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Reactivity to unpredictable threat as a treatment target for fear-based anxiety disorders

  • S. M. Gorka (a1), L. Lieberman (a2), H. Klumpp (a1), K. L. Kinney (a1) (a2), A. E. Kennedy (a1) (a3), O. Ajilore (a1), J. Francis (a1), J. Duffecy (a1), M. G. Craske (a4), J. Nathan (a1), S. Langenecker (a1), S. A. Shankman (a1) (a2) and K. L. Phan (a1) (a2) (a3) (a5)...

Abstract

Background

Heightened reactivity to unpredictable threat (U-threat) is a core individual difference factor underlying fear-based psychopathology. Little is known, however, about whether reactivity to U-threat is a stable marker of fear-based psychopathology or if it is malleable to treatment. The aim of the current study was to address this question by examining differences in reactivity to U-threat within patients before and after 12-weeks of selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioral therapy (CBT).

Methods

Participants included patients with principal fear (n = 22) and distress/misery disorders (n = 29), and a group of healthy controls (n = 21) assessed 12-weeks apart. A well-validated threat-of-shock task was used to probe reactivity to predictable (P-) and U-threat and startle eyeblink magnitude was recorded as an index of defensive responding.

Results

Across both assessments, individuals with fear-based disorders displayed greater startle magnitude to U-threat relative to healthy controls and distress/misery patients (who did not differ). From pre- to post-treatment, startle magnitude during U-threat decreased only within the fear patients who received CBT. Moreover, within fear patients, the magnitude of decline in startle to U-threat correlated with the magnitude of decline in fear symptoms. For the healthy controls, startle to U-threat across the two time points was highly reliable and stable.

Conclusions

Together, these results indicate that startle to U-threat characterizes fear disorder patients and is malleable to treatment with CBT but not SSRIs within fear patients. Startle to U-threat may therefore reflect an objective, psychophysiological indicator of fear disorder status and CBT treatment response.

Copyright

Corresponding author

*Address for correspondence: S. M. Gorka, Ph.D., Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA. (Email: sgorka2@uic.edu)

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Keywords

Reactivity to unpredictable threat as a treatment target for fear-based anxiety disorders

  • S. M. Gorka (a1), L. Lieberman (a2), H. Klumpp (a1), K. L. Kinney (a1) (a2), A. E. Kennedy (a1) (a3), O. Ajilore (a1), J. Francis (a1), J. Duffecy (a1), M. G. Craske (a4), J. Nathan (a1), S. Langenecker (a1), S. A. Shankman (a1) (a2) and K. L. Phan (a1) (a2) (a3) (a5)...

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