Fear Extinction in Traumatized Civilians with Posttraumatic Stress Disorder: Relation to Symptom Severity
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Background The symptoms of posttraumatic stress disorder (PTSD) can be explained, at least in part, as an inability to inhibit learned fear during conditions of safety. Our group has shown that fear inhibition is impaired in both combat and civilian PTSD populations. On the basis of our earlier findings, we employed an established fear extinction paradigm to further explore fear dysregulation in a civilian traumatized population.Methods Fear-potentiated startle (FPS) was examined in 127 trauma-exposed individuals with and without PTSD. We used a protocol in which conditioned fear was first acquired through the presentation of one colored shape (reinforced conditioned stimulus, [CS+]) that was paired with an aversive air blast to the larynx (unconditioned stimulus) and a different colored shape that was not paired to the air blast (nonreinforced condition stimulus). Fear was extinguished 10 min later through repeated presentations of the CSs without reinforcement.Results Both groups demonstrated successful fear conditioning on the basis of startle and unconditioned stimulus-expectancy ratings; however, participants with PTSD displayed greater FPS responses to the CS+ and nonreinforced conditioned stimulus compared with the group without PTSD. During fear extinction, the PTSD group showed elevated FPS responses to the previously reinforced CS+ during the early and middle stages of extinction. During the acquisition and extinction phases, PTSD participants with higher levels of reexperiencing symptoms exhibited greater potentiated startle responses to the CS+ compared with PTSD participants with lower reexperiencing symptoms.Conclusions These results suggest that PTSD is associated with enhanced fear learning and a greater "fear load" to extinguish after conditioned fear is acquired.
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High levels of conditioned fear remaining during late extinction are related to impaired inhibition, best predicted by responses to the CS− at the end of acquisition.
“High levels of conditioned fear remaining during late extinction are related to impaired inhibition, as it is best predicted by responses to the CS− (i.e., safety signal) at the end of acquisition (15).”
From Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors (2014) · cites this paper as [15]
The authors' group showed heightened levels of fear during early extinction in a previously traumatized population with PTSD consisting primarily of African-American women living in a low-socioeconomic urban environment, termed 'fear load'.
“For example, our group showed heightened levels of fear during early extinction in a previously traumatized population with PTSD consisting of primarily African-American women living in a low-socioeconomic urban environment; we termed this pattern of extinction learning as being indicative of “fear load,” or the over-expression of fear during early extinction.”
From Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors (2014) · cites this paper as [15]
Previous work from the authors' lab suggests that the early phase of within-session extinction learning involves persistent excitation, predicted by the level of fear expression to the CS+ at the end of acquisition.
“With regard to over-expression of acquired fear, previous work from our lab (15) suggests that the early phase of within-session extinction learning involves persistent excitation, as it is predicted by the level of fear expression to the CS+ (i.e., the danger signal) at the end of acquisition.”
From Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors (2014) · cites this paper as [15]
During extinction learning, increased fear-potentiated startle was associated with re-experiencing symptoms of PTSD.
“In addition, during extinction learning, increased fear-potentiated startle was associated with re-experiencing symptoms of PTSD (15).”
From Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors (2014) · cites this paper as [15]
A more robust fear response to both the CS+ (danger cue) and the CS− (safety cue) during acquisition was associated with higher re-experiencing and hyperarousal symptoms.
“The same study showed a more robust fear response to both the CS+ (danger cue) and the CS− (safety cue) during acquisition that was associated with higher re-experiencing and hyperarousal symptoms.”
From Conditioned fear associated phenotypes as robust, translational indices of trauma-, stressor-, and anxiety-related behaviors (2014) · cites this paper as [15]
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Self-citationDeficient fear extinction memory in posttraumatic stress disorder.
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Estrogen and Extinction of Fear Memories:Implications for Posttraumatic Stress Disorder Treatment
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Self-citationDexamethasone Treatment Leads to Enhanced Fear Extinction and Dynamic Fkbp5 Regulation in Amygdala
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Fear Processing, Psychophysiology, and PTSD
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Self-citation
- Authors
- Norrholm, S. D., Jovanovic, T., Olin, I. W., Sands, L. A., Karapanou, I., Bradley, B., & Ressler, K. J.
- Affiliations
- Emory University (US)
- Howard Hughes Medical Institute (US)
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 69
- Issue
- 6
- Pages
- 556-563
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC3052965
- OpenAlex
- W2046222481
- Cited by
- 397
- References
- 46
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 12 · 2023: 22 · 2022: 30 · 2021: 32 · 2020: 24 · 2019: 29 · 2018: 32 · 2017: 30 · 2016: 31 · 2015: 25 · 2014: 32 · 2013: 23 · 2012: 16
- FWCI
- 19.63
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- Department of Defense/Congressionally Directed Medical Research Program (W81XWH-08-2-0170)
- Emory University Research Committee
- Clinical and Translational Science Award program, National Institutes of Health (UL1 RR025008)
- National Center for Research Resources
- National Institute of Mental Health (F32 MH070129, MH071537)
- American Foundation for Suicide Prevention
- National Centers for Research Resources (M01 RR00039)
- Burroughs Wellcome Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- post-traumatic stress disorder, fear extinction, fear potentiation, fear conditioning, fear inhibition, re-experiencing symptoms, symptom severity, civilian trauma
- MeSH terms
- Adult, Analysis of Variance, Conditioning, Classical, Discrimination, Psychological, Extinction, Psychological, Fear, Female, Humans, Male, Middle Aged, Psychometrics, Psychophysics, Severity of Illness Index, Reflex, Startle, Stress Disorders, Post-Traumatic, Wounds and Injuries
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