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Depressionen und Angststörungen sind die beiden häufigsten psychischen Erkrankungen. Für Angststörungen wurde in zahlreichen Untersuchungen die Bedeutung veränderter Muster in den basalen emotional-assoziativen Lernprozessen für die Ätiologie und Aufrechterhaltung der Erkrankung gezeigt. Hierzu zählen eine verstärkte Akquisitionsreaktion auf den konditionierten Stimulus, Defizite in der Inhibition der Furchtreaktion auf den Sicherheit signalisierenden Stimulus, Übergeneralisierung und Beeinträchtigungen in der Extinktion konditionierter Reaktionen.
Aufgrund der hohen Prävalenzen einer Komorbidität mit Depressionen rückte in den letzten Jahren zunehmend die Untersuchung der genannten Prozesse bei Depressionen in den Fokus. Hierfür konnten bisher keine einheitlichen Ergebnisse gezeigt werden.
Weiterhin wird der Subtyp der ängstlichen Depression einerseits mit hohen Prävalenzen beschrieben, andererseits zeigen Untersuchungen eine schlechtere Prognose, stärkere Einschränkungen in der Funktionalität und ein schlechteres Ansprechen auf die Therapie im Vergleich zu depressiven Patienten ohne hohes Ängstlichkeitsniveau.
In dieser Arbeit wurden die Akquisition, Generalisierung und Extinktion in einem differentiellen Konditionierungsparadigma bei schwer depressiven ängstlichen und nicht ängstlich-depressiven Patienten sowie einer gesunden Kontrollgruppe untersucht. Ängstliche und nicht ängstlich-depressive Patienten zeigten ein beeinträchtigtes Sicherheitslernen in der Akquisition und Beeinträchtigungen in der Extinktion der konditionierten Furcht. Es ergaben sich keine Unterschiede hinsichtlich der Stärke der Generalisierung zwischen Patienten und den gesunden Kontrollen und es konnten keine differenzierenden Muster zwischen den ängstlich- und den nicht ängstlich-depressiven Patienten gezeigt werden.
Zusammenfassend weisen die Ergebnisse auf Veränderungen im Furchtlernen bei Patienten mit Depressionen hin. Es konnten keine Belege für unterschiedliche Mechanismen im Furchtlernen von ängstlich- und nicht ängstlich-depressiven Patienten gefunden werden. Unsere Ergebnisse stützen somit die Klassifikation der ängstlichen Depression als Subtyp der Depression. Weiterhin weisen die Ergebnisse der beeinträchtigten Extinktion bei Patienten mit Depressionen darauf hin, dass Expositionselemente, welche bei der Therapie von Angststörungen als Verfahren der Wahl eingesetzt werden, auch bei der Behandlung von Depressionen integriert werden sollten, um so den Therapieerfolg zu verbessern.
Abstract
Tobacco addiction is considered as a chronic relapsing disorder, characterized by compul-sive drug seeking and intake. Learning processes are stressed to account for the situational-specific expression of core features of the disorder, e.g., craving for drug, tolerance and ex-cessive consumption. According to incentive theories, smoke conditioned stimuli are hy-pothesized to be appetitive in nature, promoting craving, approach and consummatory be-havior. Commonly, smoking cues are treated as simple excitatory conditioned stimuli formed by a close and reliable overlap with the drug effect. However, the smoking ritual comprises a multitude of stimuli which may give rise to different forms of learning and con-ditioned responses partially opposing each other. Previous research suggests the predictive content and the temporal proximity of smoking stimuli to the drug effect as important de-terminants of cue reactivity. In contrast to stimuli related to the preparatory stage of smok-ing and the start of consumption (BEGIN stimuli), stimuli from the terminal stage of smok-ing (END stimuli) apparently lack high cue reactivity. Several lines of evidence suggest the poor cue properties of terminal stimuli to be related to their signaling of poor smoke availa-bility. Indeed, cue reactivity is commonly decreased when smoking appears to be unavaila-ble. Moreover, the learning literature suggests that stimuli predictive for the non-availability of reward may acquire the capacity to modulate or oppose the responses of ex-citatory conditioned stimuli. Therefore, the aim of the present thesis was to enhance our knowledge of stimulus control in human drug addiction and incentive motivation by running a series of conditioning studies with smoke intake and monetary reward as reinforcer. Sub-jective report and physiological measures of motivational valence and consummatory re-sponse tendencies were used as dependent variables.
The first experiment of this thesis used a differential conditioning paradigm to reveal evi-dence for the conditioning of preparatory and consummatory responses to a CS+ for smok-ing. Neutral pictograms served as CSs and single puffs on a cigarette as US. In line with the predictions of incentive theories, the excitatory CS+ for smoking acquired the ability to evoke an appetitive conditioned response, as indicated by enhanced activity of the M. zy-gomaticus major. Moreover, anticipation of puffing on the cigarette increased the activity of the M. orbicularis oris (lip muscle), indicating the activation of consummatory response tendencies. Finally, the CS+ evoked stronger skin conductance responses, indicative of in-creased autonomic arousal and orienting in preparation for action. In contrast, the rating data were apparently unaffected by the experimental contingency. In sum, the physiological data provide support for the notion that excitatory smoke conditioning gives rise to appeti-tive and consummatory conditioned responses, which may at least partially contribute to the maintenance of tobacco addiction.
The second experiment of this thesis adapted the conditioning protocol of the first study to probe the functional significance of terminal stimuli in the control of addictive behavior. This study manipulated the predictive relationship of BEGIN and END stimuli to smoke rein-forcement to provide further support for the differential reactivity to both stimuli and the retarded (i.e., delayed) conditioning of END stimuli. Overall, the results of the first study of this thesis were conceptually replicated as the association of a BEGIN stimulus with smoke intake resulted in the acquisition of appetitive and consummatory physiological responses. Importantly, the results revealed evidence for a retarded excitatory conditioning of END stimuli. Thus, pairing of an END stimulus with smoke intake failed to produce a conditioned discrimination in terms of motivational valence and autonomic arousal, as indicated by the activity of the M. corrugator supercilii and the skin conductance data. These results provide further support for the notion that END stimuli may be weak cues for smoking. Moreover, in light of the results of the first study of this thesis, the retarded excitatory conditioning of terminal stimuli may be suggestive of an inhibitory response component, which may be re-lated to their signaling of poor smoke availability. In sum, these results add to a growing body of data, which suggest that the expression of cue reactivity may be modulated by the temporal proximity and the availability of the drug effect.
The aim of the third study of this thesis was to provide “proof of concept” for an inhibi-tory conditioning notion of terminal stimuli. In this analog study BEGIN and END stimuli were emulated as discriminative SD and S for monetary reward. During an acquisition phase conditioned inhibition was established to the S predictive of the non-availability of re-ward. Subsequently a retardation test was used to substantiate conditioned inhibition. In this test, excitatory conditioning of the previous S was compared to the excitatory condi-tioning of a novel control stimulus. Importantly, the results revealed evidence for reward conditioned inhibition as indicated by the retarded acquisition of subjective (pleasure and reward expectancy) and physiological (skin conductance and activity of the M. orbicularis oculi) responses. In sum, these results provide support for the notion that stimuli predictive for the non-availability of reward may acquire the capacity to oppose the responses of ex-citatory conditioned stimuli. Thus, future research may benefit from the consideration of inhibitory conditioning processes in drug addiction, which may be of theoretical, methodo-logical and clinical importance.
In sum, the present thesis revealed evidence for 1) an appetitive nature of excitatory condi-tioned smoking cues, 2) the dependency of this learning process on the temporal position of the conditioned stimuli in the intake ritual and 3) the acquisition of conditioned inhibition by a stimulus predictive for the non-availability of reward, as evident in retarded excitatory conditioning. Overall, these studies made a novel contribution to the field of human drug addiction and incentive motivation and provided valuable suggestions for further research.
The propounded thesis investigated fear learning including fear conditioning, its generalization as well as its extinction in 133 healthy children and adolescents aged 8 to 17 years. The main goal was to analyze these processes also in the course of childhood and adolescence due to far less research in this age span compared to adults. Of note, childhood is the typical period for the onset of anxiety disorders. To achieve this, an aversive discriminative fear conditioning, generalization and extinction paradigm, which based on the “screaming lady paradigm” from Lau et al. (2008) and was adapted by Schiele & Reinhard et al. (2016), was applied. All probands traversed the pre-acquisition (4 x CS-, 4 x CS+, no US), the acquisition (12 x CS-, 12 x CS+, reinforcement rate: 83%), the generalization (12 x CS-, 12 x GS4, 12 x GS3, 12 x GS2, 12 x GS1, 12 x CS+, reinforcement rate: 50%) and the extinction (18 x CS-, 18 x CS+, no US). The generalization stimuli, i.e. GS1-GS4, were built out of CS- and CS+ in different mixtures on a percentage basis in steps of 20% from CS- to CS+. Pictures of faces of two actresses with a neutral expression were used for the discriminative conditioning, whereby the CS+ was paired with a 95-dB loud female scream at the same time together with a fearful facial expression (US). CS- and GS1-GS4 were never followed by the US. Subjective ratings (arousal, valence and US expectancy) were collected and further the psychophysiological measure of the skin conductance response (SCR). The hypotheses were 1) that underage probands show a negative correlation between age and overgeneralization and 2) that anxiety is positively correlated with overgeneralization in the same sample. ANOVAs with repeated measures were conducted for all four dependent variables with phase (pre-acquisition phase, 1. + 2. acquisition phase, 1. + 2. generalization phase, 1. - 3. extinction phase) and stimulus type
(CS-, CS+, GS1-GS4) as within-subject factors. For the analyses of the modulatory effects of age and anxiety in additional separate ANCOVAs were conducted including a) age, b) the STAIC score for trait anxiety and c) the CASI score for anxiety sensitivity as covariates. Sex was always included as covariate of no interest. On the one hand, findings indicated that the general extent of the reactions (arousal, valence and US expectancy ratings and the SCR) decreased with growing age, i.e. the older the probands the lower their reactions towards the stimuli regardless of the type of dependent variable. On the other hand, ratings of US expectancy, i.e. the likelihood that a stimulus is followed by a US (here: female scream coupled with a fearful facial expression), showed better discrimination skills the older the probands were, resulting in a smaller overgeneralization within older probands. It must be emphasized very clearly that no causality can be derived. Thus, it was only an association revealed between
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age and generalization of conditioned fear, which is negative. Furthermore, no obvious impact of trait anxiety could be detected on the different processes of fear learning. Especially, no overgeneralization was expressed by the probands linked to higher trait anxiety. In contrast to trait anxiety, for anxiety sensitivity there was an association between its extent and the level of fear reactions. This could be described best with a kind of parallel shifts: the higher the anxiety sensitivity, the stronger the fear reactions. Likewise, for anxiety sensitivity no overgeneralization due to a stronger extent of anxiety sensitivity could be observed.
Longitudinal follow-up examinations and, furthermore, neurobiological investigations are needed for replication purposes and purposes of gaining more supporting or opposing insights, but also for the profound exploration of the impact of hormonal changes during puberty and of the maturation processes of different brain structures. Finally, the question whether enhanced generalization of conditioned fear facilitates the development of anxiety disorders or vice versa remains unsolved yet.
Renewal of fear is one form of relapse that occurs after successful therapy, resulting from an encounter with a feared object in a context different from the context of the exposure therapy. According to Bouton (1994), the return of fear, provoked by context change, indicates that the fear was not erased in the first place. More importantly, the return of fear indicates that during the exposure session a new association was learned that connected the feared object with “no fear”; yet, as Bouton further argues, this association is context dependent. Such dependence could explain effects like renewal. In a new context, the therapeutic association will not be expressed and thus will no longer inhibit the fear. The assumption that an association is context dependent has been tested and showed robust results (Balooch & Neumann, 2011; Siavash Bandarian Balooch, Neumann, & Boschen, 2012; Culver, Stoyanova, & Craske, 2011; Kim & Richardson, 2009; Neumann & Kitlertsirivatana, 2010). Research for the treatment of anxiety disorders, aiming to reduce fear and, more importantly, prevent relapse, is flourishing. There are several exposure protocols currently under investigation: multiple contexts exposure (MCE), which aims at reducing the return of fear due to renewal (e.g., Balooch & Neumann, 2011); prolonged exposure (PE), which aims at strengthening the inhibitory association during the extinction learning (e.g., Thomas, Vurbic, & Novak, 2009); and reconsolidation update (RU), which aims at “updating” the reconsolidation process by briefly exposing the CS+ before the actual extinction takes place (Schiller et al., 2010). So far, however, few clinical studies conducted on humans have investigated these novel treatment protocols, and as far as I know none has investigated the mechanisms of action behind these protocols with a human clinical sample. The present thesis has three main goals. The first is to demonstrate that exposure therapy in multiple contexts reduces the likelihood of renewal. The second is to examine the mechanisms contributing to the effect of MCE and the third is to shed light on the concept of context in the framework of the conditioning and extinction paradigm. To this end, three studies were conducted. The first study investigated the effect of MCE on renewal, the second and third studies examined working mechanisms of MCE. In the first study thirty spider-phobic participants were exposed four times to a virtual spider. The exposure trials were conducted either in one single context or in four different contexts. Finally, all participants completed both a virtual renewal test, with the virtual spider presented in a novel virtual context, and an in vivo behavioral avoidance test with a real spider. This study successfully demonstrated the efficacy of MCE on reducing renewal. Study 2 investigated the working mechanisms behind MCE by utilizing a differential conditioning paradigm and conducting the extinction in multiple contexts, targeting similar renewal attenuation as achieved in study 1. This was followed by two tests that attempted to reveal extinction-relevant associations like ones causing context inhibitory effects. This study had three main hypotheses: (1) The extinction context is associated with the exposure, and thus operates as a safety signal at some point during the extinction; it will therefore compete with the safety learning of the CS, leading to a decreased extinction effect on the CS if the extinction is conducted in only one context. (2) The elements (e.g., room color, furniture) of the extinction context are connected to the therapeutic association and therefore should serve as reminders of the extinction, causing a stronger fear inhibition when presented during a test. (3) Therapy process factors, according to emotional processing theory, determine the renewal effect (e.g., initial fear activation, and within-session and between-session activation are correlated with the strength of renewal). In this study, however, no differences between the groups at the renewal phase were observed, presumably because the extinction was too strong to enable a renewal of fear at the test phase conducted immediately following the extinction. This hence rendered the two inhibitory tests useless. Study 3 aimed at defining the concept of context in the conditioning and exposure framework. Study 3 utilized the phenomenon known as generalization decrement, whereby a conditioned response is reduced due to change in the environment. This allowed context similarity to be quantified. After an acquisition phase in one context, participants were tested in one of three contexts, two of which differed in only one dimension (configuration of objects vs. features). The third group was tested in the same context and served as control group. The goal was to show that both configuration and features play an important role in the definition of context. There was, however, no significant statistical difference between the groups at the test phases, likely because of context novelty effects (participants exposed to a new context following extinction in another context expected a second extinction phase, and thus demonstrated greater fear than expected in all three groups).
Angststörungen gehören zu den häufigsten psychischen Erkrankungen in Deutschland, dabei könnten Hirnstimulationstechniken unterstützend zu bisherigen Therapieverfahren Anwendung finden. Für die Entstehung und Behandlung von Angststörungen spielen die Prozesse der Konditionierung und Extinktion eine große Rolle, wobei im präfrontalen Kortex eine erhöhte Aktivität gemessen werden kann. 51 gesunde Probanden nahmen an einem Furchtkonditionierungsexperiment mit zwei männlichen Gesichtern als CS+ und CS- sowie einem Schrei als aversiven Stimulus teil. Es wurde untersucht, inwieweit die bilaterale transkranielle Gleichstromstimulation (tDCS) des dorsolateralen präfrontalen Kortex die Extinktion moduliert. Die Stimulation erfolgte mittels tDCS links-kathodal über Position F3, rechts-anodal über Position F4 für 20 Minuten mit 2 mA und einer Elektrodengröße von 35 cm². Es wurden die Hautleitfähigkeit und der Startle-Reflex als physiologische Parameter der Furcht erfasst sowie Valenz und Arousal für die Stimuli durch subjektive Ratings erhoben. Bei den erfolgreich konditionierten Probanden (n = 28) kam es in der verum-tDCS-Gruppe während der frühen Extinktion zu einer signifikanten Zunahme der Hautleitfähigkeit auf CS-. Möglicherweise wurde durch die tDCS-Stimulation des dorsolateralen präfrontalen Kortex eine Furchtgeneralisierung ausgelöst. Ein anderer Erklärungsansatz für die gefundenen Ergebnisse ist die Modulation von Aufmerksamkeitsprozessen durch die Stimulation. Weitere Forschung ist nötig, bevor eine klinische tDCS-Anwendung bei Patienten mit Angststörungen möglich ist.
In situations of real threat, showing a fear reaction makes sense, thus, increasing the chance to survive. The question is, how could anybody differentiate between a real and an apparent threat? Here, the slogan counts “better safe than sorry”, meaning that it is better to shy away once too often from nothing than once too little from a real threat. Furthermore, in a complex environment it is adaptive to generalize from one threatening situation or stimulus to another similar situation/stimulus. But, the danger hereby is to generalize in a maladaptive manner involving as it is to strong and/or fear too often “harmless” (safety) situations/stimuli, as it is known to be a criterion of anxiety disorders (AD). Fear conditioning and fear generalization paradigms are well suited to investigate fear learning processes. It is remarkable that despite increasing interest in this topic there is only little research on fear generalization. Especially, most research on human fear conditioning and its generalization has focused on adults, whereas only little is known about these processes in children, even though AD is typically developing during childhood. To address this knowledge gap, four experiments were conducted, in which a discriminative fear conditioning and generalization paradigm was used.
In the first two experiments, developmental aspects of fear learning and generalization were of special interest. Therefore, in the first experiment 267 children and 285 adults were compared in the differential fear conditioning paradigm and generalization test. Skin conductance responses (SCRs) and ratings of valence and arousal were obtained to indicate fear learning. Both groups displayed robust and similar differential conditioning on subjective and physiological levels. However, children showed heightened fear generalization compared to adults as indexed by higher arousal ratings and SCRs to the generalization stimuli. Results indicate overgeneralization of conditioned fear as a developmental correlate of fear learning. The developmental change from a shallow to a steeper generalization gradient is likely related to the maturation of brain structures that modulate efficient discrimination between threatening and (ambiguous) safety cues. The question hereby is, at which developmental stage fear generalization gradients of children adapt to the gradients of adults. Following up on this question, in a second experiment, developmental changes in fear conditioning and fear generalization between children and adolescents were investigated. According to experiment 1 and previous studies in children, which showed changes in fear learning with increasing age, it was assumed that older children were better at discriminating threat and safety stimuli. Therefore, 396 healthy participants (aged 8 to 12 years) were examined with the fear conditioning and generalization paradigm. Again, ratings of valence, arousal, and SCRs were obtained. SCRs indicated differences in fear generalization with best fear discrimination in 12-year-old children suggesting that the age of 12 years seems to play an important role, since generalization gradients were similar to that of adults. These age differences were seen in boys and girls, but best discrimination was found in 12-year-old boys, indicating different development of generalization gradients according to sex. This result fits nicely with the fact that the prevalence of AD is higher in women than in men.
In a third study, it was supposed that the developmental trajectory from increased trait anxiety in childhood to manifest AD could be mediated by abnormal fear conditioning and generalization processes. To this end, 394 children aged 8 to 12 years with different scores in trait anxiety were compared with each other. Results provided evidence that children with high trait anxiety showed stronger responses to threat cues and impaired safety signal learning contingent on awareness as indicated by arousal at acquisition. Furthermore, analyses revealed that children with high trait anxiety showed overall higher arousal ratings at generalization. Contrary to what was expected, high trait anxious children did not show significantly more fear generalization than children with low trait anxiety. However, high-trait-anxious (HA) participants showed a trend for a more linear gradient, whereas moderate-trait-anxious (MA) and low-trait-anxious (LA) participants showed more quadratic gradients according to arousal. Additionally, after controlling for age, sex and negative life experience, SCR to the safety stimulus predicted the trait anxiety level of children suggesting that impaired safety signal learning may be a risk factor for the development of AD.
Results provide hints that frontal maturation could develop differently according to trait anxiety resulting in different stimuli discrimination. Thus, in a fourth experiment, 40 typically developing volunteers aged 10 to 18 years were screened for trait anxiety and investigated with the differential fear conditioning and generalization paradigm in the scanner. Functional magnetic resonance imaging (fMRI) were used to identify the neural mechanisms of fear learning and fear generalization investigating differences in this neural mechanism according to trait anxiety, developmental aspects and sex. At acquisition, HA participants showed reduced activation in frontal brain regions, but at generalization, HA participants showed an increase in these frontal regions with stronger linear increase in activation with similarity to CS+ in HA when compared to LA participants. This indicates that there is a hyper-regulation in adolescents to compensate the higher difficulties at generalization in form of a compensatory mechanism, which decompensates with adulthood and/or may be collapsed in manifest AD. Additionally, significant developmental effects were found: the older the subjects the stronger the hippocampus and frontal activation with resemblance to CS+, which could explain the overgeneralization of younger children. Furthermore, there were differences according to sex: males showed stronger activation with resemblance to CS+ in the hippocampus and frontal regions when compared to females fitting again nicely with the observation that prevalence rates for AD are higher for females than males.
In sum, the studies suggest that investigating developmental aspects of (maladaptive) overgeneralization may lead to better understanding of the mechanisms of manifest anxiety disorders, which could result in development and provision of prevention strategies. Although, there is need for further investigations, the present work gives some first hints for such approaches.
The thesis deals with the question which motivation direction—approach or avoidance—is connected to the emotion relief—a positive, low-arousal emotion, which is caused by an expected or nonexpected, motive-consistent change for the better, thus caused by the absence of an aversive stimulus. Based on the idea of postulating different levels of approach avoidance motivation, the Reflective-Impulsive Model of Behavior (RIM, Strack & Deutsch, 2004) is applied to relief and approach avoidance. The RIM differentiates between an impulsive and a reflective system of information processing, with both systems working in relative independence from each other. Two central variables moderate the relation between relief and approach avoidance. The first is the psychological system in which approach avoidance is processed and assessed. Two levels of approach avoidance are distinguished: an impulsive distance orientation (distance change in relation to specific stimuli) and a reflective goal orientation (attainment of positive versus avoidance of negative end states). The second is the psychological system in which relief developed: In the impulsive system, relief develops as the affect that is conditioned to the absence of negative states; in the reflective system, relief develops as a result of goal-oriented behaviour of controlling or preventing of negative stimulation. The thesis looks at both moderators (level of approach avoidance and psychological system of development of relief) at once. The central prediction for the impulsive distance orientation is: Relief leads to an approach distance orientation (distance reduction), independent from the system in which relief develops. The central prediction for the reflective goal orientation is: Relief leads to an avoidance goal orientation (control of negative end states). This latter prediction is only made for the case when relief was caused by (develops in) the reflective system, that is by one’s own, goal-directed behaviour; it is further necessary for an avoidance goal orientation that the relief state cannot certainly reached, instead there always has to uncertainty in the control of negative states. The methodology in the thesis is based on studies of aversive conditioning. In most studies, a differentiation paradigm is applied. The impulsive relief is operationalized via a classically conditioned relief (aversive CS-), whereas the reflective relief is operationalized via an active avoidance paradigm which ensures the methodological comparability of “reflective relief” to “impulsive relief”. The predictions are as follows: Prediction A: Relief will elicit positive affective valence and an approach distance orientation. This should be true for both relief that is caused by the impulsive system and for relief that is caused by the reflective system (Experiments 2-3). Prediction B: More positive valence of relief—caused by a larger change of affective states—will elicit a stronger approach distance orientation (Experiment 4). Prediction C: Relief caused by the impulsive system will not elicit a specific goal orientation (Experiment 5). Prediction D: Uncertain self-induced relief—caused by the reflective system—will elicit an avoidance goal orientation (Experiments 6-7). In addition, Experiment 1 validated the conditioning paradigm used for the elicitation of relief. The experiments in the thesis support all predictions made in the theoretical part. The work has implications for the assumptions made in the RIM (Strack & Deutsch, 2004). In the impulsive system, the affective valence determines approach avoidance orientation (e.g., R. Neumann & Strack, 2000), the reflective goal not playing an important role. Relief elicits an approach orientation in the impulsive system. In the reflective system, the active goal is decisive for the approach avoidance orientation. Uncertain self-caused relief elicits an avoidance goal orientation in the reflective system. The studies of the thesis thus support and validate the assumptions made in the RIM (Strack & Deutsch, 2004) in the specific field of motivational direction.
Anxiety is an affective state characterized by a sustained, long-lasting defensive response, induced by unpredictable, diffuse threat. In comparison, fear is a phasic response to predictable threat. Fear can be experimentally modeled with the help of cue conditioning. Context conditioning, in which the context serves as the best predictor of a threat due to the absence of any conditioned cues, is seen as an operationalization of sustained anxiety.
This thesis used a differential context conditioning paradigm to examine sustained attention processes in a threat context compared to a safety context for the first time. In three studies, the attention mechanisms during the processing of contextual anxiety were examined by measuring heart rate responses and steady-state-visually evoked potentials (ssVEPs). An additional focus was set on the processing of social cues (i.e. faces) and the influence of contextual information on these cues. In a last step, the correlates of sustained anxiety were compared to evoked responses by phasic fear, which was realized in a previously established paradigm combining predictable and unpredictable threat.
In the first study, a contextual stimulus was associated with an aversive loud noise, while a second context remained unpaired. This conditioning paradigm created an anxiety context (CTX+) and a safety context (CTX-). After acquisition, a social agent vs. an object was presented as a distractor in both contexts. Heart rate and cortical responses, with ssVEPs by using frequency tagging, to the contexts and the distractors were assessed. Results revealed enhanced ssVEP amplitudes for the CTX+ compared to the CTX− during acquisition and during presentation of distractor stimuli. Additionally, the heart rate was accelerated in the acquisition phase, followed by a heart rate deceleration as a psychophysiological marker of contextual anxiety.
Study 2 used the same context conditioning paradigm as Study 1. In contrast to the first study, persons with different emotional facial expressions were presented in the anxiety and safety contexts in order to compare the differential processing of these cues within periods of threat and safety. A similar anxiety response was found in the second study, although only participants who
Abstract
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were aware of the contingency between contexts and aversive event showed a sensory amplification of the threat context, indicated by heart rate response and ssVEP activation. All faces irrespective of their emotional expression received increased attentional resources when presented within the anxiety context, which suggests a general hypervigilance in anxiety contexts.
In the third study, the differentiation of predictable and unpredictable threat as an operationalization of fear and anxiety was examined on a cortical and physiological level. In the predictable condition, a social cue was paired with an aversive event, while in the unpredictable condition the aversive event remained unpaired with the respective cue. A fear response to the predictable cue was found, indicated by increased oscillatory response and accelerated heart rate. Both predictable and unpredictable threat yielded increased ssVEP amplitudes evoked by the context stimuli, while the response in the unpredictable context showed longer-lasting ssVEP activation to the threat context.
To sum up, all three studies endorsed anxiety as a long-lasting defensive response. Due to the unpredictability of the aversive events, the individuals reacted with hypervigilance in the anxiety context, reflected in a facilitated processing of sensory information and an orienting response. This hypervigilance had an impact on the processing of novel cues, which appeared in the anxiety context. Considering the compared stimuli categories, the stimuli perceived in a state of anxiety received increased attentional resources, irrespective of the emotional arousal conveyed by the facial expression. Both predictable and unpredictable threat elicited sensory amplification of the contexts, while the response in the unpredictable context showed longer-lasting sensory facilitation of the threat context.
Pavlovian fear conditioning describes a form of associative learning in which a previously neutral stimulus elicits a conditioned fear response after it has been temporally paired with an aversive consequence. Once acquired, the fear response can be extinguished by repeatedly presenting the former neutral stimulus in the absence of the aversive consequence. Although most patients suffering from anxiety disorders cannot recall a specific conditioned association between a formerly neutral stimulus and the feeling of anxiety, the produced behavioral symptoms, such as avoidance or safety behavior to prevent the anticipated aversive consequence are commonly exhibited in all anxiety disorders. Moreover, there is considerable similarity between the neural structures involved in fear and extinction in the rodent and in the human. Translational research thus contributes to the understanding of neural circuitries involved in the development and maintenance of anxiety disorders, and further provides hypotheses for improvements in treatment strategies aiming at inhibiting the fear response.
Since the failure to appropriately inhibit or extinguish a fear response is a key feature of pathological anxiety, the present preclinical research focuses on the interplay between the amygdala and the medial prefrontal cortex (mPFC) during fear learning with particular regard to the prefrontal recruitment during fear extinction and its recall. By firstly demonstrating an increased mPFC activity over the time course of extinction learning with functional near-infrared spectroscopy, the main study of this dissertation focused on repetitive transcranial magnetic stimulation (rTMS) as brain stimulation technique suitable to enhance extinction learning. Since hypofrontality is assumed to underlie the maintenance of pathological anxiety, rTMS application revealed an increased mPFC activity, which resulted in a decreased fear response on the behavioral level both during extinction learning as well as during the recall of extinction 24 hours later and in the absence of another stimulation. The following attempt to improve the generalization of extinction with rTMS from an extinguished stimulus to a second stimulus which was reinforced but not extinguished was at least partially evidenced. By revealing an increased prefrontal activity to the non-extinguished stimulus, the active and the placebo rTMS condition, however, did not differ on behavioral parameters. These preclinical findings were discussed in the light of genetic and environmental risk factors with special regard to the combination of a risk variant of the neuropeptide S receptor 1 gene polymorphism (NPSR1 rs324981) and anxiety sensitivity. While the protective homozygous AA genotype group showed no correlation with anxiety sensitivity, the NPSR1 T genotype group exhibited an inverse correlation with anxiety sensitivity in the presence of emotionally negative stimuli. In light of other findings assuming a role of the NPSR1 T allele in panic disorder, the revealed hypofrontality was discussed to define a risk group of patients who might particularly benefit from an augmentation of exposure therapy with rTMS.
Taken together, the presented studies support the central role of the prefrontal cortex in fear extinction and suggest the usefulness of rTMS as an augmentation strategy to exposure therapy in order to decrease therapy relapse rates. The combination of rTMS and extinction has been herein evidenced to modulate fear processes in a preclinical approach thereby establishing important implications for the design of future clinical studies.
In dieser Doktorarbeit habe ich die Regulation der Expression des zuckerbelohnten Verhaltens durch den Fütterungszustand bei Drosophila melanogaster untersucht. Die Fliegen können während einer Trainingsphase mit Hilfe einer Zuckerbelohnung auf einen bestimmten Duft konditioniert werden. Nach dem Training können die Fliegen dann auf das olfaktorische Gedächtnis getestet werden. Die Bereitschaft das zuckerkonditionierte Gedächtnis im Test zu zeigen wird vom Fütterungszustand kontrolliert, wie ich in Übereinstimmung mit den Ergebnissen früherer Arbeiten demonstrierte (Tempel et al. 1983; Gruber 2006; Krashes et al. 2008). Nur nicht gefütterte Fliegen exprimieren das Gedächtnis, während Fütterungen bis kurz vor dem Test eine reversibel supprimierende Wirkung haben. Einen ähnlichen regulatorischen Einfluss übt der Futterentzug auch auf die Expression anderer futterbezogener Verhaltensweisen, wie z.B. die naive Zuckerpräferenz, aus. Nachdem ich den drastischen Einfluss des Fütterungszustands auf die Ausprägung des zuckerkonditionierten Verhaltens gezeigt bzw. bestätigt hatte, habe ich nach verhaltensregulierenden Faktoren gesucht, die bei einer Fütterung die Gedächtnisexpression unterdrücken. Als mögliche Kandidaten untersuchte ich Parameter, die zum Teil bereits bei verschiedenen futterbezogenen Verhaltensweisen unterschiedlicher Tierarten als „Sättigungssignale“ identifiziert worden waren (Marty et al. 2007; Powley and Phillips 2004; Havel 2001; Bernays and Chapman 1974; Simpson and Bernays 1983; Gelperin 1971a). Dabei stellte sich heraus, dass weder die „ernährende“ Eigenschaft des Futters, noch ein durch Futteraufnahme bedingter Anstieg der internen Glukosekonzentration für die Suppression des zuckerkonditionierten Gedächtnisses notwendig sind. Die Unterdrückung der Gedächtnisexpression kann auch nicht durch Unterschiede in den aufgenommenen Futtermengen, die als verhaltensinhibitorische Dehnungssignale des Verdauungstrakts wirken könnten, oder mit der Stärke des süßen Geschmacks erklärt werden. Die Suppression des zuckerbelohnten Verhaltens folgte den Konzentrationen der gefütterten Substanzen und war unabhängig von deren chemischen Spezifität. Deshalb wird die Osmolarität des aufgenommenen Futters als ein entscheidender Faktor für die Unterdrückung der zuckerkonditionierten Gedächtnisexpression angenommen. Weil nur inkorporierte Substanzen einen Unterdrückungseffekt hatten, wird ein osmolaritätsdetektierender Mechanismus im Körper 67 postuliert, wahrscheinlich im Verdauungstrakt und/oder der Hämolymphe. Die Hämolymphosmolarität ist als „Sättigungssignal“ bei einigen wirbellosen Tieren bereits nachgewiesen worden (Bernays and Chapman 1974; Simpson and Raubenheimer 1993; Gelperin 1971a; Phifer and Prior 1985). Deshalb habe ich mit Hilfe genetischer Methoden und ohne die Fliegen zu füttern, versucht über einen künstlich induzierten Anstieg der Trehaloseund Lipidkonzentrationen die Osmolarität der Hämolymphe in Drosophila zu erhöhen. Eine solche konzentrationserhöhende Wirkung für Lipide und die Trehalose, dem Hauptblutzucker der Insekten, ist bereits für das adipokinetische Hormon (AKH), das von Zellen der Corpora cardiaca exprimiert wird, nachgewiesen worden (Kim and Rulifson 2004; Lee and Park 2004; Isabel et al. 2005). Es stellte sich heraus, dass die künstliche Stimulierung AKH-produzierender Neurone das zuckerkonditionierten Verhalten temporär, reversible und selektiv unterdrückt. Gleiche Behandlungen hatten keinen Effekt auf ein aversiv konditioniertes olfaktorisches Gedächtnis oder ein naives Zuckerpräferenzverhalten. Wie aus dieser Arbeit hervorgeht, stellt wahrscheinlich die Osmolarität des Verdauungstrakts und der Hämolymphe oder nur der Hämolymphe ein physiologisches Korrelat zum Fütterungszustand dar und wirkt als unterdrückendes Signal. Dass Fütterungen das zuckerkonditionierte Verhalten und die Zuckerpräferenz supprimieren, die künstliche Stimulation AKH-produzierender Zellen aber selektiv nur die zuckerbelohnte Gedächtnisexpression unterdrückt, deutet auf mindestens zwei unterschiedliche „Sättigungssignalwege“ hin. Außerdem macht es deutlich wie uneinheitlich futterbezogene Verhaltensweisen, wie das zuckerbelohnte Verhalten und die naive Zuckerpräferenz, reguliert werden.
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.
Endogenous clocks help animals to anticipate the daily environmental changes. These
internal clocks rely on environmental cues, called Zeitgeber, for synchronization. The
molecular clock consists of transcription-translation feedback loops and is located in
about 150 neurons (Helfrich-Förster and Homberg, 1993; Helfrich-Förster, 2005). The
core clock has the proteins Clock (CLK) and Cycle (CYC) that together act as a
transcription activator for period (per) and timeless (tim) which then, via PER and TIM
block their own transcription by inhibiting CLK/CYC activity (Darlington et al., 1998;
Hardin, 2005; Dubruille and Emery, 2008). Light signals trigger the degradation of TIM
through a blue-light sensing protein Cryptochrome (CRY) and thus, allows CLK/CYC to
resume per and tim transcription (Emery et al., 1998; Stanewsky et al., 1998).
Therefore, light acts as an important Zeitgeber for the clock entrainment. The
mammalian clock consists of similarly intertwined feedback loops.
Endogenous clocks facilitate appropriate alterations in a variety of behaviors
according to the time of day. Also, these clocks can provide the phase information to the
memory centers of the brain to form the time of day related associations (TOD). TOD
memories promote appropriate usage of resources and concurrently better the survival
success of an animal. For instance, animals can form time-place associations related to
the availability of a biologically significant stimulus like food or mate. Such memories will
help the animal to obtain resources at different locations at the appropriate time of day.
The significance of these memories is supported by the fact that many organisms
including bees, ants, rats and mice demonstrate time-place learning (Biebach et al.
1991; Mistlberger et al. 1997; Van der Zee et al. 2008; Wenger et al. 1991). Previous
studies have shown that TOD related memories rely on an internal clock, but the identity
of the clock and the underlying mechanism remain less well understood. The present
study demonstrates that flies can also form TOD associated odor memories and further
seeks to identify the appropriate mechanism.
Hungry flies were trained in the morning to associate odor A with the sucrose
reward and subsequently were exposed to odor B without reward. The same flies were
exposed in the afternoon to odor B with and odor A without reward. Two cycles of the
65
reversal training on two subsequent days resulted in the significant retrieval of specific
odor memories in the morning and afternoon tests. Therefore, flies were able to
modulate their odor preference according to the time of day. In contrast, flies trained in
a non-reversal manner were unable to form TOD related memories. The study also
demonstrates that flies are only able to form time-odor memories when the two
reciprocal training cycles occur at a minimum 6 h interval.
This work also highlights the role of the internal state of flies in establishing timeodor
memories. Prolonged starvation motivates flies to appropriate their search for the
food. It increases the cost associated with a wrong choice in the T-maze test as it
precludes the food discovery. Accordingly, an extended starvation promotes the TOD
related changes in the odor preference in flies already with a single cycle of reversal
training. Intriguingly, prolonged starvation is required for the time-odor memory
acquisition but is dispensable during the memory retrieval.
Endogenous oscillators promote time-odor associations in flies. Flies in constant
darkness have functional rhythms and can form time-odor memories. In contrast, flies
kept in constant light become arrhythmic and demonstrated no change in their odor
preference through the day. Also, clock mutant flies per01 and clkAR, show compromised
performance compared to CS flies when trained in the time-odor conditioning assay.
These results suggest that flies need a per and clk dependent oscillator for establishing
TOD related memories. Also, the clock governed rhythms are necessary for the timeodor
memory acquisition but not for the retrieval.
Pigment-Dispersing Factor (PDF) neuropeptide is a clock output factor (Park and
Hall, 1998; Park et al., 2000; Helfrich-Förster, 2009). pdf01 mutant flies are unable to
form significant time-odor memories. PDF is released by 8 neurons per hemisphere in
the fly brain. This cluster includes the small (s-LNvs) and large (l-LNvs) ventral lateral
neurons. Restoring PDF in these 16 neurons in the pdf01 mutant background rescues
the time-odor learning defect. The PDF neuropeptide activates a seven transmembrane
G-protein coupled receptor (PDFR) which is broadly expressed in the fly brain (Hyun et
al., 2005). The present study shows that the expression of PDFR in about 10 dorsal
neurons (DN1p) is sufficient for robust time-odor associations in flies.
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In conclusion, flies use distinct endogenous oscillators to acquire and retrieve
time-odor memories. The first oscillator is light dependent and likely signals through the
PDF neuropeptide to promote the usage of the time as an associative cue during
appetitive conditioning. In contrast, the second clock is light independent and
specifically signals the time information for the memory retrieval. The identity of this
clock and the underlying mechanism are open to investigation.
Eine der größten Herausforderungen in der Neurobiologie ist es, die neuronalen Prozesse zu verstehen, die Lernen und Gedächtnis zugrundeliegen. Welche biochemischen Pfade liegen z.B. der Koinzidenzdetektion von Reizen (klassische Konditionierung) oder einer Handlung und ihren Konsequenzen (operante Konditionierung) zugrunde? In welchen neuronalen Unterstrukturen werden diese Informationen gespeichert? Wie ähnlich sind die Stoffwechselwege, die diese beiden Arten des assoziativen Lernens vermitteln und auf welchem Niveau divergieren sie? Drosophila melanogaster ist wegen der Verfügbarkeit von Lern-Paradigmen und neurogenetischen Werkzeugen ein geeigneter Modell-Organismus, zum diese Fragen zu adressieren. Er ermöglicht eine umfangreiche Studie der Funktion des Gens S6KII, das in der Taufliege in klassischer und operanter Konditionierung unterschiedlich involviert ist (Bertolucci, 2002; Putz et al., 2004). Rettungsexperimenten zeigen, dass die olfaktorische Konditionierung in der Tully Maschine (ein klassisches, Pawlow’sches Konditionierungsparadigma) von dem Vorhandensein eines intakten S6KII Gens abhängt. Die Rettung war sowohl mit einer vollständigen, als auch einer partiellen Deletion erfolgreich und dies zeigt, dass der Verlust der phosphorylierenden Untereinheit der Kinase die Hauptursache des Funktionsdefektes war. Das GAL4/UAS System wurde benutzt, um die S6KII Expression zeitlich und räumlich zu steuern. Es wurde gezeigt, dass die Expression der Kinase während des adulten Stadiums für die Rettung hinreichend war. Dieser Befund schließt eine Entwicklungsstörung als Ursache für den mutanten Phänotyp aus. Außerdem zeigte die gezielte räumliche Rettung von S6KII die Notwendigkeit der Pilzkörper und schloss Strukturen wie das mediane Bündel, die Antennalloben und den Zentralkomplex aus. Dieses Muster ist dem vorher mit der rutabaga Mutation identifizierten sehr ähnlich (Zars et al., 2000). Experimente mit der Doppelmutante rut, ign58-1 deuten an, dass rutabaga und S6KII im gleichen Signalweg aktiv sind. Vorhergehende Studien hatten bereits gezeigt, dass die unterschiedlichen Ergebnisse bei operanter und klassischer Konditionierung auf verschiedenen Rollen für S6KII in den zwei Arten des Lernens hindeuten (Bertolucci, 2002; Putz, 2002). Diese Schlussfolgerung wurde durch den mutanten Phänotyp der transgenen Linien in der Positionskonditionierung und ihr wildtypisches Verhalten in der klassischen Konditionierung zusätzlich bekräftigt. Eine neue Art von Lern-Experiment, genannt „Idle Experiment“, wurde entworfen. Es basiert auf der Konditionierung der Laufaktivität, stellt eine operante Aufgabenstellung dar und überwindet einige der Limitationen des „Standard“ Heat-Box Experimentes. Die neue Art des Idle Experimentes erlaubt es, „gelernte Hilflosigkeit“ in Fliegen zu erforschen, dabei zeigte sich eine erstaunliche Ähnlichkeit zu den Vorgängen in komplizierteren Organismen wie Ratten, Mäusen oder Menschen. Gelernte Hilflosigkeit in der Taufliege wurde nur in den Weibchen beobachtet und wird von Antidepressiva beeinflusst.
Bei der Entstehung und Aufrechterhaltung von Furcht und Angsterkrankungen stellt, neben der Furchtkonditionierung, die Generalisierung der konditionierten Furcht einen wesentlichen Mechanismus dar. Die der Generalisierung zugrunde liegenden psychologischen und biologischen Prozesse sind jedoch beim Menschen bisher nur wenig untersucht.
Ziel dieser Arbeit war, anhand eines neu entwickelten experimentellen Paradigmas den Einfluss eines psychometrisch bestimmbaren angstspezifischen Faktors sowie der mit Furcht und Angst assoziierten Genotypen Stathmin1, COMT Val158Met und BDNF Val66Met auf die Furchtkonditionierung und Generalisierung konditionierter Furcht zu untersuchen und somit mögliche Risikofaktoren für die Entstehung von Angsterkrankungen zu bestimmen. Hierfür wurden N = 126 gesunde Versuchspersonen (n = 69 weiblich; mittleres Alter M = 23.05, SD = 3.82) für die genannten Polymorphismen genotypisiert und zu ängstlichen und affektiven Symptomen befragt. In einer Akquisitionsphase wurden den Probanden zwei neutrale weibliche Gesichter präsentiert (CS), von denen eines mit einem Schrei sowie einem ängstlichen Gesichtsausdruck (UCS) gepaart wurde. Der sich anschließende Generalisierungstest erfolgte anhand von vier Gesichtern, die in der Ähnlichkeit zwischen den beiden CS schrittweise übergingen. Die Furchtreaktion wurde über die Bewertung von Valenz, Arousal und Kontingenzerwartung sowie über die Hautleitfähigkeitsreaktion (SCR) erfasst.
Die Analyse der Fragebögen anhand einer Hauptachsenanalyse und anhand von Strukturgleichungsmodellen erbrachte eine zweifaktorielle Lösung, die die Konstrukte Depression und Angst abbildete. Nur der Faktor Angst war mit einer veränderten Furchtkonditionierung und Furchtgeneralisierung assoziiert: Hoch Ängstliche zeigten eine stärkere konditionierte Furchtreaktion (Arousal) und wiesen eine stärkere Generalisierung der Valenzeinschätzung und Kontingenzerwartung auf. Für den Stathmin1 Genotyp ergaben sich geschlechtsspezifische Effekte. Bei den männlichen Versuchspersonen zeigte sich in Folge der Akquisition ein stärkerer Abfall der Valenz für den CS+ in der Gruppe der Stathmin1 T Allelträger, die ebenfalls eine stärkere Generalisierung der Furchtreaktion, abgebildet in allen verbalen Maßen, aufwiesen. Ein gegenteiliger Befund ergab sich für die Gruppe der Frauen, insofern eine mit dem Stathmin1 C Allel assoziierte höhere Generalisierung der Valenz, des Arousals und der Kontingenzerwartung festgestellt werden konnte. Für den COMT Val158Met Genotyp ergaben sich keine Einflüsse auf die Akquisition der konditionierten Furcht. Für Träger des COMT 158Val Allels zeigte sich jedoch eine stärkere Generalisierung der Valenz und der Kontingenzerwartung. Auch für den BDNF Val66Met Genotyp konnte keine Veränderung der Furchtakquisition beobachtet werden. Es ergaben sich jedoch Hinweise auf eine erhöhte Generalisierung der Kontingenzerwartung in der Gruppe der BDNF 66Val Homozygoten. Für keinen der beschriebenen Faktoren konnte ein Einfluss auf die Furchtkonditionierung oder deren Generalisierung anhand der SCR abgebildet werden.
Unsere Ergebnisse weisen auf einen psychometrisch erfassbaren Faktor und genetische Einflüsse hin, die über den Prozess einer stärkeren Generalisierung der konditionierten Furcht das Risiko für die Entstehung von Angsterkrankungen erhöhen können. Jedoch sollten die Befunde in größeren Stichproben repliziert werden. Neben der frühzeitigen Identifikation von Risikofaktoren sollten in zukünftigen Studien darüber hinaus wirksame Maßnahmen zur Prävention und Intervention entwickelt werden, um diesem Risiko entgegen zu wirken.
Scientific surveys provide sufficient evidence that anxiety disorders are one of the most common psy-chiatric disorders in the world. The lifetime prevalence rate of anxiety disorder is 28.8% (Kessler, et al., 2005). The most widely studied anxiety disorders are as follows panic disorder (PD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), social phobia (or social anxiety disorder), specific phobias, and generalized anxiety disorder (GAD). (NIMH Article, 2009). Classical conditioning is the stable paradigm used from the last one century to understand the neurobi-ology of fear learning. Neurobiological mechanism of fear learning is well documented with the condi-tioning studies. In the therapy of anxiety disorders, exposure based therapies are known to be the most effective approaches. Flooding is a form of exposure therapy in which a participant is exposed to the fear situation and kept in that situation until their fear dissipates. The exposure therapy is based on the phenomena of extinction; this means that a conditioned response diminishes if the conditioned stimulus (CS) is repeatedly presented without an unconditioned stimulus (UCS). One problem with extinction as well as with exposure-based therapy is the problem of fear return (for e.g. renewal, spontaneous recov-ery and reinstatement) after successful extinction. Therefore, extinction does not delete the fear memory trace. It has been well documented that memory processes can be modulated or disrupted using several sci-entific paradigms such as behavioral (for e.g. exposure therapy), pharmacological (for e.g. drug manipu-lation), non-invasive stimulation (for e.g. non-invasive stimulation such as electroconvulsive shock (ECS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), etc. However, modulation of memory processes after reactivation or via non-invasive stimulation is still not clear, which is the focus of the current study. In addition, study of genetic variant suggests that genetic differences play a vital role in the psychiatric disorder especially in fear learning. Hence, it is also one of the concerns of the current dissertation to investigate the interaction between gene and reconsolidation of memory. With respect to fear-conditioning, there are three findings in the current dissertation, which are as fol-lows: (i) In the first study we investigated that non-invasive weak electrical stimulation interferes with the consolidation process and disrupts the fear consolidation to attain stable form. This might offer an effective treatment in the pathological memories, for e.g. PTSD, PD, etc. (ii) In the second study we demonstrated whether a brief single presentation of the CS will inhibit the fear recovery. Like earlier studies we also found that reactivation followed by reconsolidation douses fear return. Attenuation of fear recovery was observed in the reminder group compared to the no-reminder group. (iii) Finally, in our third study we found a statistically significant role of brain derived neurotrophic factor (BDNF) polymorphism in reconsolidation. Results of the third study affirm the involvement of BDNF variants (Met vs. Val) in the modulation of conditioned fear memory after its reactivation. In summary, we were able to show in the current thesis modulation of associative learning and recon-solidation via transcranial direct current stimulation and genetic polymorphism.
In order to survive, organisms avoid threats and seek rewards. Classical conditioning is a simple model to explain how animals and humans learn associations between events that allow them to predict threats and rewards efficiently. In the classical conditioning paradigm, a neutral stimulus is paired with a biologically significant event (the unconditioned stimulus – US). In virtue of this association, the neutral stimulus acquires affective motivational properties, and becomes a conditioned stimulus (CS+). Defensive responses emerge for pairings with an aversive US (e.g., pain), and appetitive responses emerge for pairing with an appetitive event (e.g., reward). It has been observed that animals avoid a CS+ when it precedes an aversive US during a training phase (CS+ US; forward conditioning); whereas they approach a CS+ when it follows an aversive US during the training phase (US CS+; backward conditioning). These findings indicate that the CS+ acquires aversive properties after a forward conditioning, whereas acquires appetitive properties after a backward conditioning. It is thus of interest whether event timing also modulates conditioned responses in such an opponent fashion in humans, who are capable of explicit cognition about the associations. For this purpose, four experiments were conducted in which a discriminative conditioning was applied in groups of participants that only differed in the temporal sequence between CS+ onset and US onset (i.e., the interstimulus interval – ISI). During the acquisition phase (conditioning), two simple geometrical shapes were presented as conditioned stimuli. One shape (CS+) was always associated with a mild painful electric shock (i.e., the aversive US) and the other one (CS-) was never associated with the shock. In a between-subjects design, participants underwent either forward or backward conditioning. During the test phase (extinction), emotional responses to CS+ and CS- were tested and the US was never presented. Additionally, a novel neutral shape (NEW) was presented as control stimulus. To assess cognitive components, participants had to rate both the valence (the degree of unpleasantness or pleasantness) and the arousal (the degree of calmness or excitation) associated with the shapes before and after conditioning. In the first study, startle responses, an ancestral defensive reflex consisting of a fast twitch of facial and body muscles evoked by sudden and intense stimuli, was measured as an index of stimulus implicit valence. Startle amplitude was potentiated in the presence of the forward CS+ whilst attenuated in the presence of the backward CS+. Respectively, the former response indicates an implicit negative valence of the CS+ and an activation of the defensive system; the latter indicated an implicit positive valence of the CS+ and an activation of the appetitive system. In the second study, the blood-oxygen level dependent (BOLD) response was measured by means of functional magnetic resonance imaging (fMRI) to investigate neural responses after event learning. Stronger amygdala activation in response to forward CS+ and stronger striatum activation in response to backward CS+ were found in comparison to CS-. These results support the notion that the defensive motivational system is activated after forward conditioning since the amygdala plays a crucial role in fear acquisition and expression. Whilst the appetitive motivational system is activated after backward conditioning since the striatum plays a crucial role in reward processing. In the third study, attentional processes underlying event learning were observed by means of steady-state visual evoked potentials (ssVEPs). This study showed that both forward and backward CS+ caught attentional resources. More specifically, ssVEP amplitude was higher during the last seconds of forward CS+ that is just before the US, but during the first seconds of backward CS+ that is just after the US. Supposedly, attentional processes were located at the most informative part of CS+ in respect to the US. Participants of all three studies rated both forward and backward CS+ more negative and arousing compared to the CS-. This indicated that event timing did not influence verbal reports similarly as the neural and behavioral responses indicating a dissociation between the explicit and implicit responses. Accordingly, dual process theories propose that human behavior is determined by the output of two systems: (1) an impulsive implicit system that works on associative principles, and (2) a reflective explicit system that functions on the basis of knowledge about facts and values. Most importantly, these two systems can operate in a synergic or antagonistic fashion. Hence, the three studies of this thesis congruently suggest that the impulsive and the reflective systems act after backward association in an antagonistic fashion. In sum, event timing may turn punishment into reward in humans even though they subjectively rate the stimulus associated with aversive events as being aversive. This dissociation might contribute to understand psychiatric disorders, like anxiety disorders or drug addiction.