Development of anxiety: The role of threat appraisal and fear learning

Mood and Anxiety Disorders Program, National Institute of Mental Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
Depression and Anxiety (Impact Factor: 4.41). 01/2011; 28(1):5-17. DOI: 10.1002/da.20733
Source: PubMed


Anxious individuals exhibit threat biases at multiple levels of information processing. From a developmental perspective, abnormal safety learning in childhood may establish threat-related appraisal biases early, which may contribute to chronic disorders in adulthood. This review illustrates how the interface among attention, threat appraisal, and fear learning can generate novel insights for outcome prediction. This review summarizes data on amygdala function, as it relates to learning and attention, highlights the importance of examining threat appraisal, and introduces a novel imaging paradigm to investigate the neural correlates of threat appraisal and threat-sensitivity during extinction recall. This novel paradigm can be used to investigate key questions relevant to prognosis and treatment. Depression and Anxiety, 2011.© 2010 Wiley-Liss, Inc.

Download full-text


Available from: Daniel S Pine
    • "Given that the ability to correctly detect new associations plays an important role in updating fear memories during extinction, this impaired recognition may serve as a harbinger of diminished extinction in CBT, and/or may reflect a biological marker for OCD symptom persistence into adulthood. Indeed, youth with fear-based psychopathology who fail to develop more complex fear learning capabilities (e.g., fear extinction, discrimination) may have a higher risk of symptom persistence into adulthood.[49]Across participants, anxiety severity was associated with larger SCRs to both the CS+ and CS− during the acquisition phase. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Fear acquisition and extinction are central constructs in the cognitive-behavioral model of obsessive-compulsive disorder (OCD), which underlies exposure-based cognitive-behavioral therapy (CBT). Youth with OCD may have impairments in fear acquisition and extinction that carry treatment implications. We examined these processes using a differential conditioning procedure. Methods: Forty-one youth (19 OCD, 22 community comparisons) completed a battery of clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. Results: During habituation, no difference between groups was observed. During acquisition, differential fear conditioning was observed across participants as evidenced by larger SCRs to the CS+ compared to CS-; there were no between-group differences. Across participants, the number and frequency of OCD symptoms and anxiety severity was associated with greater reactivity to stimuli during acquisition. During extinction, a three-way interaction and follow-up tests revealed that youth with OCD showed a different pattern of SCR extinction compared to the community comparison group. Conclusions: Youth with OCD exhibit a different pattern of fear extinction relative to community comparisons. This may be attributed to impaired inhibitory learning and contingency awareness in extinction. Findings suggest the potential benefit of utilizing inhibitory-learning principles in CBT for youth with OCD, and/or augmentative retraining interventions prior to CBT to reduce threat bias and improve contingency detection.
    No preview · Article · Jan 2016 · Depression and Anxiety
  • Source
    • "In essence, appraisal establishes the personal relevance of environmental stimuli according to the individual's concern for well-being, based on needs, goals, and beliefs [53] [20]. 'Threat appraisal' therefore denotes classifying a stimulus based on its capacity for harming the organism [9]. A possible negative outcome of this adaptive mechanism, having evolved to assist effective threat detection [29], is that threat cues can take on excessive salience, creating a hyper-vigilance or attentional bias towards threat [28] [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A key factor in the transition to psychosis is the appraisal of anomalous experiences as threatening. Cognitive models of psychosis have identified attentional and interpretative biases underlying threat-based appraisals. While much research has been conducted into these biases within the clinical and cognitive literature, little examination has occurred at the neural level. However, neurobiological research in social cognition employing threatening stimuli mirror cognitive accounts of maladaptive appraisal in psychosis. This review attempted to integrate neuroimaging data regarding social cognition in psychosis with the concepts of attentional and interpretative threat biases. Systematic review methodology was used to identify relevant articles from Medline, PsycINFO and EMBASE, and PubMed databases. The selective review showed that attentional and interpretative threat biases relate to abnormal activation of a range of subcortical and prefrontal structures, including the amygdala, insula, hippocampus, anterior cingulate, and prefrontal cortex, as well as disrupted connectivity between these regions, when processing threatening and neutral or ambiguous stimuli. Notably, neural findings regarding the misattribution of threat to neutral or ambiguous stimuli presented a more consistent picture. Overall, however, the findings for any specific emotion were mixed, both in terms of the specific brain areas involved and the direction of effects (increased/decreased activity), possibly owing to confounds including small sample sizes, varying experimental paradigms, medication, and heterogeneous, in some cases poorly characterised, patient groups. Further neuroimaging research examining these biases by employing experimentally induced anomalous perceptual experiences and well-characterised large samples is needed for greater aetiological specificity.
    Full-text · Article · Oct 2015 · European Psychiatry
  • Source
    • "Another bias that is introduced into this loop of decisions and predictions is attentional bias. It is well documented that people with anxiety disorders show enhanced threat detection, persistently pay more attention to these stimuli, and show a bias in threat appraisal (Britton et al. 2011). Although the role of the hippocampus in this attention bias is not clear, such a role does seem consistent with hippocampal function in orienting, attention, and persistence, as discussed above. "

    Full-text · Dataset · Sep 2015
Show more