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      High Current Anxiety Symptoms, But Not a Past Anxiety Disorder Diagnosis, are Associated with Impaired Fear Extinction

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          Abstract

          Although impaired fear extinction has repeatedly been demonstrated in patients with anxiety disorders, little is known about whether these impairments persist after treatment. The current comparative exploratory study investigated fear extinction in 26 patients treated for their anxiety disorder in the years preceding the study as compared to 17 healthy control subjects. Fear-potentiated startle and subjective fear were measured in a cue and context fear conditioning paradigm within a virtual reality environment. Results indicated no differences in fear extinction between treated anxiety patients and control subjects. However, scores on the Beck Anxiety Inventory across all participants revealed impaired extinction of fear potentiated startle in subjects with high compared to low anxiety symptoms over the past week. Taken together, this exploratory study found no support for impaired fear extinction in treated anxiety patients, and implies that current anxiety symptoms rather than previous patient status determine the success of extinction.

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          Most cited references40

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          Updated meta-analysis of classical fear conditioning in the anxiety disorders.

          The aim of the current study was twofold: (1) to systematically examine differences in fear conditioning between anxiety patients and healthy controls using meta-analytic methods, and (2) to examine the extent to which study characteristics may account for the variability in findings across studies. Forty-four studies (published between 1920 and 2013) with data on 963 anxiety disordered patients and 1,222 control subjects were obtained through PubMed and PsycINFO, as well as from a previous meta-analysis on fear conditioning (Lissek et al.). Results demonstrated robustly increased fear responses to conditioned safety cues (CS-) in anxiety patients compared to controls during acquisition. This effect may represent an impaired ability to inhibit fear in the presence of safety cues (CS-) and/or may signify an increased tendency in anxiety disordered patients to generalize fear responses to safe stimuli resembling the conditioned danger cue (CS+). In contrast, during extinction, patients show stronger fear responses to the CS+ and a trend toward increased discrimination learning (differentiation between the CS+ and CS-) compared to controls, indicating delayed and/or reduced extinction of fear in anxiety patients. Finally, none of the included study characteristics, such as the type of fear measure (subjective vs. psychophysiological index of fear), could account significantly for the variance in effect sizes across studies. Further research is needed to investigate the predictive value of fear extinction on treatment outcome, as extinction processes are thought to underlie the beneficial effects of exposure treatment in anxiety disorders.
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            Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire.

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              [The MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders].

              The MINI-International Neuropsychiatric Interview (MINI(-Plus)) is a structured diagnostic interview, developed to assess the diagnoses of psychiatric patients according to DSM-IV and ICD-10 criteria in less time than other diagnostic interviews such as the Structured Clinical Interview for DSM-IV disorders (SCID), the Composite International Diagnostic Interview (CIDI) or the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) tend to take. The good psychometric characteristics of the MINI (-Plus) make it a good choice for research purposes. Because of its brevity (20-30 minutes) the interview seems to be especially convenient for diagnosing psychiatric patients in everyday clinical practice. Initial experiences and results with the MINI-Plus in a selected group of Dutch psychiatric patients are described.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                26 February 2016
                2016
                : 7
                : 252
                Affiliations
                [1] 1Department of Clinical and Health Psychology, Utrecht University Utrecht, Netherlands
                [2] 2Altrecht Academic Anxiety Centre Utrecht, Netherlands
                [3] 3Department of Experimental Psychology, Utrecht University Utrecht, Netherlands
                [4] 4Helmholtz Research Institute Utrecht, Netherlands
                Author notes

                Edited by: John Monterosso, University of Southern California, USA

                Reviewed by: Erica Duncan, Emory University, USA; Pauline Dibbets, Maastricht University, Netherlands

                *Correspondence: Puck Duits, p.duits@ 123456uu.nl

                This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2016.00252
                4767935
                26955364
                d1d059a9-8a26-4762-a0d5-582a10d1b353
                Copyright © 2016 Duits, Cath, Heitland and Baas.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 August 2015
                : 09 February 2016
                Page count
                Figures: 6, Tables: 3, Equations: 0, References: 57, Pages: 12, Words: 0
                Categories
                Psychology
                Original Research

                Clinical Psychology & Psychiatry
                anxiety,extinction,treated patients,cue,context,startle,fear conditioning
                Clinical Psychology & Psychiatry
                anxiety, extinction, treated patients, cue, context, startle, fear conditioning

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