Neuroimaging of Pavlovian Fear Conditioning Processes in Patients With Pathological Anxiety

The University of Texas System (UT)

Status: Unknown

Conditions: Social Phobia; Post Traumatic Stress Disorder; Panic Disorder; Anxiety Disorders; Phobia

Treatments: Behavioral: Novelty facilitated extinction; Behavioral: Standard Extinction

Study type: Interventional

Funder types: Other

Identifiers

NCT03498599

UTfearconditioning

Details and patient eligibility

About

The purpose of this study is to use functional magnetic resonance imaging to investigate how the human brain learns to form associations between neutral and emotional stimuli. The study is based on the basic principles of Pavlovian conditioning.

When someone learns that a neutral stimulus (such as the sound of a bell) predicts an unpleasant stimulus (such as a mild electrical shock), the neutral stimulus takes on the properties of an emotional stimulus.

The investigators are interested in the neural processes involved in this learning in people with a clinical anxiety disorder and posttraumatic stress disorder (PTSD).

Full description

This study uses functional MRI in people with anxiety and stress-related disorders to evaluate the neural correlates of fear conditioning and extinction. During fear conditioning participants see a picture of a face that predicts a mild electrical shock to the wrist. Participants then return the next day to the scanner for a test of fear expression 24-hours after fear conditioning. The investigators are simultaneously measuring autonomic arousal in the scanner using measures of skin conductance responses (i.e., sweating).

The primary objective of this study is to evaluate different forms of Pavlovian fear extinction in patients who suffer from pathological anxiety. The investigators are interested in the effects of extinction and extinction retention over a delay in regions that are known to show abnormalities in anxiety populations. This includes the amygdala, ventromedial prefrontal cortex, and the hippocampus.

The study is testing behavioral strategies and does not include any pharmacological manipulations.

Enrollment: 40 estimated patients

Sex: All

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Male or female volunteer aged 18-50 years old
2. Able to understand procedures and agree to participate in the study by giving written informed consent.
3. Speaks fluent English.
4. Not taking illicit drugs.
5. No history of neurological problems.
6. Eligible for MRI, including no metal in the body or body piercings that cannot be removed.

Exclusion criteria

1. Current comorbid Axis 1 psychiatric disorder
2. Women who are current pregnant or breastfeeding
3. Lifetime diagnosis of any psychotic disorder, cognitive suicidal ideation, substance abuse or alcohol dependence, hoarding.
4. Medications that act on the central nervous system that interfere with interpretation of the findings (e.g., painkillers, Adderall)
5. Claustrophobia
6. Patients who are unable to comply with procedures or assessments.

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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40 participants in 2 patient groups

Novelty facilitated extinction

Experimental group

Description:

Behavioral intervention. After Pavlovian fear conditioning, the shock is omitted and replaced by a novel, surprising, and neutral auditory tone.

Treatment:

Behavioral: Novelty facilitated extinction

Standard extinction

Other group

Description:

The shock is omitted during standard extinction

Treatment:

Behavioral: Standard Extinction