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Reactivity to unpredictable threat as a treatment target for fear-based anxiety disorders

Published online by Cambridge University Press:  24 April 2017

S. M. Gorka ,
L. Lieberman ,
H. Klumpp ,
K. L. Kinney ,
A. E. Kennedy ,
O. Ajilore ,
J. Francis ,
J. Duffecy ,
M. G. Craske  and
J. Nathan
...Show all authors
S. M. Gorka*
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
L. Lieberman
Affiliation:
Department of Psychology, University of Illinois-Chicago, 1007 West Harrison St. (M/C 285) Chicago, IL 60607, USA
H. Klumpp
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
K. L. Kinney
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA Department of Psychology, University of Illinois-Chicago, 1007 West Harrison St. (M/C 285) Chicago, IL 60607, USA
A. E. Kennedy
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA Jesse Brown VA Medical Center, Mental Health Service Line, 820 S. Damen Avenue Chicago, IL 60612, USA
O. Ajilore
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
J. Francis
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
J. Duffecy
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
M. G. Craske
Affiliation:
Department of Psychology, University of California, Los Angeles, Franz Hall – Box 95156 Los Angeles, CA 90094, USA
J. Nathan
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
S. Langenecker
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA
S. A. Shankman
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA Department of Psychology, University of Illinois-Chicago, 1007 West Harrison St. (M/C 285) Chicago, IL 60607, USA
K. L. Phan
Affiliation:
Department of Psychiatry, University of Illinois-Chicago, 1747 West Roosevelt Road Chicago, IL 60608, USA Department of Psychology, University of Illinois-Chicago, 1007 West Harrison St. (M/C 285) Chicago, IL 60607, USA Jesse Brown VA Medical Center, Mental Health Service Line, 820 S. Damen Avenue Chicago, IL 60612, USA Department of Anatomy and Cell Biology & the Graduate Program in Neuroscience, University of Illinois-Chicago, 808 S. Wood Street Chicago, IL 60612, USA
*
*Address for correspondence: S. M. Gorka, Ph.D., Department of Psychiatry, University of Illinois atChicago, 1747 Roosevelt Road, Chicago, IL 60608, USA. (Email: sgorka2@uic.edu)
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Abstract

Background

Heightened reactivity to unpredictable threat (U-threat) is a core individual difference factor underlying fear-based psychopathology. Little is known, however, about whether reactivity to U-threat is a stable marker of fear-based psychopathology or if it is malleable to treatment. The aim of the current study was to address this question by examining differences in reactivity to U-threat within patients before and after 12-weeks of selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioral therapy (CBT).

Methods

Participants included patients with principal fear (n = 22) and distress/misery disorders (n = 29), and a group of healthy controls (n = 21) assessed 12-weeks apart. A well-validated threat-of-shock task was used to probe reactivity to predictable (P-) and U-threat and startle eyeblink magnitude was recorded as an index of defensive responding.

Results

Across both assessments, individuals with fear-based disorders displayed greater startle magnitude to U-threat relative to healthy controls and distress/misery patients (who did not differ). From pre- to post-treatment, startle magnitude during U-threat decreased only within the fear patients who received CBT. Moreover, within fear patients, the magnitude of decline in startle to U-threat correlated with the magnitude of decline in fear symptoms. For the healthy controls, startle to U-threat across the two time points was highly reliable and stable.

Conclusions

Together, these results indicate that startle to U-threat characterizes fear disorder patients and is malleable to treatment with CBT but not SSRIs within fear patients. Startle to U-threat may therefore reflect an objective, psychophysiological indicator of fear disorder status and CBT treatment response.

Keywords

Anxietydistressfearstartle potentiationtemporal stabilityunpredictable threat
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 14 , October 2017 , pp. 2450 - 2460
Copyright
Copyright © Cambridge University Press 2017 

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