Uncertain in the face of change: Lack of contingency shift awareness during extinction is associated with higher fear-potentiated startle and PTSD symptoms in children

• Published in: International journal of psychophysiology 2022-08, Vol.178, p.90-98
• Main Authors: Jovanovic, T., Wiltshire, C.N., Reda, M.H., France, J., Wanna, C.P., Minton, S.T., Davie, W., Grasser, L.R., Winters, S., Schacter, H., Marusak, H.A., Stenson, A.F.
• Format: Article
• Language: English
• Subjects: Adolescent; Anxiety; Child; Children; Extinction, Psychological - physiology; Fear - physiology; Fear conditioning; Fear extinction; Humans; Phobic Disorders; PTSD; Reflex, Startle - physiology; Stress Disorders, Post-Traumatic; Uncertainty
• ISSN: 0167-8760; 1872-7697
• DOI: 10.1016/j.ijpsycho.2022.06.008

Intolerance of uncertainty is a transdiagnostic risk factor for fear-related disorders and is associated with higher levels of anxiety in children and adolescents. It is unclear how uncertainty relates to development of psychopathology in children who have experienced trauma in early life. The present study used a fear-potentiated startle paradigm in children to examine associations between uncertainty (assessed as unawareness of a change in reinforcement during fear extinction) and symptoms of anxiety and posttraumatic stress disorder (PTSD), as well as startle potentiation to threat and safety cues. Results showed that unaware children had strong positive associations between trauma exposure and PTSD symptoms, whereas aware children did not. Uncertainty interacted with anxiety in that children who were both unaware and had higher anxiety displayed higher fear-potentiated startle to safety cues and did not show discrimination between threat and safety during fear conditioning. These results suggest that anxious children who persist in associating a threat cue with an aversive event during extinction, after repeated presentations of the no longer reinforced conditioned stimulus, may express psychophysiological phenotypes related to PTSD. •This study used a fear-potentiated startle paradigm in children to examine associations between uncertainty and symptoms of anxiety and posttraumatic stress disorder (PTSD)•Uncertainty was operationalized as the lack of contingency awareness of the absence of the aversive stimulus during fear extinction•Uncertainty interacted with anxiety in that children who were both unaware and had higher anxiety displayed higher fear-potentiated startle to safety cues and did not show discrimination between threat and safety during fear conditioning.•Children that were not aware of the contingency shift during fear extinction, and persisted in associating the threat cue with an aversive event, had strong positive associations between trauma exposure and PTSD symptoms, whereas aware children did not.•These results suggest that intolerance of uncertainty captured with fear-potentiated startle may increase risk for psychopathology in children with trauma exposure.