Relief from pain is positively valenced and entails reward-like properties. Notably, stimuli that became associated with pain relief elicit reward-like implicit responses too, but are explicitly evaluated by humans as aversive. Since the unpredictability of pain makes pain more aversive, this study examined the hypotheses that the predictability of pain also modulates the valence of relief-associated stimuli. In two studies, we presented one conditioned stimulus \((_{FORWARD}CS+)\) before a painful unconditioned stimulus (US), another stimulus \((_{BACKWARD}CS+)\) after the painful US, and a third stimulus (CS−) was never associated with the US. In Study 1, \(_{FORWARD}CS+\) predicted half of the USs while the other half was delivered unwarned and followed by \(_{BACKWARD}CS+\). In Study 2, all USs were predicted by \(_{FORWARD}CS+\) and followed by \(_{BACKWARD}CS+\). In Study 1 both \(_{FORWARD}CS+\) and \(_{BACKWARD}CS+\) were rated as negatively valenced and high arousing after conditioning, while \(_{BACKWARD}CS+\) in Study 2 acquired positive valence and low arousal. Startle amplitude was significantly attenuated to \(_{BACKWARD}CS+\) compared to \(_{FORWARD}CS+\) in Study 2, but did not differ among CSs in Study 1. In summary, predictability of aversive events reverses the explicit valence of a relief-associated stimulus.

The extinction of conditioned fear depends on an efficient interplay between the amygdala and the medial prefrontal cortex (mPFC). In rats, high-frequency electrical mPFC stimulation has been shown to improve extinction by means of a reduction of amygdala activity. However, so far it is unclear whether stimulation of homologues regions in humans might have similar beneficial effects. Healthy volunteers received one session of either active or sham repetitive transcranial magnetic stimulation (rTMS) covering the mPFC while undergoing a 2-day fear conditioning and extinction paradigm. Repetitive TMS was applied offline after fear acquisition in which one of two faces (CS+ but not CS−) was associated with an aversive scream (UCS). Immediate extinction learning (day 1) and extinction recall (day 2) were conducted without UCS delivery. Conditioned responses (CR) were assessed in a multimodal approach using fear-potentiated startle (FPS), skin conductance responses (SCR), functional near-infrared spectroscopy (fNIRS), and self-report scales. Consistent with the hypothesis of a modulated processing of conditioned fear after high-frequency rTMS, the active group showed a reduced CS+/CS− discrimination during extinction learning as evident in FPS as well as in SCR and arousal ratings. FPS responses to CS+ further showed a linear decrement throughout both extinction sessions. This study describes the first experimental approach of influencing conditioned fear by using rTMS and can thus be a basis for future studies investigating a complementation of mPFC stimulation to cognitive behavioral therapy (CBT).

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.

Fear and anxiety are crucial for adaptive responding in life‐threatening situations. Whereas fear is a phasic response to an acute threat accompanied by selective attention, anxiety is characterized by a sustained feeling of apprehension and hypervigilance during situations of potential threat. In the current literature, fear and anxiety are usually considered mutually exclusive, with partially separated neural underpinnings. However, there is accumulating evidence that challenges this distinction between fear and anxiety, and simultaneous activation of fear and anxiety networks has been reported. Therefore, the current study experimentally tested potential interactions between fear and anxiety. Fifty‐two healthy participants completed a differential fear conditioning paradigm followed by a test phase in which the conditioned stimuli were presented in front of threatening or neutral contextual images. To capture defense system activation, we recorded subjective (threat, US‐expectancy), physiological (skin conductance, heart rate) and visuocortical (steady‐state visual evoked potentials) responses to the conditioned stimuli as a function of contextual threat. Results demonstrated successful fear conditioning in all measures. In addition, threat and US‐expectancy ratings, cardiac deceleration, and visuocortical activity were enhanced for fear cues presented in threatening compared with neutral contexts. These results are in line with an additive or interactive rather than an exclusive model of fear and anxiety, indicating facilitated defensive behavior to imminent danger in situations of potential threat.

In classical conditioning, an initially neutral stimulus (conditioned stimulus, CS) becomes associated with a biologically salient event (unconditioned stimulus, US), which might be pain (aversive conditioning) or food (appetitive conditioning). After a few associations, the CS is able to initiate either defensive or consummatory responses, respectively. Contrary to aversive conditioning, appetitive conditioning is rarely investigated in humans, although its importance for normal and pathological behaviors (e.g., obesity, addiction) is undeniable. The present study intents to translate animal findings on appetitive conditioning to humans using food as an US. Thirty-three participants were investigated between 8 and 10 am without breakfast in order to assure that they felt hungry. During two acquisition phases, one geometrical shape (avCS+) predicted an aversive US (painful electric shock), another shape (appCS+) predicted an appetitive US (chocolate or salty pretzel according to the participants' preference), and a third shape (CS) predicted neither US. In a extinction phase, these three shapes plus a novel shape (NEW) were presented again without US delivery. Valence and arousal ratings as well as startle and skin conductance (SCR) responses were collected as learning indices. We found successful aversive and appetitive conditioning. On the one hand, the avCS+ was rated as more negative and more arousing than the CS and induced startle potentiation and enhanced SCR. On the other hand, the appCS+ was rated more positive than the CS and induced startle attenuation and larger SCR. In summary, we successfully confirmed animal findings in (hungry) humans by demonstrating appetitive learning and normal aversive learning.