Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis

Baroni, Marina; Frumento, Sergio; Cesari, Valentina; Gemignani, Angelo; Menicucci, Danilo; Rutigliano, Grazia

doi:10.1016/j.neubiorev.2021.06.023

Cited by 16 publications

(13 citation statements)

References 97 publications

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“…This pattern fits with bifactorial models of fear regulation describing the relation between a faster (and not necessarily conscious) threatdetection circuit and a slower circuit allowing the cognitive emotional representation [1]. The different ability of these two factors to affect each other was proposed as a marker of disorders such as specific phobias [3] or Panic disorder [27].…”

Section: Discussionsupporting

confidence: 71%

Subjective fear in virtual reality: a linear mixed-effects analysis of skin conductance

Baldini¹,

Frumento²,

Menicucci³

et al. 2022

Preprint

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<div><div><div><p>The investigation of the physiological and pathological processes involved in fear perception is complicated due to the difficulties in reliably eliciting and measuring the complex construct of fear. This study proposes a novel approach to induce and measure subjective fear and its physiological correlates combining virtual reality (VR) with a mixed-effects model based on skin conductance (SC). Specifically, we developed a new VR scenario applying specific guidelines derived from horror movies and video games. Such a VR environment was used to induce fear in eighteen volunteers in an experimental protocol, including two relaxation scenarios and a neutral virtual environment. The SC signal was acquired throughout the experiment, and after each virtual scenario, the emotional state and fear perception level were assessed using psychometric scales. We statistically evaluated the greatest sympathetic activation induced by the fearful scenario compared to the others, showing significant results for most SC-derived features. Finally, we developed a rigorous mixed-effects model to explain the perceived fear as a function of the SC features. Model-fitting results showed a significant relationship between the fear perception scores and a combination of features extracted from both fast- and slow-varying SC components, proposing a novel solution for a more objective fear assessment.</p></div></div></div>

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Section: Discussionsupporting

confidence: 71%

Subjective fear in virtual reality: a linear mixed-effects analysis of skin conductance

Baldini¹,

Frumento²,

Menicucci³

et al. 2022

Preprint

Self Cite

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“…Given the low probability that every stimulus was successfully masked, we should consider the possibility that even phobic stimuli that were consciously detected were too brief to induce the conscious feeling of fear. This evidence would fit with our idea that the nervous circuits involved in detecting and fearing a phobic stimulus are different and should be integrated into a therapeutic protocol targeting both top-down and bottom-up processes involved in desensitization [ 5 , 6 ]. This could finally affect the “feeling a feeling” level described by Damasio [ 14 ] that could be erroneously thought to overlap perfectly with the subjective threshold of perception (i.e., the moment at which subjects can first discriminate stimuli, even if at a chance level [ 15 ]).…”

Section: Introducing Emotionally-subliminal Stimulimentioning

confidence: 62%

“…Despite their efficacy, traditional exposure therapies are hardly accepted by the majority of phobic patients, and their clinical success is significantly affected by motivational factors [ 4 ]. Thus, the possibility of obtaining a comparable reduction of phobic symptoms through a safer, subliminal exposure gained a growing interest [ 5 , 6 ]. The observation that these protocols subliminally induced habituation in physiological reactions to phobic stimuli led some researchers [ 7 ] to incautiously compare their efficacy to that of traditional exposure therapy, despite the most clinically-relevant component of phobia (i.e., the subjective feeling of fear) was unaffected [ 6 ].…”

Section: Putting the Mental Back In Exposure Therapiesmentioning

confidence: 99%

Perceptually Visible but Emotionally Subliminal Stimuli to Improve Exposure Therapies

2022

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Subliminal stimuli are gaining growing interest due to their capability to induce desensitization to pathologically feared (e.g., phobic) pictures without inducing exaggerated emotional reactions. However, unresolved methodological issues cast significant doubt on the reliability of these findings and their interpretation. The studies most robustly assessing stimulus detection found that ~30% of the supposed-to-be-subliminal stimuli were, in fact, detected, suggesting that the beneficial effects attributed to subliminal stimuli may result from those actually seen. Nevertheless, a deeper analysis of the data underlying this misinterpretation unveils theoretical and clinical implications. Since the purpose of subliminal stimulation is to reduce the aversiveness of exposure therapies while maintaining their efficacy, researchers should measure the emotional relevance of supposed-to-be-subliminal stimuli that are, in fact, detected. A distinction is needed between perceptually- and emotionally-subliminal stimuli: the former is not consciously detected; the latter just fails to elicit emotional reactions. Emotionally-subliminal stimuli could represent an intermediate step of exposure in addition to those involving perceptually subliminal or supraliminal stimuli. Importantly, emotionally subliminal stimuli could make patients able to sustain a conscious exposure to feared stimuli without exaggeratedly reacting to them: if confirmed by empirical data, this unexpected disconfirmation of patients’ beliefs could pave the way for successful therapy while increasing their self-efficacy and compliance to treatment.

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“…Research on unconscious processing of subliminal stimuli in panic disorders suggests the existence of subliminal threat cues in panic disorder, possibly influenceable via treatment[ 28 ]. Distinguishing between conscious and unconscious knowledge proved to be difficult in experiments investigating conditioning[ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Concerning the treatment relationship, several nonverbal events are unconscious and can often convey a patient’s emotional and mental state in a way that verbal communication cannot[ 38 ]. Phenomenological philosophical concepts of empathy[ 39 - 41 ] claim that visible bodily expressions and resonance shed light on others’ inner mental states and enable us to “experience others’ minds”[ 28 ]. Within this empathic understanding, bodily resonance is supposed to be accompanied by contextual knowledge and differentiation between self and others.…”

Section: Discussionmentioning

confidence: 99%

Personalized treatment - which interaction ingredients should be focused to capture the unconscious

Steinmair¹,

Löffler‐Stastka²

2022

WJCC

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A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at s upporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

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Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis

Cited by 16 publications

References 97 publications

Subjective fear in virtual reality: a linear mixed-effects analysis of skin conductance

Subjective fear in virtual reality: a linear mixed-effects analysis of skin conductance

Perceptually Visible but Emotionally Subliminal Stimuli to Improve Exposure Therapies

Personalized treatment - which interaction ingredients should be focused to capture the unconscious

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