Journal
ANXIETY STRESS AND COPING
Volume 22, Issue 1, Pages 5-25Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/10615800802478247
Keywords
mental imagery; fear; anxiety; social anxiety; phobia; GAD; panic; agoraphobia; startle; psychophysiology; comorbidity; depression; emotional reactivity; narrative imagery
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Funding
- NIMH NIH HHS [P50 MH052384-10, F31 MH069048, P50 MH052384, P50 MH 72850, P50 MH052384-07, F31 MH 069048, P50 MH052384-08, P50 MH072850, P50 MH052384-06, P50 MH052384-09] Funding Source: Medline
- NATIONAL INSTITUTE OF MENTAL HEALTH [P50MH072850, P50MH052384, F31MH069048] Funding Source: NIH RePORTER
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This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxiety disorder patients - panic disorder with agoraphobia, generalized anxiety disorder, or anxious patients with comorbid depression - show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxiety disorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.
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