Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety

Fraunfelter, Laura-Ashley; Gerdes, Antje B. M.; Alpers, Georg W.

doi:10.1016/j.neubiorev.2022.104707

“…A meta-analysis of 16 conditioned fear generalization studies involving individuals with various anxiety disorders revealed a small positive effect size for the linear effect (Hedges' g = 0.24) and, more importantly, a stronger effect size on the quadratic effect (for the subset of nine studies for which this information was available; Hedges' g = 0.3) 112 . An independent meta-analysis of a subset of 11 studies confirmed the quadratic effect (as calculated by a departure-fromlinearity index; Hedges' g = 0.44) 113 . Together, these meta-analyses confirm a broader fear gradient in individuals with an anxiety disorder relative to non-anxious controls.…”

Section: Generalizationmentioning

confidence: 75%

Understanding clinical fear and anxiety through the lens of human fear conditioning

Beckers

¹

,

Hermans

²

,

Lange

³

et al. 2023

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Fear is an adaptive emotion that mobilizes defensive resources upon confrontation with danger. However, fear becomes maladaptive and can give rise to the development of clinical anxiety when it exceeds the degree of threat, generalizes broadly across stimuli and contexts, persists after the danger is gone or promotes excessive avoidance behaviour. Pavlovian fear conditioning has been the prime research instrument that has led to substantial progress in understanding the multi-faceted psychological and neurobiological mechanisms of fear in past decades. In this Perspective, we suggest that fruitful use of Pavlovian fear conditioning as a laboratory model of clinical anxiety requires moving beyond the study of fear acquisition to associated fear conditioning phenomena: fear extinction, generalization of conditioned fear and fearful avoidance. Understanding individual differences in each of these phenomena, not only in isolation but also in how they interact, will further strengthen the external validity of the fear conditioning model as a tool with which to study maladaptive fear as it manifests in clinical anxiety.

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“…People with anxiety do show behavioral, psychophysiological, and neural differences with paradigms such as fear conditioning, safety learning, and extinction learning; however, these learning differences are not consistent with the idea of greater aversive conditioning in anxiety. Rather, in threat learning, people with anxiety disorders show elevated responding to safety signals (CS-) during conditioning, greater responses to the cue previously associated with threat (CS+E) during extinction (Duits et al, 2015), and greater generalization of learned threat (S. E. Cooper et al, 2022;Fraunfelter et al, 2022), accompanied by reduced ventromedial prefrontal cortex (vmPFC) activation (Marin et al, 2017(Marin et al, , 2020. Outside of learning paradigms, people with fear-based disorders, such as panic disorder and posttraumatic stress disorder, show elevated psychophysiological responses to uncertain threat (Gorka et al, 2017;Grillon et al, 2008Grillon et al, , 2009McTeague & Lang, 2012a).…”

Section: A Current Ideas About the Role Of Uncertainty In Anxietymentioning

confidence: 99%

“…Failure to discern between irreducible and unexpected uncertainty can lead to difficulties determining when contexts have changed, potentially explaining fear extinction and retention impairments commonly seen in anxiety (Duits et al, 2015;Marin et al, 2017). Within a context, difficulties estimating the amount of irreducible uncertainty present may impair detection of consistently safe stimuli, as is found with reduced safety signal learning (Duits et al, 2015), and discerning differences in contingencies between similar stimuli, as seen with overgeneralization of conditioned fear (S. E. Cooper et al, 2022;Fraunfelter et al, 2022). In terms of neural function, anxiety, and particularly panic and other fear-based disorders, is linked to impaired noradrenergic function (Bremner et al, 1996;Charney, 1984;Hendrickson & Raskind, 2016;Kalk et al, 2011;Naegeli et al, 2018).…”

Section: E Anxiety As Maladaptive Aversive Uncertainty Learningmentioning

confidence: 99%

Anxiety as a disorder of uncertainty: implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy

Brown

¹

,

Price

²

,

Dombrovski

³

2023

Cogn Affect Behav Neurosci

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In cognitive-behavioral conceptualizations of anxiety, exaggerated threat expectancies underlie maladaptive anxiety. This view has led to successful treatments, notably exposure therapy, but is not consistent with the empirical literature on learning and choice alterations in anxiety. Empirically, anxiety is better described as a disorder of uncertainty learning. How disruptions in uncertainty lead to impairing avoidance and are treated with exposure-based methods, however, is unclear. Here, we integrate concepts from neurocomputational learning models with clinical literature on exposure therapy to propose a new framework for understanding maladaptive uncertainty functioning in anxiety. Specifically, we propose that anxiety disorders are fundamentally disorders of uncertainty learning and that successful treatments, particularly exposure therapy, work by remediating maladaptive avoidance from dysfunctional explore/exploit decisions in uncertain, potentially aversive situations. This framework reconciles several inconsistencies in the literature and provides a path forward to better understand and treat anxiety.

show abstract

“…People with anxiety do show behavioral, psychophysiological, and neural differences with paradigms such as fear conditioning, safety learning, and extinction learning; however, these learning differences are not consistent with the idea of greater aversive conditioning in anxiety. Rather, in threat learning, people with anxiety disorders show elevated responding to safety signals (CS-) during conditioning, greater responses to the cue previously associated with threat (CS+E) during extinction (Duits et al, 2015), and greater generalization of learned threat (S. E. Cooper et al, 2022;Fraunfelter et al, 2022), accompanied by reduced ventromedial prefrontal cortex (vmPFC) activation (Marin et al, 2017(Marin et al, , 2020. Outside of learning paradigms, people with fear-based disorders, such as panic disorder and posttraumatic stress disorder, show elevated psychophysiological responses to uncertain threat (Gorka et al, 2017;Grillon et al, 2008Grillon et al, , 2009.…”

Section: A Current Ideas About the Role Of Uncertainty In Anxietymentioning

confidence: 99%

“…Failure to discern between irreducible and unexpected uncertainty can lead to difficulties determining when contexts have changed, potentially explaining fear extinction and retention impairments commonly seen in anxiety (Duits et al, 2015;Marin et al, 2017). Within a context, difficulties estimating the amount of irreducible uncertainty present may impair detection of consistently safe stimuli, as is found with reduced safety signal learning (Duits et al, 2015), and discerning differences in contingencies between similar stimuli, as seen with overgeneralization of conditioned fear (S. E. Cooper et al, 2022;Fraunfelter et al, 2022). In terms of neural function, anxiety, and particularly panic and other fear-based disorders, is linked to impaired noradrenergic function (Bremner et al, 1996;Charney, 1984;Hendrickson & Raskind, 2016;Kalk et al, 2011;Naegeli et al, 2018).…”

Section: E Anxiety As Maladaptive Aversive Uncertainty Learningmentioning

confidence: 99%

Anxiety as a disorder of uncertainty: Implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy

Brown¹

2022

Preprint

0

View full text Add to dashboard Cite

Cognitive-behavioral conceptualizations of anxiety view exaggerated threat expectancies as central to maladaptive anxiety. This view has led to successful treatments, notably exposure therapy, but is not consistent with the empirical literature on learning and choice alterations in anxiety. Empirically, anxiety is better described as a disorder of uncertainty. How disruptions in uncertainty lead to impairing avoidance and are treated with exposure-based methods, however, is unclear. Here, we integrate concepts from neurocomputational learning models with clinical literature on exposure therapy to propose a new framework for understanding maladaptive uncertainty functioning in anxiety, particularly fear-based disorders. Specifically, we propose that anxiety disorders are fundamentally disorders of uncertainty learning and that successful treatments, particularly exposure therapy, work by remediating maladaptive avoidance from dysfunctional explore/exploit decisions in uncertain, potentially aversive situations. This framework reconciles several inconsistencies in the literature and provides a path forward to better understand and treat anxiety.

show abstract

Fear one, fear them all: A systematic review and meta-analysis of fear generalization in pathological anxiety

Cited by 32 publications

References 87 publications

Understanding clinical fear and anxiety through the lens of human fear conditioning

Understanding clinical fear and anxiety through the lens of human fear conditioning

Anxiety as a disorder of uncertainty: implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy

Anxiety as a disorder of uncertainty: Implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy

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