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Phasic and sustained fear in humans elicits distinct patterns of brain activity
Open accessAbstract
Aversive events are typically more debilitating when they occur unpredictably than predictably. Studies in humans and animals indicate that predictable and unpredictable aversive events can induce phasic and sustained fear, respectively. Research in rodents suggests that anatomically related but distinct neural circuits may mediate phasic and sustained fear. We explored this issue in humans by examining threat predictability in three virtual reality contexts, one in which electric shocks were predictably signaled by a cue, a second in which shocks occurred unpredictably but never paired with a cue, and a third in which no shocks were delivered. Evidence of threat-induced phasic and sustained fear was presented using fear ratings and skin conductance. Utilizing recent advances in functional magnetic resonance imaging (fMRI), we were able to conduct whole-brain fMRI at relatively high spatial resolution and still have enough sensitivity to detect transient and sustained signal changes in the basal forebrain. We found that both predictable and unpredictable threat evoked transient activity in the dorsal amygdala, but that only unpredictable threat produced sustained activity in a forebrain region corresponding to the bed nucleus of the stria terminalis complex. Consistent with animal models hypothesizing a role for the cortex in generating sustained fear, sustained signal increases to unpredictable threat were also found in anterior insula and a frontoparietal cortical network associated with hypervigilance. In addition, unpredictable threat led to transient activity in the ventral amygdala–hippocampal area and pregenual anterior cingulate cortex, as well as transient activation and subsequent deactivation of subgenual anterior cingulate cortex, limbic structures that have been implicated in the regulation of emotional behavior and stress responses. In line with basic findings in rodents, these results provide evidence that phasic and sustained fear in humans may manifest similar signs of distress, but appear to be associated with different patterns of neural activity in the human basal forebrain.
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In the paper
“Whereas a comparison between Uons and Nons revealed increased transient activity in anterior BNST (t17=4.41, P<0.001), a comparison between Ucxt and Ncxt showed no significant difference in sustained activity in anterior BNST (t17=1.42, P=0.18).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Compared to the predictable context, the unpredictable context induced enhanced transient activity in the thalamus, mid-cingulate, and pregenual anterior cingulate cortex as well (Table 2).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“As was found in Uons>Nons and Uons>Pons, the predictable context transiently increased activity bilaterally in the anterior part of the BNST complex compared to the no-shock context (Table 1).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Consistent with the voxel-wise analyses, there was a trend for Ucxt to show greater sustained activity in dorsal BNST relative to Ncxt (t17=1.82, P=0.08).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Follow-up analyses of left and right dorsal amygdala ROIs yielded a similar result (left, t17=0.23, P=0.82; right, t17=0.71, P=0.49).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Importantly, unpredictable threat elicited sustained increased activity in the dorsal portion of the BNST complex (Table 1, Fig. 3C) in the approximate vicinity of the supracapsular BNST.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“This contrast revealed greater brain activity to Pcue than Ucue in a region of the dorsal amygdala overlapping the dorsal amygdala activation in Pcue>Ncue (Table 1).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“but that only unpredictable threat produced sustained activity in a forebrain region corresponding to the bed nucleus of the stria terminalis complex”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Abstract
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In the paper
“In addition, Uons compared to Pons showed that transient activity in anterior BNST was greater to the unpredictable context than the predictable context (t17=2.27, P<0.05), and Pons compared to Nons showed that transient activation of anterior BNST tended to be greater to the predictable context than the no-shock context (t17=1.93, P<0.07).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“However, when whole-brain correction was performed using a voxel-wise threshold of P<0.05, the unpredictable context showed a sustained deactivation in subgenual anterior cingulate cortex (sACC) relative to the predictable context (Table 2)”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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- It may state two separate claims as one. 39
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In the paper
“Transient activation of the ventral amygdala was present but not statistically significant after correction.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“We found no significant differences in sustained activity in the extended amygdala between unpredictable and predictable contexts, or predictable and no-shock contexts (Table 1).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“and that the unpredictable context (Ucxt) [ANX: 7.3 (0.3); SCR: 0.33 (0.06)] was more anxiogenic than the no-shock context (Ncxt) [ANX: 0.7 (0.2); t17=18.5, P<0.001; SCR: 0.14 (0.03); t17=4.8, P<0.001] and predictable context (Pcxt) [ANX: 4.3 (0.5); t17=7.7, P<0.001; SCR: 0.26 (0.04); t17=1.8, P=0.09].”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Follow-up analyses indicated that increased transient activity in response to unpredictable threat was significant in the right dorsal amygdala but not the left (Fig. 5A; left, t17=0.58; P=0.57; right, t17=2.57; P=0.02).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“The predictable context also generated sustained increased activity in superior and middle frontal cortex, and sustained decreased activity in the cerebellum and medial orbital cortex relative to the no-shock context (Table 2).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“With this value temporarily removed from the analysis, the difference in sustained activity between Ucxt and Ncxt was significant in bilateral dorsal BNST (t16=2.27, P=0.037) and left dorsal BNST (left, t16=2.89, P=0.011; right, t16=1.44, P=0.17).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Subjects rated the shock level used in the study as moderately painful (mean=3.4; SD=0.4) based on a 1–5 scale (1, not at all; 3, moderately; 5, extremely).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
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In the paper
“The peak coordinates of the right BNST (9 0 10) activation were identical to those associated with the onset of unpredictable threat, but the peak coordinates of the left BNST (−6 0 6) activation were slightly more posteromedial and ventral compared to those associated with unpredictable threat onset (−9 2 10 ).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“We also found sustained increased activity in anterior insula, frontal (superior, inferior, middle, frontopolar) and inferior parietal cortical regions, and the mid-cingulate (Table 2, Fig. 4C and D).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“As in the voxel-wise analyses, no significant differences were found in sustained activity in dorsal BNST between unpredictable and predictable contexts (Ucxt>Pcxt, t17=1.13, P=0.28), or predictable and no-shock contexts (Pcxt>Ncxt, t17=0.75, P=0.47).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Note that with the previously indentified “outlier” removed from the analysis, the linear trend in sustained activity across contexts was significant in bilateral dorsal BNST (F(1, 16)=5.17, P=0.037) and left dorsal BNST (left; F(1, 16)=8.37, P=0.010; right, F(1, 16)=2.07, P=0.169).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Whereas both predictable and unpredictable threat contexts evoked transient activity in sACC, thereafter unpredictable threat contexts were associated with a greater sustained decrease in sACC activity.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
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In the paper
“Rodent data suggest that phasic fear responses rely on the central nucleus of the amygdala (CeA), which in humans is located in the dorsal part of the amygdala (Amunts et al., 2005)”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
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In the paper
“a brief, discrete cue that predictably signals an imminent threat evokes a rapid apprehensive state (phasic fear) that diminishes quickly once the threat is terminated”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
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In the paper
“animal models of sustained fear posit that cortical inputs from the insula may also underlie sustained fear, possibly mediating cognitive components of anxious apprehension (Davis et al., 2010b).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Davis et al., 2010b
- Not checked yetcites McDonald et al., 1999 source
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In the paper
“neuroimaging studies in humans have likewise implicated the amygdala in fear acquisition and extinction (Buchel et al., 1998; LaBar et al., 1998; Milad et al., 2007; Phelps et al., 2004)”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
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In the paper
“However, Somerville et al. (2010) recently examined the role of the BNST in anxious-related vigilance.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Somerville et al. (2010) source
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In the paper
“Rodent data suggest that highly related but partially distinct functional neuroanatomical networks may underlie phasic and sustained fear (Davis et al., 2010b).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Davis et al., 2010b
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In the paper
“We tested these predictions using a well-validated instructed threat procedure (Davis et al., 2010b; Grillon et al., 2004), and neuroimaging methods that assured good signal detection of transient cue- and context-related responses, as well as sustained context-related responses in the basal forebrain.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Davis et al., 2010b
- Not checked yetcites Grillon et al., 2004 source
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In the paper
“sustained fear responses are dependent on the bed nucleus of the stria terminalis (BNST), which is located in the ventromedial basal forebrain and receives input from the CeA and the more ventrally located basolateral amygdala complex (BLC) (Walker and Davis, 2008)”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Walker and Davis, 2008 source
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In the paper
“Hasler et al. (2007) found that a visual threat cue increased cerebral blood flow in the left amygdala relative to a comparable safe cue.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Hasler et al. (2007) source
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In the paper
“Because the CeA and BNST project to the same neural mediators of fear symptoms, each of these components of the extended amygdala are capable of generating defensive responses (Davis and Whalen, 2001).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Davis and Whalen, 2001 source
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In the paper
“an area that also has strong projections to medial prefrontal cortical regions associated with the regulation of emotions and visceral reactions (Price and Drevets, 2010).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Price and Drevets, 2010 source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Though no shocks were ever administered, the threat cue evoked enhanced arousal and fear as indexed by skin conductance, and relative to the safe cue, produced a rapid and short-lasting activation in left dorsal amygdala.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Phelps et al. (2001) source
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In the paper
“compared to generic cost functionals, provides superior spatial alignment between T2*- and T1-weighted images in brain structures near the ventricles (Saad et al., 2009).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
What the sources say
- Not checked yetcites Saad et al., 2009 source
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In the paper
“This allowed us to conduct whole-brain fMRI at roughly 4 times higher spatial resolution (1.7 × 1.7 × 3.5 mm3) and still have enough sensitivity to detect BOLD signal changes (Bodurka et al., 2007).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Because animal models of sustained fear hypothesize that a part of the CeA different from that involved in phasic fear may be transiently involved in initiating sustained fear (Davis et al., 2010b), we tested for a transient fear response to unpredictable threat in bilateral dorsal amygdala.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
What the sources say
- Not checked yetcites Davis et al., 2010b
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In the paper
“A log transformation (log [1 + SCR]) was performed to normalize the distribution, and the magnitudes were range corrected (SCR/SCRmax) for each subject to attain statistical normality and to reduce error variance (Lykken and Venables, 1971).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
What the sources say
- Not checked yetcites Lykken and Venables, 1971
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“statistical conclusions concerning the extended amygdala were based on small volume correction (SVC) for multiple tests (Worsley et al., 1996).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Data analysis
What the sources say
- Not checked yetcites Worsley et al., 1996 source
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In the paper
“Anatomical delineation of the BNST was performed using a standardized protocol by a trained research assistant blind to the subjects' identity and adherence to the protocol was assessed by the first author.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Data analysis
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These results also confirm that under predictable threat, the cue elicited a phasic apprehensive state that was greater than that elicited by other cues, and greater than the predictable context in the absence of a cue.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
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In the paper
“Therefore, the absence of cues in Pcxt may have signaled relative safety; however, unlike Ncxt, Pcxt was not a safe context in an absolute sense because Pcxt was associated with cue-related shock, much like the context in background contextual conditioning studies (Calandreau et al., 2005).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
What the sources say
- Not checked yetcites Calandreau et al., 2005 source
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In the paper
“The above correction procedures resulted in a minimum cluster size threshold of 40 mm3 for the extended amygdala, and a minimum cluster size threshold of 120 mm3 for all other brain regions.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Data analysis
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In the paper
“To optimize our ability to detect fMRI signal changes from small brain structures and to avoid any reduction in spatial resolution, we did not spatially filter or smooth the EPI data.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
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In the paper
“Since entry into each context occurred at several locations within the VR environment, it is unlikely that the onset of a context would be associated with any specific cue within a context.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
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In the paper
“Imaging at a higher spatial resolution can decrease partial volume effects but can come at the cost of a reduced MRI signal-to-noise ratio (SNR) (Edelstein et al., 1986).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Introduction
What the sources say
- Not checked yetcites Edelstein et al., 1986 source
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Retrospective fear ratings obtained immediately following scanning were used to confirm understanding of the threat instructions.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Previous studies of instructed fear using simple threat cues (e.g., colored squares) have associated phasic fear responses with a left hemisphere bias (Phelps et al., 2001; Funayama et al., 2001; Hasler et al., 2007).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Results
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Besides the 18 subjects included in the study, 4 were excluded because of excessive shock-related head motion (n=1), failure of the shock delivery system (n=2), and scanner malfunction (n=1).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Subjects
Strength:plain· not yet calibratedn = 4Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All subjects in the study exhibited minimal head motion during imaging (mean= 2.1 mm, SD=1.6).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Subjects
Strength:plain· not yet calibratedn = 18Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Previous research in our laboratory has shown that similarly constructed VR stimuli are effective for studying context manipulations in the MRI environment (Alvarez et al., 2008).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
What the sources say
- Not checked yetcites Alvarez et al., 2008 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To ensure that subjects understood the threat procedure, they were exposed to the VR contexts and tone prior to the study, and were required to paraphrase the shock and no-shock contingencies.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of coregistration between EPI and anatomical datasets was visually verified for each subject.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Context assignment was reversed for the remaining subjects so as to counterbalance across subjects which environment was associated with predictable and unpredictable shock; the virtual restaurant was always the no-shock context.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“SCRs to cue and context onset that were contaminated by a shock, or an early cue in the case of a context, were omitted from analyses, assuring that the SCR data were not affected by nuisance factors.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Materials and methods > Experimental procedures
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“these results provide evidence that phasic and sustained fear in humans may manifest similar signs of distress, but appear to be associated with different patterns of neural activity in the human basal forebrain.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because subjects in the present study were forewarned of the threat associated with each cue, subjects encountering a predictable cue would be expected to engage in conscious appraisal of imminent threat.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“It is also consistent with previous studies showing a rapid reduction in amygdala activation over time in fear conditioning (Buchel et al., 1998; LaBar et al., 1998) and threat of shock (Phelps et al., 2001).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“This result is consistent with studies in rodents, primates, and humans that demonstrate a role for the CeA in mediating behavioral and physiological responses evoked by conditioned and unconditioned stimuli including contexts (Davis and Whalen, 2001; Kalin et al., 2004; LeDoux, 2000).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Hence, any conclusions regarding fMRI signals in the CeA must remain tentative.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
None of the sources cited for this claim have been checked yet.
In the paper
“This conjecture is supported by research indicating that the BLC is well positioned to receive incoming sensory information concerning threats in the environment, and to convey this information to output areas including the CeA and BNST (Amaral et al., 1992; Dong et al., 2001).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Amaral et al., 1992
- Not checked yetcites Dong et al., 2001 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This null finding is perplexing considering that ROIs typically increase the power to detect an effect.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The posterior cingulate and precuneus are part of a cortical midline network associated with self-referential processing in the spatial domain (Northoff et al., 2006)”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Northoff et al., 2006 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“It has been suggested that anterior insula might mediate cognitive aspects of worry (Walker and Davis, 2008).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Walker and Davis, 2008 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“According to this model, cortical and subcortical input converge on the basolateral amygdala and lateral CeA, which in turn project to the lateral BNST and trigger a cascade of neurochemical release, resulting in a relatively long-lasting apprehensive state.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Davis et al., 2010b
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“The supracapsular BNST is a small basal forebrain structure that is relatively well developed in humans (Strenge et al., 1977).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Strenge et al., 1977
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“A comparable area of the BNST has been associated with hypervigilant threat monitoring (Somerville et al., 2010).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Somerville et al., 2010 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“suggesting that imminent threats likely evoke greater phasic fear than temporally unpredictable threats, but the latter may give rise to greater vigilance.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Because enhanced activity in the BNST occurred during an anticipatory period of 10–28 s, Straube et al. (2007) interpreted their finding as evidence for BNST involvement in anticipatory anxiety.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Straube et al. (2007) source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This proposal is compatible with a recently described neural model of sustained fear (Davis et al., 2010b).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Davis et al., 2010b
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The supracapsular and lateral BNST share a similar cellular and neurochemical makeup, and the supracapsular BNST merges into and shares afferent and efferent pathways with the lateral BNST (Shammah-Lagnado et al., 2000)”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Shammah-Lagnado et al., 2000 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Conscious appraisal processes have been hypothesized to involve a neural circuit including the dmPFC/dACC (Mechias et al., 2010).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Mechias et al., 2010 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This may account for the dynamic pattern of activation observed in sACC in response to unpredictable threat.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Contexts that signal a longer duration threat initially elicit transient activity in the ventral amygdala/hippocampus and dorsal amygdala, with the former structures possibly being responsible for activation of the latter.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Summary and caveats
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Subgenual anterior cingulate cortex (sACC) is central to the medial prefrontal network that has been associated with mood and anxiety dysregulation, and has been implicated in the regulation of visceral responses during stress and anxiety (Price and Drevets, 2010).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Price and Drevets, 2010 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, we suggest that long-duration states of anxiety engender hypervigilance mediated by frontoparietal networks, and modulation of visceral function via mechanisms within anterior insula, pACC and sACC.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Summary and caveats
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“The finding that unpredictable threat induced sustained activity of frontoparietal areas involved in sustained attention (Pardo et al., 1991), is consistent with previous neuroimaging studies linking unpredictable threat to hypervigilance (Carlsson et al., 2006; Hasler et al., 2007).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Pardo et al., 1991 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“In the present study, unpredictable threat contexts compared to predictable threat contexts elicited greater transient activity in pregenual anterior cingulate cortex (pACC), a cingulate subregion that differs from sACC in its cytological and transmitter receptor architecture (Palomero-Gallagher, et al., 2008).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Palomero-Gallagher, et al., 2008 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Although the medial prefrontal network was not the focus of this study, the activations observed in this network are consistent with previous imaging studies implicating medial prefrontal cortex in distal threat (Mobbs et al., 2009), and suggest that contextually induced sustained anxiety may involve complex oscillations in neural activity in key prefrontal regions such as pACC and sACC.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Mobbs et al., 2009 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Previous neuroimaging findings indicating that contextual fear conditioning elicits sustained activity in anterior insula are consistent with this interpretation (Alvarez et al., 2008).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Alvarez et al., 2008 source
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Notwithstanding the limitations of this investigation, the present study took advantage of recent advances in fMRI data acquisition and processing, allowing us to conduct whole-brain fMRI at about 4 times higher spatial resolution than typical fMRI studies, yet still have sufficient sensitivity to detect small signal changes in the basal forebrain.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Summary and caveats
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Clinical studies indicate that metabolism in sACC is elevated in the depressed phase relative to the remitted phase of the same patients with major depressive disorder (Drevets et al., 2008).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
- Not checked yetcites Drevets et al., 2008 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To sum up, the present study suggests that predictable and unpredictable threats can induce phasic and sustained fear in humans, and that these apprehensive states elicit distinct patterns of activation in the basal forebrain including, potentially, the extended amygdala.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Summary and caveats
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The finding that unpredictable threat induced sustained activity of frontoparietal areas involved in sustained attention (Pardo et al., 1991), is consistent with previous neuroimaging studies linking unpredictable threat to hypervigilance (Carlsson et al., 2006; Hasler et al., 2007).”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Predictable and unpredictable threat are associated with different patterns of brain activation
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The present study provides further support for this hypothesis.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Summary and caveats
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Conscious appraisal of predictable threat cues may activate threat evaluation processes in dmPFC/dACC.”
§ Phasic and sustained fear in humans elicits distinct patterns of brain activity > Discussion > Summary and caveats
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
The paper relies on this without support.
It is currently unclear whether similar mechanisms support the expression of phasic and sustained fear in humans.
“It is currently unclear whether similar mechanisms support the expression of phasic and sustained fear in humans.”
The paper relies on this without support.
Standard fMRI voxel volumes are typically not small enough to decrease partial volume effects nor provide the spatial resolution required to detect fMRI signal changes from small brain regions.
“Standard fMRI voxel volumes (e.g., 3.8 × 3.8 × 4.0 mm3) are typically not small enough to decrease partial volume effects nor do they provide the spatial resolution required to detect fMRI signal changes from small brain regions.”
The paper relies on this without support.
The transition at context onset prevented unwanted orienting responses.
“This transition at context onset prevented unwanted orienting responses.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Also, it appears to be involved in anticipatory anxiety and threat monitoring.[32][33][34]”
From Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder (2016) · cites this paper as [32]
In the citing paper
“both Alvarez et al (2011) and Mobbs et al (2010) also show amygdala activation during threat conditions, highlighting the well-documented role of the amygdala in evaluating threat”
From The human BNST: functional role in anxiety and addiction (2016) · cites this paper as Alvarez et al (2011)
In the citing paper
“Alvarez et al (2011) used the NPU-threat task to examine brain responses during unpredictable contexts compared with predictable contexts.Analogous to findings in rodents, the BNST was active during unpredictable threat ('anxiety') conditions but not during predictable threat ('fear') conditions, whereas the amygdala showed the opposite pattern-the amygdala was active during predictable threat”
From The human BNST: functional role in anxiety and addiction (2016) · cites this paper as Alvarez et al (2011)
Statistics that don’t add up
Each reported p-value recomputed from its test statistic and degrees of freedom.
Inconsistent p-value: F(1, 17)=4.21, p = .055
MinorThe paper reports p = .055 here; recomputing from the test statistic and its degrees of freedom gives p = .056. The check cannot tell whether the statistic or the p-value is the misprint.
Reported p = .055 · recomputed p = .056
“F(1, 17)=4.21, P=0.055”
Inconsistent p-value: F(1, 17)=5.80, p = .027
MinorThe paper reports p = .027 here; recomputing from the test statistic and its degrees of freedom gives p = .028. The check cannot tell whether the statistic or the p-value is the misprint.
Reported p = .027 · recomputed p = .028
“F(1, 17)=5.80, P=0.027”
Inconsistent p-value: F(1, 16)=8.37, p = .010
MinorThe paper reports p = .01 here; recomputing from the test statistic and its degrees of freedom gives p = .011. The check cannot tell whether the statistic or the p-value is the misprint.
Reported p = .01 · recomputed p = .011
“F(1, 16)=8.37, P=0.010”
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Doesn’t add upF(1, 17) = 5.8reported p = .027 · recomputed p = .028
“F(1, 17)=5.80, p = .027”
- Doesn’t add upF(1, 17) = 4.21reported p = .055 · recomputed p = .056
“F(1, 17)=4.21, p = .055”
- Doesn’t add upF(1, 16) = 8.37reported p = .01 · recomputed p = .011
“F(1, 16)=8.37, p = .010”
- Not confirmedF(1, 17) = 1.72reported p = .206 · recomputed p = .207
“F(1, 17)=1.72, p = .206”
- ConsistentF(1.6, 27.5) = 38.13reported p < .001 · recomputed p < .001
“F(1.6, 27.5)=38.13, p < .001”
- ConsistentF(1.6, 28.5) = 17.74reported p < .001 · recomputed p < .001
“F(1.6, 28.5)= 17.74, p < .001”
- ConsistentF(1, 17) = 343.2reported p < .001 · recomputed p < .001
“F(1,17)=343.2, p < .001”
- ConsistentF(1, 17) = 22.9reported p < .001 · recomputed p < .001
“F(1,17)=22.9, p < .001”
- ConsistentF(1, 17) = 19.44reported p < .001 · recomputed p < .001
“F(1, 17)=19.44, p < .001”
- ConsistentF(1, 17) = 14.45reported p = .0014 · recomputed p = .001
“F(1, 17)=14.45, p = .0014”
- ConsistentF(1, 17) = 3.32reported p = .086 · recomputed p = .086
“F(1, 17)=3.32, p = .086”
- ConsistentF(1, 16) = 5.17reported p = .037 · recomputed p = .037
“F(1, 16)=5.17, p = .037”
- ConsistentF(1, 16) = 2.07reported p = .169 · recomputed p = .169
“F(1, 16)=2.07, p = .169”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Self-check results appear here once an independent check has confirmed them.
Citations
Cites
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Neurocircuitry of Mood Disorders
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“Therefore, we further hypothesized that the threat of unpredictable shock would generate sustained activity in anterior insula, an area that also has strong projections to medial prefrontal cortical regions associated with the regulation of emotions and visceral reactions (Price and Drevets, 2010).”
InfluentialThe amygdala: Neurobiological aspects of emotion, memory, and mental dysfunction.
Aggleton, J. P. (1992) · Wiley-Liss eBooks · Cited by 1,536
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Figel, B., Brinkmann, L., Buff, C., Heitmann, C. Y., Hofmann, D., Bruchmann, M., Becker, M. P. I., Herrmann, M. J., & Straube, T. (2019) · NeuroImage: Clinical · doi:10.1016/j.nicl.2019.101735 · Cited by 38
Using the Threat Probability Task to Assess Anxiety and Fear During Uncertain and Certain Threat
Bradford, D. E., Magruder, K. P., Korhumel, R. A., & Curtin, J. J. (2014) · Journal of Visualized Experiments · doi:10.3791/51905 · Cited by 37
Gorka, S. M., Nelson, B. D., Sarapas, C., Campbell, M. L., Lewis, G. F., Bishop, J. R., Porges, S. W., & Shankman, S. A. (2013) · Journal of Psychophysiology · doi:10.1027/0269-8803/a000091 · Cited by 36
The neural basis of improved cognitive performance by threat of shock
Torrisi, S., Robinson, O. J., O’Connell, K., Davis, A., Balderston, N. L., Ernst, M., & Grillon, C. (2016) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsw088 · Cited by 40
Self-citationNeuroimaging the temporal dynamics of human avoidance to sustained threat
Schlund, M. W., Hudgins, C. D., Magee, S., & Dymond, S. (2013) · Behavioural Brain Research · doi:10.1016/j.bbr.2013.09.042 · Cited by 33
The Effect of Glucose on Hippocampal-Dependent Contextual Fear Conditioning
Glenn, D. E., Minor, T. R., Vervliet, B., & Craske, M. G. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.09.022 · Cited by 34
The relationship between dlPFC activity during unpredictable threat and CO2-induced panic symptoms
Balderston, N. L., Liu, J., Roberson‐Nay, R., Monique Ernst, D., & Grillon, C. (2017) · Translational Psychiatry · doi:10.1038/s41398-017-0006-5 · Cited by 33
Self-citationNelson, B. D., Liu, H., Sarapas, C., & Shankman, S. A. (2016) · Journal of Experimental Psychopathology · doi:10.5127/jep.048115 · Cited by 32
Gorka, S. M., Teppen, T. L., Radoman, M., Phan, K. L., & Pandey, S. C. (2019) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyz057 · Cited by 34
Depressed mood enhances anxiety to unpredictable threat
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Metadata
- Authors
- Alvarez, R. P., Chen, G., Bodurka, J., Kaplan, R., & Grillon, C.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Alvarez, Ruben P.
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 55
- Issue
- 1
- Pages
- 389-400
- ISSN
- 1053-8119 (ISSN-L)
- PMC
- PMC3100535
- OpenAlex
- W2027289999
- Semantic Scholar
- 99e0c06ed1cdabb20db71e1b5b5f5ffe3ba61183
- Cited by
- 299
- References
- 70
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 17 · 2023: 16 · 2022: 18 · 2021: 20 · 2020: 24 · 2019: 28 · 2018: 17 · 2017: 31 · 2016: 34 · 2015: 24 · 2014: 14 · 2013: 21 · 2012: 12
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- NeuroImage (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (ZIAMH002798)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- bed nucleus of the stria terminalis, anterior insula, hypervigilance, pregenual anterior cingulate cortex, subgenual anterior cingulate cortex, basal forebrain, skin conductance
- MeSH terms
- Brain, Fear, Humans, Magnetic Resonance Imaging, Male, Nerve Net, Young Adult
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