Category: Adult Anxiety
Background: Uncertainty is a ubiquitous human experience. Excessive attempts to avoid states of uncertainty, also subsumed under the term Intolerance of Uncertainty (IU), are at the heart of anxious pathology. Desensitizing individuals to uncertain situations is one of the primary goals of extinction-based cognitive-behavior therapy. In our study, we sought to test the efficacy of safety signal learning, a novel approach that may directly target extreme reactions in the face of uncertain threat.
Methods: Forty-seven subjects from the community (age range: 18-29) completed a safety signal learning task, in which conditioned stimuli were geometric shapes of different colors and the unconditioned stimulus was an aversive white noise. Our paradigm was comprised of four phases: Fear acquisition, testing, extinction, and fear reversal. Outcome variables were reaction times, ratings of the shapes, and changes in state anxiety. Sensitivity to threat uncertainty was measured by self-reported IU.
Results: All subjects discriminated between threat and safety signals by demonstrating faster reaction times towards threat versus safety signals during fear acquisition, testing, and fear reversal (all Fs > 5.27, all ps < .02). Individuals low on IU demonstrated less discrimination between the stimuli once the former threat cue was not predictive of the aversive noise anymore, whereas individuals high on IU revealed upholding discrimination between the stimuli and lower changes in state anxiety consistent with generalized, long-lasting fear responding (all Fs > 4.18, all ps < .05). Furthermore, participants high on IU showed transfer of the safety signal when it was paired with the threat cue, indicated by relatively slower reaction times (M = 510.28, SD = 117.92) compared to pairing with a novel stimulus (M = 469.01, SD = 128.59) and to the threat cue alone (M = 448.78, SD = 113.58). Individuals low on IU demonstrated the opposite pattern of slower reaction times when the threat stimulus was paired with a novel stimulus (M = 507.54, SD = 202.35) as opposed to pairing with the safety signal (M = 483.51, SD = 191.60) and the threat cue alone (M = 466.12, SD =183.05), F(3, 114) = 5.19, p = .002. The results were unique to IU and did not generalize to self-reported worry or trait anxiety.
Conclusions: We conclude that high IU may be a trait that is characterized by extinction-resistant, global, and enduring fear responses which may be related to poorer outcomes of exposure-based CBT. Novel approaches that facilitate tolerating uncertain threat, such as the use of safety signals, may thus be particularly important for individuals who are sensitive to uncertainty.
Luise Pruessner– Visiting Graduate Student, Yale University, New Haven, Connecticut
Melanie Silverman– Research Coordinator, Weil Cornell Medical College of Cornell University
Danielle Dellarco– Research Coordinator, Weill Cornell Medical College of Cornell University
Jason Haberman– Lab Manager, Yale University
Emily Cohodes– Graduate Student, Yale University
Paola Odriozola– Graduate Student, Yale University
Dylan Gee– Assistant Professor, Yale University, New Haven, Connecticut
Weil Cornell Medical College of Cornell University
Weill Cornell Medical College of Cornell University