Key factors behind various specific phobia subtypes.

While it has been suggested that more than a quarter of the whole population is at risk of developing some form of specific phobia (SP) during their lives, we still know little about the various risk and protective factors and underlying mechanisms. Moreover, although SPs are distinct mental disorder categories, most studies do not distinguish between them, or stress their differences. Thus, our study was manifold. We examined the psychometric properties of the Specific Phobia Questionnaire (SPQ) and assessed whether it can be used for screening in the general population in a large sample (N = 685). Then, using general linear modeling on a second sample (N = 432), we tested how potential socio-demographic, cognitive emotion regulatory, and personality variables were associated with the five SP subtypes. Our results show that the SPQ is a reliable screening tool. More importantly, we identified transdiagnostic (e.g., younger age, female gender, rumination, catastrophizing, positive refocusing) as well as phobia-specific factors that may contribute to the development and maintenance of SPs. Our results support previous claims that phobias are more different than previously thought, and, consequently, should be separately studied, instead of collapsing into one category. Our findings could be pertinent for both prevention and intervention strategies.

The role of self-reported fear and disgust in the activation of behavioral harm avoidance related to medical settings.

Introduction: Although adaptive defense mechanisms are useful in helping us avoid getting injured, they are also triggered by medical interventions and procedures, when avoidance is harmful. A body of previous results showed that both fear and disgust play a pivotal role in medical avoidance. However, the underlying mechanisms are not fully understood. Thus, the aim of the current study was to examine the effects of experience, perceived control, and pain on medical avoidance with disgust and fear as mediating factors from an evolutionary perspective. Methods: We assessed participants' knowledge of and experience with medical procedures, former negative medical experiences, and health-related information; their life history strategy variation; pain-related fear and anxiety of medical procedures; perceived control over emotional reactions and extreme threats; disgust sensitivity; blood-injury-injection phobia and medical treatment avoidance. Results: We found that more knowledge, experience, and a slower life strategy were linked to a greater level of perceived control and attenuated emotional reactions. Further, better ability to control affective and stress reactions to negative experiences was linked to reduced disgust and fear of pain, and thus might mitigate the level of perceived threat, and diminish fear and disgust reactions. Discussion: More knowledge and experiences, better perceived control together with reduced disgust and fear of pain can decrease the probability of avoiding medical situations. Implications to treatment are discussed. Results support the importance of targeting these contextual factors in prevention to increase the likelihood of people attending regular screenings or seeking medical care when needed.

An ethologically based view into human fear.

The quality of the defensive response to a threat depends on the elements that trigger the fear response. The current classification system of phobias does not account for this. Here, we analyze the fear-eliciting elements and discern the different types of fears that originate from them. We propose Pain, Disgust, Vasovagal response, Visual-vestibular and postural interactions, Movement and Speed, Distance and Size, Low and mid-level visual features, Smell, and Territory and social status. We subdivide phobias according to the fear-eliciting elements most frequently triggered by them and their impact on behavior. We discuss the implications of a clinical conceptualization of phobias in humans by reconsidering the current nosology. This conceptualization will facilitate finding etiological factors in defensive behavior expression, fine-tuning exposure techniques, and challenging preconceived notions of preparedness. This approach to phobias leads to surprising discoveries and shows how specific responses bear little relation to the interpretation we might later give to them. Dividing fears into their potentially fear-eliciting elements can also help in applying the research principles formulated by the Research Domain Criteria initiative.

Fear inoculation among snake experts.

BACKGROUND: Fear acquisition of certain stimuli, such as snakes, is thought to be rapid, resistant to extinction, and easily transferable onto other similar objects. It has been hypothesized that due to increased survival chances, preparedness to instantly acquire fear towards evolutionary threats has been hardwired into neural pathways of the primate brain. Here, we compare participants' fear of snakes according to experience; from those who often deal with snakes and even suffer snakebites to those unfamiliar with snakes. METHODS: The Snake Questionnaire-12 (SNAQ-12) and Specific Phobia Questionnaire (SPQ) were administered to three groups of participants with a different level of experience with snakes and snakebites: 1) snake experts, 2) firefighters, and 3) college students. RESULTS: This study shows that individuals more experienced with snakes demonstrate lower fear. Moreover, participants who have suffered a snakebite (either venomous or not) score lower on fear of snakes (SNAQ-12), but not of all other potentially phobic stimuli (SPQ). CONCLUSIONS: Our results suggest that a harmless benign exposure might immunize people to highly biologically prepared fears of evolutionary threats, such as snakes.

Super-natural fears.

Supernatural fears, although common, are not as well-understood as natural fears and phobias (e.g., social, blood, and animal phobias) which are prepared by evolution, such that they are easily acquired through direct experience and relatively immune to cognitive mediation. In contrast, supernatural fears do not involve direct experience but seem to be related to sensory or cognitive biases in the interpretation of stimuli as well as culturally driven cognitions and beliefs. In this multidisciplinary synthesis and collaborative review, we claim that supernatural beliefs are "super natural." That is, they occur spontaneously and are easy to acquire, possibly because such beliefs rest on intuitive concepts such as mind-body dualism and animism, and may inspire fear in believers as well as non-believers. As suggested by psychological and neuroscientific evidence, they tap into an evolutionarily prepared fear of potential impending dangers or unknown objects and have their roots in "prepared fears" as well as "cognitively prepared beliefs," making fear of supernatural agents a fruitful research avenue for social, anthropological, and psychological inquires.

"Finding an Emotional Face" Revisited: Differences in Own-Age Bias and the Happiness Superiority Effect in Children and Young Adults.

People seem to differ in their visual search performance involving emotionally expressive faces when these expressions are seen on faces of others close to their age (peers) compared to faces of non-peers, known as the own-age bias (OAB). This study sought to compare search advantages in angry and happy faces detected on faces of adults and children on a pool of children (N = 77, mean age = 5.57) and adults (N = 68, mean age = 21.48). The goals of this study were to (1) examine the developmental trajectory of expression recognition and (2) examine the development of an OAB. Participants were asked to find a target face displaying an emotional expression among eight neutral faces. Results showed that children and adults found happy faces significantly faster than angry and fearful faces regardless of it being present on the faces of peers or non-peers. Adults responded faster to the faces of peers regardless of the expression. Furthermore, while children detected angry faces significantly faster compared to fearful ones, we found no such difference in adults. In contrast, adults detected all expressions significantly faster when they appeared on the faces of other adults compared to the faces of children. In sum, we found evidence for development in detecting facial expressions and also an age-dependent increase in OAB. We suggest that the happy face could have an advantage in visual processing due to its importance in social situations and its overall higher frequency compared to other emotional expressions. Although we only found some evidence on the OAB, using peer or non-peer faces should be a theoretical consideration of future research because the same emotion displayed on non-peers' compared to peers' faces may have different implications and meanings to the perceiver.

On the Nature of Fear and Anxiety Triggered by COVID-19.

Emergencies that occur during natural disasters, such as avalanches, earthquakes, and floods, tend to be sudden, unexpected, and ephemeral and recruit defensive responses, similar to the ones recruited when faced with dangerous animals. Defensive behaviors are triggered by activity in survival circuits that detects imminent threats and fear is the conscious emotion of that follows immediately. But this particular threat (COVID-19) is useable and mysterious, triggering anxieties much more than fear. We conducted a literature search on May 1, 2020 in Google Scholar, PsychInfo, and PubMed with search terms related to COVID-19 fears and found 28 relevant articles. We categorized the papers into six groups based on the content and implications: fear of the unknown, social isolation, hypochondriasis, disgust, information-driven fears, and compliance. Considering the nature of fear and anxiety, combined with the characteristics of the present COVID-19 situation, we contemplate that physicians and other health care workers of several specialties, as well as police officers, fire-fighters, and rescue personnel, and first responders might be more able to deal with COVID-19 if they have (a) some tolerance of the unknown, (b) low illness anxiety disorder, (c) tolerance to social isolation; (d) low levels of disgust sensitivity; (e) be granted financial support, (f) have priority if needed medical assistance (g) use caution relatively to the COVID-19 media coverage and (h) be trained to have high levels of efficacy. Possibilities for preventive and therapeutic interventions that can help both health care personnel and the general population are also discussed.

The emergency reaction questionnaire - First steps towards a new method.

During emergencies, people are more or less capable of performing adequately. Knowledge about human behavior while facing emergencies has become more significant nowadays. This knowledge can help improving our already present defensive responses and natural coping mechanisms when facing imminent dangers, natural disasters, and catastrophes. A new method is here offered to explore the core points of this topic. The Emergency Reaction Questionnaire (ERQ), is proposed for predicting one's reaction and behaviour in an emergency. First, a large item pool was created based on interviews with people facing emergencies on a weekly basis and related literature. The factor structure, reliability and validity were assessed on a large sample of lay people (N = 1115, 440 males) and specific groups of firefighters and people doing extreme sports (N = 85, all males). Participants were Caucasian with an age range of 18-70. We also used measures of anxiety, depression, and sensation seeking, behavioral inhibition and activation and coping in stressful situations. The ERQ was proved to be reliable and consistent in time and having sound psychometric properties both on the community and special samples. Results show that psychometric properties are satisfying; the test has excellent validity ratings. Consequently, the ERQ can be used in future research effectively and facilitate a better understanding of how people react in a highly dangerous situation. Future directions in the utilization of the new method are discussed.

Who worries about specific phobias? - A population-based study of risk factors.

Although specific phobia is one of the most prevalent lifetime anxiety disorders, little is known about the particular risk factors related to its development. The underlying goal of this study was to analyse the risk factors associated with worrying about specific phobias (SP) in a representative sample of community dwelling adults. The sample was composed of 8461 participants (mean age 47.68 years, range 18-85, 54.60% female), from the Australian National Mental Health Survey. A total of 188 participants (2.22%) reported worrying about SPs. Multivariate logistic regression analysis indicated that female sex (odds ratio (OR) = 1.98, p < 0.0001) and a comorbid diagnosis of lifetime major depression disorder (OR = 2.80, p < 0.0001) were the factors most strongly associated with worrying about SPs. Having experienced traumatic experiences involving significant others (OR = 1.18, p = 0.02), the number of chronic diseases (OR = 1.21, p < 0.01), and a comorbid diagnosis of substance use (OR = 2.80, p = 0.02) were also associated. Our results are in line with previous studies focusing on other anxiety disorders. We provide further evidence that substance dependence appears to serve as a unique risk factor for the subsequent onset of SP. Further empirical and clinical implications are discussed.

Are Humans Prepared to Detect, Fear, and Avoid Snakes? The Mismatch Between Laboratory and Ecological Evidence.

Since Seligman (1971) statement that the vast majority of phobias are about objects essential to the survival of a species, a multitude of laboratory studies followed, supporting the finding that humans learn to fear and detect snakes (and other animals) faster than other stimuli. Most of these studies used schematic drawings, images, or pictures of snakes, and only a small amount of fieldwork in naturalistic environments was done. We address fear preparedness theories and automatic fast detection data from mainstream laboratory data and compare it with ethobehavioral information relative to snakes, predator-prey interaction, and snakes' defensive kinematics strikes in order to analyze their potential matching. From this analysis, four main findings arose, namely that (1) snakebites occur when people are very close to the snake and are unaware or unable to escape the bite; (2) human visual detection and escape response is slow compared to the speed of snake strikes; (3) in natural environments, snake experts are often unable to see snakes existing nearby; (4) animate objects in general capture more attention over other stimuli and dangerous, but recent objects in evolutionary terms are also able to be detected fast. The issues mentioned above pose several challenges to evolutionary psychology-based theories expecting to find special-purpose neural modules. The older selective habituation hypothesis (Schleidt, 1961) that prey animals start with a rather general predator image from which specific harmless cues are removed by habituation might deserve reconsideration.

Attention allocation to 2D and 3D emotion-inducing scenes: A neurophysiological study.

Past research on emotions was mostly supported on emotion inducing slides, but studies in the field are moving towards more ecological stimuli, including 3D stimuli and virtual reality scenes. The present study aims to compare the effects of two-dimensional (2D) and three-dimensional (3D) emotion-inducing scenes in the modulation of attention, as indexed by the amplitude of the P3 event-related component in a dual-task paradigm. We recorded the EEG signal of 31 healthy male participants performing an active auditory oddball task, while simultaneously observing pleasant, unpleasant and neutral scenes in 2D or 3D. We analyzed the effects of emotional valence and visualization mode in the mean amplitude of the P3 component at Pz. The results revealed than revealed that 2D scenarios were as effective as 3D stimuli in capturing attention resources and this effect was consistently observed in all emotional scenes.

MK-801-induced behavioural sensitisation alters dopamine release and turnover in rat prefrontal cortex.

RATIONALE: Repeated exposure to psychostimulants that either increase dopamine (DA) release or target N-methyl-D-aspartate (NMDA) receptors can induce behavioural sensitisation, a phenomenon that may be important for the processes of addiction and even psychosis. A critical component of behavioural sensitisation is an increase in DA release within mesocorticolimbic circuits. In particular, sensitisation to amphetamine leads to increased DA release within well-known sub-cortical brain regions and also regulatory regions such as prefrontal cortex (PFC). However, it is unknown how DA release within the PFC of animals is altered by sensitisation to NMDA receptor antagonists. OBJECTIVES: The aims of the present study were twofold, firstly to examine whether a single dose of dizocilpine maleate (MK-801) could induce long-term behavioural sensitisation and secondly to examine DA release in the PFC of sensitised rats. MATERIALS AND METHODS: Behavioural sensitisation was assessed by measuring locomotion after drug exposure. DA release in the PFC was measured using freely moving microdialysis. RESULTS: We show that a single dose of MK-801 can induce sensitisation to subsequent MK-801 exposure in a high percentage of rats (66 %). Furthermore, rats sensitised to MK-801 have altered DA release and turnover in the PFC compared with non-sensitised rats. CONCLUSION: Schizophrenia patients have been postulated to have 'endogenous sensitisation' to psychostimulants. MK-801-induced sensitised rats, in particular when compared with non-sensitised rats, provide a useful model for studying PFC dysfunction in schizophrenia.

Visuo-vestibular contributions to anxiety and fear.

The interactive roles of the visual and vestibular systems allow for postural control within boundaries of perceived safety. In specific circumstances, visual vestibular and postural interactions act as a cue that trigger fear, similarly to what occurs in motion sickness. Unusual patterns of visuo-vestibular interaction that emerge without warning can elicit fear, which can then become associated to a certain stimuli or situation, creating a CS-US association, (i.e., phobia), or can emerge without warning but also without becoming associated to a particular concomitant event (i.e., panic). Depending on the individual sensitivity to visuo-vestibular unusual patterns and its impact in postural control, individuals will be more or less vulnerable to develop these disorders. As such, the mechanism we here propose is also sufficient to explain the lack of certain fears albeit exposure. Following this rationale, a new subcategory of anxiety disorders, named visuo-vestibular fears can be considered. This model brings important implications for developmental and evolutionary psychological science, and invites to place visuo-vestibular fears in a particular subtype or specification within the DSM-5 diagnostic criteria.

The use of healthcare services for mental health problems by middle-aged and older adults.

Although mental disorders occur commonly in later life, it has been reported that older adults are reluctant to seek help for their mental health problems. The purpose of this research study was to analyze the contact with healthcare professionals, self-perceived mental health problems and unmet needs, as reported by a nationally representative sample of community-dwelling adults. We report a cross-sectional analysis of all the respondents of the Australian National Survey of Mental Health and Wellbeing aged 55 years and older (N=3178). Results indicated that 306 (9.6%) participants had a DSM-IV classifiable mental disorder based on self-identified symptoms over the preceding 12 months. Of these, 146 (48%) reported that they had not consulted a healthcare professional to deal with their mental health problems. Among those who consulted with a healthcare professional, the general practitioner was the main point of contact. Medication and psychotherapy/counseling were the most frequent form of help obtained. Informational and instrumental help, such as help to sort out practical problems and to look after oneself, were the most reported unmet needs. These results suggest a gap in the provision of healthcare services for mental health problems directed toward the specific needs of aging adults. The reported unmet needs might be met by increasing awareness amongst healthcare professionals regarding mental health problems in later stages of life and by improving the access of older people to the services commonly provided by multidisciplinary teams.

p300/CBP-associated factor selectively regulates the extinction of conditioned fear.

It is well established that the activity of chromatin-modifying enzymes is crucial for regulating gene expression associated with hippocampal-dependent memories. However, very little is known about how these epigenetic mechanisms influence the formation of cortically dependent memory, particularly when there is competition between opposing memory traces, such as that which occurs during the acquisition and extinction of conditioned fear. Here we demonstrate, in C57BL/6 mice, that the activity of p300/CBP-associated factor (PCAF) within the infralimbic prefrontal cortex is required for long-term potentiation and is necessary for the formation of memory associated with fear extinction, but not for fear acquisition. Further, systemic administration of the PCAF activator SPV106 enhances memory for fear extinction and prevents fear renewal. The selective influence of PCAF on fear extinction is mediated, in part, by a transient recruitment of the repressive transcription factor ATF4 to the promoter of the immediate early gene zif268, which competitively inhibits its expression. Thus, within the context of fear extinction, PCAF functions as a transcriptional coactivator, which may facilitate the formation of memory for fear extinction by interfering with reconsolidation of the original memory trace.

The brain-specific microRNA miR-128b regulates the formation of fear-extinction memory.

MicroRNAs are small non-coding RNAs that mediate post-transcriptional gene silencing. Fear-extinction learning in C57/Bl6J mice led to increased expression of the brain-specific microRNA miR-128b, which disrupted stability of several plasticity-related target genes and regulated formation of fear-extinction memory. Increased miR-128b activity may therefore facilitate the transition from retrieval of the original fear memory toward the formation of a new fear-extinction memory.

Paradoxical enhancement of fear extinction memory and synaptic plasticity by inhibition of the histone acetyltransferase p300.

It is well established that the coordinated regulation of activity-dependent gene expression by the histone acetyltransferase (HAT) family of transcriptional coactivators is crucial for the formation of contextual fear and spatial memory, and for hippocampal synaptic plasticity. However, no studies have examined the role of this epigenetic mechanism within the infralimbic prefrontal cortex (ILPFC), an area of the brain that is essential for the formation and consolidation of fear extinction memory. Here we report that a postextinction training infusion of a combined p300/CBP inhibitor (Lys-CoA-Tat), directly into the ILPFC, enhances fear extinction memory in mice. Our results also demonstrate that the HAT p300 is highly expressed within pyramidal neurons of the ILPFC and that the small-molecule p300-specific inhibitor (C646) infused into the ILPFC immediately after weak extinction training enhances the consolidation of fear extinction memory. C646 infused 6 h after extinction had no effect on fear extinction memory, nor did an immediate postextinction training infusion into the prelimbic prefrontal cortex. Consistent with the behavioral findings, inhibition of p300 activity within the ILPFC facilitated long-term potentiation (LTP) under stimulation conditions that do not evoke long-lasting LTP. These data suggest that one function of p300 activity within the ILPFC is to constrain synaptic plasticity, and that a reduction in the function of this HAT is required for the formation of fear extinction memory.

Deconstructing acrophobia: physiological and psychological precursors to developing a fear of heights.

BACKGROUND: Acrophobia is one of the most prevalent phobias, affecting as many as 1 in 20 individuals. Of course, heights often evoke fear in the general population too, and this suggests that acrophobia might actually represent the hypersensitive manifestation of an everyday, rational fear. In this study, we assessed the role of sensory and cognitive variables in acrophobia. METHODS: Forty-five participants (Mean age 25.07 years, 71% female) were assessed using a booklet with self-reports as well as several behavioral measures. The data analysis consisted in multivariate linear regression using fear of heights as the outcome variable. RESULTS: The regression analyses found that visual field dependence (measured with the rod and frame test), postural control (measured with the Sharpened Romberg Test), space and motion discomfort (measured with the Situational Characteristics Questionnaire), and bodily symptoms (measured with the Bodily Sensation Questionnaire) all serve as strong predictors for fear of heights (Adjusted r(2)=.697, P<.0001). Trait anxiety (measured with the State Trait Anxiety Inventory Form Y-2) was not related with fear of heights, suggesting that this higher order vulnerability factor is not necessary for explaining this particular specific phobia in a large number of individuals. CONCLUSION: The findings reveal that fear of heights is an expression of a largely sensory phenomena, which can produce strong feelings of discomfort and fear in the otherwise calm individuals. We propose a theory that embraces all these factors and provides new insight into the aetiology and treatment of this prevalent and debilitating fear.

Specific phobias in older adults: characteristics and differential diagnosis.

BACKGROUND: Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. METHODS: A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. RESULTS: Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. CONCLUSIONS: First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.