Abstract
Context conditioning is characterized by unpredictable threat and its generalization may constitute risk factors for panic disorder (PD). Therefore, we examined differences between individuals with panic attacks (PA; N = 21) and healthy controls (HC, N = 22) in contextual learning and context generalization using a virtual reality (VR) paradigm. Successful context conditioning was indicated in both groups by higher arousal, anxiety and contingency ratings, and increased startle responses and skin conductance levels (SCLs) in an anxiety context (CTX+) where an aversive unconditioned stimulus (US) occurred unpredictably vs. a safety context (CTX−). PA compared to HC exhibited increased differential responding to CTX+ vs. CTX− and overgeneralization of contextual anxiety on an evaluative verbal level, but not on a physiological level. We conclude that increased contextual conditioning and contextual generalization may constitute risk factors for PD or agoraphobia contributing to the characteristic avoidance of anxiety contexts and withdrawal to safety contexts and that evaluative cognitive process may play a major role.
Highlights
Panic disorder (PD) is one of the most disabling of anxiety disorders affecting about 7.8 million individuals in Europe (Wittchen et al, 2011)
Results revealed successful acquisition of contextual anxiety in both groups indicated by discriminative responses to the anxiety vs. the safety context for anxiety, arousal, valence and contingency ratings and for startle responses and skin conductance levels (SCLs)
panic attacks (PA) compared to healthy controls (HC) exhibited heightened contextual conditioning, i.e., greater differential responding to Contextual stimuli (CTX)+ vs. CTX− for valence ratings after acquisition and for anxiety and valence ratings after the generalization test
Summary
Panic disorder (PD) is one of the most disabling of anxiety disorders affecting about 7.8 million individuals in Europe (Wittchen et al, 2011). Acute panic attacks (PA) of intense fear and anticipatory anxiety towards forthcoming attacks are constitutive symptoms of PD (DSM-5, American Psychiatric Association, 2013). Overgeneralization of conditioned fear responses to stimuli that resemble the original threateliciting stimulus (generalization stimuli, GSs) but have never been paired with aversive events is discussed as another risk factor for PD (Lissek, 2012; Dymond et al, 2015). Such overgeneralization of fear in PD was found for discrete stimuli predicting threat but was not examined for contexts associated with unpredictable threat so far, the latter seems highly relevant for PD
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