@phdthesis{Madeira2022,
  author    = {Madeira, Octavia},
  title     = {The Human-Experimental Virtual Elevated Plus-Maze as an Anxiety Model},
  doi       = {10.25972/OPUS-28147},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-281478},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {Anxiety research is one of the major psychological research domains and looks back on decades of research activity. Traditionally, novel theories and approaches are tested utilizing animal models. One way to study inherent anxiety in rodents is the elevated plus-maze (EPM). The EPM is a plus-shaped platform with two closed, i.e., walled, arms and two open unwalled arms. If given the opportunity to freely explore the apparatus, rodents instinctively avoid the open arms to protect themselves from predators. Hence, they spent less time on open and more time on closed arms, which is behaviorally associated with general anxiety. In the course of the pharmacological validation, it was found that this exploratory pattern can be reversed by anxiolytic substances, e.g., benzodiazepines, or potentiated by anxiogenics. One of the significant advantages of the EPM is that no prior training session is required in contrast to conditioning studies, thus allowing to observe natural behavior. Therefore, together with the economic and uncomplicated setup, the EPM has become a standard preclinical rodent anxiety test over the decades. In order to validate these rodent anxiety tests, there have recently been attempts to retranslate them to humans. A paramount of cross-species validation is not only the simple transferability of these animal tests but also the observation of anxiety behaviors that are evolutionarily conserved across species. Accordingly, it could be possible to conclude various factors associated with the etiology and maintenance of anxiety disorders in humans. So far, convincing translations of the EPM to humans are still lacking. For that reason, the primary aim of this dissertation is to retranslate the EPM throughout three studies and to evaluate cross-species validity critically. Secondly, the undertaken studies are set out to observe ambulatory activity equivalent to rodent EPM behavior, i.e., open arm avoidance. Thirdly, the undertaken studies aimed to assess the extent to which trait anxiety influences human exploratory activity on the platform to associate it with the assumption that rodent EPM-behavior is a reflection of general anxiety. Finally, virtual reality (VR) was the method of choice to maintain the economic advantage and adjust the EPM size to humans. Study 1 (N = 30) was set up to directly transfer the rodent EPM regarding test design and experimental procedure using a Computer Automatic Virtual Environment (CAVE). The results revealed that humans unlike rodents display a general open arms approach during free exploration. However, open arm avoidance was associated with high trait anxiety and acrophobia (fear of height), which was initially assessed as a control variable due to the virtual platform height. Regression analyses and subjective anxiety ratings hinted at a more significant influence of acrophobia on open arm avoidance. In addition, it was assumed that the open arms approach might have resulted from claustrophobic tendencies experienced in the closed arms due to the high walls. Study 2 (N = 61) sought to differentiate the influence of trait anxiety and acrophobia and adapt the virtual EPM to humans. Therefore, parts of the platform held a semi-transparent grid-floor texture, and the wall height on the closed arms was reduced to standard handrail level. Moreover, participants were priorly screened to exclude clinically significant levels of acrophobia, claustrophobia, and agoraphobia. The data on general exploratory activity showed no arm preference. Regression analyses confirmed that acrophobia is related to open arm avoidance, corroborating the finding of Study 1. Surprisingly, for trait anxiety, the result of Study 1 could not be replicated. Instead, for trait anxiety, no significant effect was found indicating that predominantly fear of heights shapes human EPM behavior even on a subclinical stage. In Study 3 (N = 57), the EPM was embedded into a city setting to 1) create a more natural human environment and 2) eliminate height. Furthermore, a head-mounted display was utilized for VR presentation, and arousal ratings were introduced. Participants were screened for high and low levels of trait anxiety and agoraphobia, and claustrophobia. Replicating the findings of Study 2, no difference in open and closed arm activity was observed, and no effect was found in relationship with trait anxiety. The data on anxiety ratings and claustrophobia suggest a positive correlation indicating that in this city EPM, claustrophobic tendencies might play a role in closed arm avoidance. In summary, this thesis added valuable insights into the retranslation of a well-established standard anxiety test used in rodents. However, it also majorly challenges current findings on the cross-species validity of the EPM. Various explanatory models for the results are critically discussed and associated with clinical implications concerning future research.},
  subject      = {Virtuelle Realit{\"a}t},
  language  = {en}
}
@phdthesis{Genheimer2020,
  author    = {Genheimer, Hannah},
  title     = {The acquisition of anxiety and the impact of transcutaneous vagus nerve stimulation on extinction learning in virtual contexts},
  doi       = {10.25972/OPUS-20639},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-206390},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2020},
  abstract  = {This thesis aims for a better understanding of the mechanisms underlying anxiety as well as trauma- and stressor-related disorders and the development of new therapeutic approaches. I was first interested in the associative learning mechanisms involved in the etiology of anxiety disorders. Second, I explored the therapeutic effects of transcutaneous vagus nerve stimulation (tVNS) as a promising new method to accelerate and stabilize extinction learning in humans. For these purposes, I applied differential anxiety conditioning protocols realized by the implementation of virtual reality (VR). Here, a formerly neutral virtual context (anxiety context, CTX+) is presented whereby the participants unpredictably receive mildly aversive electric stimuli (unconditioned stimulus, US). Another virtual context (safety context, CTX-) is never associated with the US. Moreover, extinction of conditioned anxiety can be modeled by presenting the same contexts without US delivery. When unannounced USs were administered after extinction, i.e. reinstatement, the strength of the "returned" conditioned anxiety can provide information on the stability of the extinction memory. In Study 1, I disentangled the role of elemental and conjunctive context representations in the acquisition of conditioned anxiety. Sequential screenshots of two virtual offices were presented like a flip-book so that I elicited the impression of walking through the contexts. Some pictures of CTX+ were paired with an US (threat elements), but not some other screenshots of the same context (non-threat elements), nor the screenshots depicting CTX- (safety elements). Higher contingency ratings for threat compared to non-threat elements revealed elemental representation. Electro-cortical responses showed larger P100 and early posterior negativity amplitudes elicited by screenshots depicting CTX+ compared to CTX- and suggested conjunctive representation. These results support the dual context representation in anxiety acquisition in healthy individuals. Study 2 addressed the effects of tVNS on the stabilization of extinction learning by using a context conditioning paradigm. Potentiated startle responses as well as higher aversive ratings in CTX+ compared to CTX- indicate successful anxiety conditioning. Complete extinction was found in startle responses and valence ratings as no differentiation between CTX+ and CTX- suggested. TVNS did not affect extinction or reinstatement of anxiety which may be related to the inappropriate transferability of successful stimulation parameters from epilepsy patients to healthy participants during anxiety extinction. Therefore, in Study 3 I wanted to replicate the modulatory effects of tVNS on heart rate and pain perception by the previously used parameters. However, no effects of tVNS were observed on subjective pain ratings, on pain tolerance, or on heart rate. This led to the conclusion that the modification of stimulation parameters is necessary for a successful acceleration of anxiety extinction in humans. In Study 4, I prolonged the tVNS and, considering previous tVNS studies, I applied a cue conditioning paradigm in VR. Therefore, during acquisition a cue (CS+) presented in CTX+ predicted the US, but not another cue (CS-). Both cues were presented in a second context (CTX-) and never paired with the US. Afterward, participants received either tVNS or sham stimulation and underwent extinction learning. I found context-dependent cue conditioning only in valence ratings, which was indicated by lower valence for CS+ compared to CS- in CTX+, but no differential ratings in CTX-. Successful extinction was indicated by equal responses to CS+ and CS-. Interestingly, I found reinstatement of conditioned fear in a context-dependent manner, meaning startle response was potentiated for CS+ compared to CS- only in the anxiety context. Importantly, even the prolonged tVNS had no effect, neither on extinction nor on reinstatement of context-dependent cue conditioning. However, I found first evidence for accelerated physiological contextual extinction due to less differentiation between startles in CTX+ compared to CTX- in the tVNS than in the sham stimulated group. In sum, this thesis first confirms the dual representation of a context in an elemental and a conjunctive manner. Second, though anxiety conditioning and context-dependent cue conditioning paradigms worked well, the translation of tVNS accelerated extinction from rats to humans needs to be further developed, especially the stimulation parameters. Nevertheless, tVNS remains a very promising approach of memory enhancement, which can be particularly auspicious in clinical settings.},
  subject      = {Angst},
  language  = {en}
}
@phdthesis{Wiemer2015,
  author    = {Wiemer, Julian},
  title     = {Maintaining factors of fear-relevant illusory correlations},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-116960},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2015},
  abstract  = {Biased cognitive processes are very likely involved in the maintenance of fears and anxiety. One of such cognitive processes is the perceived relationship between fear-relevant stimuli and aversive consequences. If this relationship is perceived although objective contingencies have been random, it is called an (a posteriori) illusory correlation. If this relationship is overestimated before objective contingencies are experienced, it is called an (a priori) expectancy bias. Previous investigations showed that fear-relevant illusory correlations exist, but very few is known about how and why this cognitive bias develops. In the present dissertation thesis, a model is proposed based on a review of the literature on fear-relevant illusory correlations. This model describes how psychological factors might have an influence on fear and illusory correlations. Several critical implications of the model were tested in four experiments. Experiment 1 tested the hypothesis that people do not only overestimate the proportion of aversive consequences (startle sounds) following emotionally negative stimuli (pictures of mutilations) relative to neutral stimuli (pictures of household objects), but also following highly arousing positive stimuli (pictures of erotic scenes), because arousal might be an important determinant of illusory correlations. The result was a significant expectancy bias for negative stimuli and a much smaller expectancy bias for positive stimuli. Unexpectedly, expectancy bias was restricted to women. An a posteriori illusory correlation was not found overall, but only in those participants who perceived the aversive consequences following negative stimuli as particularly aversive. Experiment 2 tested the same hypothesis as experiment 1 using a paradigm that evoked distinct basic emotions (pictures inducing fear, anger, disgust or happiness). Only negative emotions resulted in illusory correlations with aversive outcomes (startle sounds), especially the emotions of fear and disgust. As in experiment 1, the extent of these illusory correlations was correlated with the perceived aversiveness of aversive outcomes. Moreover, only women overestimated the proportion of aversive outcomes during pictures that evoked fear, anger or disgust. Experiment 3 used functional Magnetic Resonance Imaging (fMRI) to measure biased brain activity in female spider phobics during an illusory correlation paradigm. Both spider phobics and healthy controls expected more aversive outcomes (painful electrical shocks) following pictures of spiders than following neutral control stimuli (pictures of mushrooms). Spider phobics but not healthy controls overestimated the proportion of aversive outcomes following pictures of spiders in a trial-by-trial memory task. This a posteriori illusory correlation was correlated with enhanced shock aversiveness and activity in primary sensory-motor cortex in phobic participants. Moreover, spider phobics' brain activity in the left dorsolateral prefrontal cortex was elevated in response to spider images. This activity also predicted the extent of the illusory correlation, which supports the theory that executive and attentional resources play an important role in the maintenance of illusory correlations. Experiment 4 tested the hypothesis that the enhanced aversiveness of some outcomes would be sufficient to causally induce an illusory correlation. Neutral images (colored geometric figures) were paired with differently aversive outcomes (three startle sounds varying in intensity). Participants developed an illusory correlation between those images, which predicted the most aversive sound and this sound, which means that this association was overestimated relative to the other associations. The extent of the illusory correlation was positively correlated with participants' self-reported anxiety. The results imply that the previously found relationship between illusory correlations and outcome aversiveness might reflect a causal impact of outcome aversiveness or salience on illusory correlations. In sum, the conducted experiments indicate that illusory correlations between fear-relevant stimuli and aversive consequences might persist - among other factors - because of an enhanced aversiveness or salience of aversive consequences following feared stimuli. This assumption is based on correlational findings, a neural measure of outcome perception and a causal influence of outcome aversiveness on illusory correlations. Implications of these findings were integrated into a model of fear-relevant illusory correlations and potential implications are discussed. Future investigations should further elucidate the role of executive functions and gender effects. Moreover, the trial-by-trial assessment of illusory correlations is recommended to increase reliability of the concept. From a clinical perspective, the down-regulation of aversive experiences and the allocation of attention to non-aversive experiences might help to cure anxiety and cognitive bias.},
  subject      = {Verzerrte Kognition},
  language  = {en}
}