Acquisition of CS-US contingencies during Pavlovian fear conditioning and extinction in social anxiety disorder and posttraumatic stress disorder

Background: Fear-based disorders, like social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD), are characterized by an exaggerated fear response and avoidance to trigger cues, suggesting transdiagnostic mechanism of psychopathology. Current theories suggest that abnormalities in conditioned fear is a primary contributor to the pathophysiology of these disorders. The primary goal of this study was to compare acquisition of conditioned stimulus (CS) and aversive unconditioned stimulus (US) contingencie, during fear learning and extinction in individuals with SAD and PTSD. Methods: In a standard Pavlovian fear conditioning-extinction paradigm we measured subjective UF expectancy ratings to different CSs in patients with SAD (n=16) compared to patients with PTSD (n=13) am healthy controls (n=15) Results: Both patient groups (SAD, PTSD) acquired differential conditioning between a CS that predicted UP (CS+) and a CS that never predicted the US (CS-), however, both groups reported an increased expectancy tha the US would occur following the CS-. Additionally, the PTSD group overestimated that the US would occur in general. Neither patient group showed evidence of successful extinction of the CS+-US contingency nor differentiated their expectation of US occurrence between the CS+ and CS- during extinction learning. Limitations: Group sample sizes were small and we did not include a trauma-exposed group without PTSD Conclusions: Both SAD and PTSD generalize expectations of an aversive outcome across CSs, even when a CSs never signals an aversive outcome and PTSD may tend to over-expect threat. Fear learning and extinction abnormalities may be a core feature underlying shared symptoms across fear-based disorders.