction in women with military sexual trauma (MST), a highly traumatized and largely understudied population. Our well-established, acoustic startle-based fear acquisition and extinction paradigm was administered to 51 age-matched female veterans with prior exposure to MST receiving healthcare at one of three VA Medical Centers. Thirty women had a PTSD diagnosis and 21 did not, per clinician-administered and self-reported measures. Conditioned stimuli were geometric shapes presented on a computer screen and the unconditioned stimulus was an airblast to the larynx. Fear acquisition and fear extinction training occurred on a single day separated by 10 min. Extinction recall occurred 24 h after extinction training. All women showed fear-potentiated startle to the CS+ and CS+/CS- discrimination. During extinction training, the PTSD- and PTSD + groups significantly differed in terms of extinction success, with PTSD + women showing higher fear to the CS + at the end of extinction training compared to PTSD-women (F(1,35) = 5.52, p = 0.025). Furthermore, 86 % of the PTSD-women exhibited a ≥50 % decrease in fear-potentiated startle during extinction training yet only 53 % of the PTSD + women showed this magnitude of fear reduction [X(1,50) = 5.83, p = 0.016)]. These data support the mechanistic position that impaired fear extinction can be a central feature of PTSD, however, observed extinction impairments are nuanced and may be related to factors including age, trauma type, symptom profile, hormonal levels, and biological sex.
二十年的条件性恐惧研究表明，患有创伤后应激障碍（PTSD）的受创伤军人和平民群体存在消退障碍。我们旨在测试遭受军事性创伤（MST）的女性的恐惧消退情况，这是一个受创伤程度高且研究较少的群体。我们采用成熟的基于听觉惊吓的恐惧获得和消退范式，对51名年龄匹配、曾遭受MST且在三个退伍军人事务部医疗中心之一接受治疗的女性退伍军人进行了测试。根据临床医生的评估和自我报告的测量，30名女性被诊断患有PTSD，21名女性没有。条件刺激是电脑屏幕上呈现的几何形状，非条件刺激是喉部的一阵气流。恐惧获得和恐惧消退训练在同一天进行，间隔10分钟。消退回忆在消退训练后24小时进行。所有女性对CS+和CS+/CS-辨别都表现出恐惧增强的惊吓反应。在消退训练期间，PTSD组和PTSD+组在消退成功率方面存在显著差异，与PTSD-女性相比，PTSD+女性在消退训练结束时对CS+表现出更高的恐惧（F(1,35)=5.52，p=0.025）。此外，86%的PTSD-女性在消退训练期间恐惧增强的惊吓反应减少了≥50%，而只有53%的PTSD+女性表现出这种程度的恐惧降低[X(1,50)=5.83，p=0.016)]。这些数据支持了恐惧消退受损可能是PTSD核心特征的机制性观点，然而，观察到的消退障碍是细微的，可能与年龄、创伤类型、症状特征、激素水平和生物性别等因素有关。
