Integrating Threat Conditioning and the Hierarchical Taxonomy of Psychopathology (HiTOP) to Advance the Study of Anxiety-Related Psychopathology

Abstract

Theoretical and methodological research on threat conditioning provides important neuroscience-informed approaches to studying fear and anxiety. The conditioning framework is at the vanguard of physiological and neurobiological research into core mechanistic symptoms of anxiety-related psychopathology, providing detailed models of neural circuitry underlying variability in clinically-relevant behaviors (e.g., decreased extinction, heightened generalization) and heterogeneity in clinical anxiety presentations. Despite the strengths of the threat conditioning approach in explaining symptom-level variability and syndromal heterogeneity, the vast majority of psychopathology-oriented threat conditioning work has been conducted using the Diagnostic and Statistical Manual (DSM) paradigm. Unfortunately, DSM categorizations fail to capture symptom-level resolution afforded by threat conditioning indices. Further, relations between fine-grained neurobehavioral measures of threat conditioning and specific anxiety symptoms are substantially attenuated by within-category heterogeneity, arbitrary boundaries, comorbidity, and limited reliability of the DSM. Conversely, the Hierarchical Taxonomy of Psychopathology (HiTOP) is a promising approach for modeling anxiety symptoms studied by threat conditioning work and for relating threat conditioning to broader anxiety-related constructs. To date, HiTOP has had a minimal impact on the threat conditioning field. Here, we propose that combining the HiTOP and neurobehavioral threat conditioning approaches is an important next step in studying anxiety-related pathology. We provide a brief review of prominent DSM critiques and how they affect threat conditioning studies and suggest solutions and recommendations that flow from the HiTOP perspective. Our hope is that this effort serves as both an inflection point and practical primer for HiTOP-aligned threat conditioning research that benefits both fields.