To Avoid or Not to Avoid: The Role of Neuroticism and Trauma, Predictability Information, and Hormones on Fear Generalization

Abstract

Fear generalization is a key construct for understanding why some individuals struggle to feel safe in objectively non-threatening situations. Although fear is generally adaptive, danger cues can proliferate when conditioned fear spreads to similar but innocuous stimuli (Lissek, 2012). Individuals with higher neuroticism are more likely to react negatively to stressful life events (Uliaszek et al., 2009) and a combination of high neuroticism and trauma exposure may confer greater risk for fear overgeneralization (Parslaw, Jorm, Christiansen, 2006). Increasing the availability of predictability information decreases stress (Grillon et al., 2008; 2009), and manipulating the content of such information (e.g. danger versus safety information) may influence appraisals of ambiguous generalization stimuli. Additionally, women are disproportionately affected by anxiety-based disorders (McLean, Asnaani, Litz, & Hoffman, 2011), and low estradiol hormone levels have been implicated as a possible risk factor for maladaptive fear responding (Glover, Jovanovic, & Norrholm, 2011). Seventy-seven women, selected for either high stress load (high neuroticism + trauma exposure) or low stress load (low neuroticism + no trauma exposure), underwent a fear acquisition and generalization task. Using the well-established "Screaming Lady" paradigm (Lau et al., 2008), two female neutral faces served as conditioned danger (CS+) and safety (CS-) cues, the former paired and the latter unpaired with a loud scream paired with a fearful face (unconditioned stimulus; US). Participants were then randomized to receive either danger or safety cue predictability information. The spread of fear to generalization stimuli (GS 1-4), which consisted of female faces morphed on a continuum between conditioned danger and safety, was measured via online risk ratings of GS and behavioral avoidance of GS. Salivary levels of estradiol and progesterone were measured prior to the fear generalization task. As expected, individuals with high stress load showed overgeneralized fear and avoidance patterns to the most ambiguous stimuli at the end of the task, pointing towards effects of high neuroticism and trauma exposure on the persistence of overgeneralized responding. The provision of safety cue information protected low stress load individuals from overgeneralized avoidance of ambiguous stimuli, but did not alter responding for the high stress load individuals. The present study highlights clinical implications for optimizing current treatments, exploring the potential utility of safety cue information, and proactively increasing resilience and preventing future psychopathology by strategically targeting preclinical transdiagnostic factors, such as neuroticism, that increase vulnerability for overgeneralized fear responding after negative life events.