Children's self-reported coping strategies: the role of defensiveness and repressive adaptation

This study examined differences in self-reported coping strategies across children classified according to Weinberger et al.'s (1979) adaptive style paradigm. Consistent with the larger literature, it was hypothesized that repressors (i.e. characterized by high self-reported defensiveness and low self-reported distress) would endorse fewer behaviorally and cognitively avoidant coping strategies than other adaptive style groups. Participants included 134 children, ranging in age from 10 to 13 (M=11.26, sd=.59), who completed measures of defensiveness, trait anxiety, and coping. Consistent with the hypotheses, results indicated significantly lower endorsement of avoidant coping strategies, and significantly higher endorsement of approach-oriented strategies among repressors, but no significant differences across adaptive style groups for other forms of coping. Results indicate that, consistent with other indicators of psychological functioning, the measurement of coping strategies is subject to the effects of socially desirable responding. Further, results provide evidence that measures of coping may be contaminated by items reflecting adjustment problems.     

Activity in the human amygdala corresponds to early, rather than late period autonomic responses to a signal for shock

Laboratory animal and human subject studies report that the amygdala is a critical brain structure that supports the acquisition and expression of conditional fear. Recent functional neuroimaging studies in humans have reported that activity in this region is closely related to the behavioral expression of conditional skin conductance responses (SCR). However, SCR waveforms following conditional stimulus (CS) presentation contain both early period and late period responses that may differ with respect to underlying central processes. It is not known whether amygdala activity corresponds to the expression of early conditonal responses (CRs) that occur shortly following CS onset or late CRs that closely precede UCS onset. The present study used event-related functional magnetic resonance imaging and concurrent skin conductance measurements to determine whether amygdala activity is more closely related to the expression of early or late period CRs. Increased amygdala activity was detected during the formation of early, but not late period CRs. Additionally, this pattern of amygdala activity did not dissipate, but persisted into late stages of the experiment. These findings are consistent with the idea that amygdala responding is critically involved in the generation of CRs formed shortly following CS onset.     

Illness perception in individuals with atopic dermatitis

Accumulating evidence suggests that in order to understand and respond to the difficulties presented by illness, patients construct their own "common sense" cognitive model of illness. This study set out to examine self-help group members, and students' beliefs about their atopic dermatitis (AD) and to investigate their relationship with symptom report and clinical and demographic variables. A total of 284 participants with AD undertook a self-assessment of their disease severity and completed the Revised Illness Perception Questionnaire. The most frequent symptoms associated with AD were itching, sleep difficulties and pain. The most commonly reported triggers of AD were stress, hereditary factors and emotional state. Over 75% of participants believed that their condition would be chronic. Self-help group members reported more significant consequences of the condition, a greater emotional impact, while the student group felt they had more personal control of their AD. Multiple regression analyses indicated that illness beliefs, in particular perceived consequences associated with AD and personal control, accounted for a significant proportion of the variance in emotional response to the condition. This study suggests that participants' beliefs and emotional response are more strongly associated with the meaning they ascribe to their condition rather than its severity.     

Impact of hormonal contraceptives on sex differences in fear conditioning and fear extinction in PTSD

Sex differences in the neurobiological mechanisms involved in fear conditioning and extinction have been suggested to contribute to differential vulnerability for the development of posttraumatic stress disorder (PTSD) in women compared with men. Reproductive hormones, such as estradiol, have been shown to facilitate fear conditioning and extinction learning and may explain some of these differences. However, the effect of commonly used hormonal contraceptives on the neurobiological mechanisms of fear conditioning and extinction is poorly understood. A laboratory study was conducted in trauma-exposed men and women with and without full or partial PTSD to examine effects of sex and use of hormonal birth control on fear conditioning, fear extinction learning, and extinction retention. Participants underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS−) with shock. Extinction learning occurred 72 h later, and extinction retention was tested 1 wk after extinction. Women on hormonal contraceptives (HCs) demonstrated enhanced acquisition of fear conditioning and enhanced extinction of fear as compared with women off hormonal birth control and men. While clinical implications have yet to be determined, these results suggest that hormonal contraceptives may facilitate learning during both fear acquisition and extinction. Understanding the impact of sex and hormones on fear conditioning and extinction processes may lead to new insights into the pathophysiology of PTSD and result in advancements in treatment that may vary by sex.

It is widely recognized that posttraumatic stress disorder (PTSD) is a common consequence of trauma exposure, and women are at particularly high risk, with some but not all studies finding that women develop PTSD at twice the rate of men, despite greater trauma exposure in men (Breslau et al. 1998; Tanielian et al. 2008). Although some have suggested that greater exposure to interpersonal violence may contribute to higher rates of PTSD in women, other evidence implicates sex differences in the neurobiological mechanisms that are involved in fear conditioning and extinction. Enhanced fear conditioning and diminished extinction of conditioned fear have been associated with higher levels of endogenous estrogen in women, as well as the development and maintenance of PTSD in both sexes (Orr et al. 2000; Milad et al. 2009b; Glover et al. 2012). Furthermore, as one of the most empirically supported treatments for PTSD is prolonged exposure therapy, which is largely based on fear extinction principles and the success of extinction learning (Rothbaum and Davis 2003), a clear understanding of the individual factors impacting fear conditioning and extinction is critical.Although some of the studies examining sex differences in fear conditioning are inconsistent (Guimaraes et al. 1991; Zorawski et al. 2005; Milad et al. 2006), an increasing body of evidence from rodent and human studies supports the existence of sex differences in fear extinction learning and recall (Maren et al. 1994; Pryce et al. 1999; Milad et al. 2009a; Merz et al. 2013). One possible explanation for the lack of consistent findings in the fear conditioning literature may be related to potential floor effects associated with subclinical impairment of nonclinical samples, as most laboratory studies examining sex differences were conducted in healthy humans. Another explanation that is gaining substantial support is the impact of hormones that differ between the sexes, among individuals, and even within individuals across time (Quirk and Mueller 2008; Lebron-Milad and Milad 2012; Arevalo et al. 2015; Hwang et al. 2015; Herrera et al. 2017; Maeng et al. 2017; Antov and Stockhorst 2018).The available literature indicates that estradiol, the primary estrogen in women during the childbearing years, is also present at overall lower concentrations in males and plays a large role in the fear conditioning and extinction differences observed between men and women (Gupta et al. 2001; Jasnow et al. 2006; Chang et al. 2009; Milad et al. 2009a, 2010; Zeidan et al. 2011; Maddox et al. 2018; Matsumoto et al. 2018; Carvalho et al. 2021). In both sexes, estradiol plays a variety of important functions in the brain, including the regulation of oxidative stress, inflammation, and gene expression, as well as in cognitive functions such as learning and memory (Hammoud et al. 2020). Estrogen receptors are found throughout brain regions that are important for fear conditioning and extinction processes (e.g., the amygdala, ventromedial prefrontal cortex, and hippocampus), likely via enhancements to learning and memory (Milad et al. 2008; Quirk and Mueller 2008; Lebron-Milad and Milad 2012). In women, as peripheral levels of estradiol vary over the course of the menstrual cycle, so do levels of estradiol in the brain (Arevalo et al. 2015). Estradiol has been shown to enhance memory consolidation across stages of fear conditioning, extinction, and retention (Lebron-Milad and Milad 2012). Most relevant to learning in PTSD, women with high levels of estradiol demonstrate enhanced memory formation in the presence of stress exposure (Herrera et al. 2017; Antov and Stockhorst 2018). In animal and human models, higher estradiol levels appear to facilitate acquisition of fear conditioning and extinction (Maeng et al. 2017). For example, women with high endogenous estradiol levels have enhanced responses in fear circuitry during fear conditioning, extinction, and recall as compared with men (Hwang et al. 2015). When phase of menstrual cycle has been taken into account, differences have been observed in conditioned fear responses and severity of PTSD symptoms. Specifically, when women are in the midluteal phase of the menstrual cycle (higher endogenous estradiol), they demonstrate a stronger positive relationship between SCR during fear conditioning and PTSD symptoms than women in the early follicular phase of menstruation (lower endogenous estradiol) (Carpenter et al. 2022). In the complimentary literature on the startle response, low-estradiol women demonstrated reduced discrimination between CS+ and CS− during fear conditioning and reduced inhibition of fear-potentiated startle during extinction and extinction recall, indicating less successful learning than their high-estradiol counterparts (Glover et al. 2012, 2013; Armbruster et al. 2018). This literature suggests that higher levels of estradiol relate to enhanced acquisition of associations between an unconditioned stimulus (UCS) and a conditioned stimulus (CS) during fear conditioning and enhanced extinction of this association during the extinction phase due to greater memory consolidation.A variety of factors can account for hormone differences in women, including menstrual phase, age, and use of hormonal birth control. Approximately 11%–20% of women aged 20–39 yr use oral contraceptives (OCs) (Daniels and Abma 2020). Commonly used OCs directly affect estradiol levels and hormonal fluctuation associated with the menstrual cycle. However, hormonal contraceptives (HCs) have received little attention in the fear conditioning literature. At the time of writing, we were unable to locate studies examining the impact of other HCs on fear conditioning circuitry, although these forms of birth control are increasingly popular among women, and evidence suggests that a variety of HCs has impacts on brain structure, function, and cognitive processes (Brønnick et al. 2020). Literature suggests that estradiol levels in women on HCs are typically low, similar to those of women in the early follicular phase of menstruation (Brynhildsen 2014). Although Hwang et al. (2015) did not demonstrate an effect of HCs on fear conditioning, many HCs contain ethinyl estradiol, which is synthetic estrogen that binds to estrogen receptors at high levels. Further research is needed to determine whether synthetic estrogen present in HCs impacts fear conditioning and fear extinction and contributes to associated sex differences, particularly in a highly sensitized population such as those with PTSD. In the current study, differences in fear conditioning, extinction, and retention were examined in women on hormonal birth control and in the early follicular phase of the menstrual cycle as compared with men to determine whether the synthetic hormones present in HCs confer any enhancement to these processes over and above women off of birth control with theoretically low levels of endogenous estradiol.Fear conditioning is measured by assessing the differential SCR to a conditioned stimulus (CS+) paired with an unconditioned stimulus (shock; UCS) and a stimulus unpaired with a shock (CS−). Greater acquisition of fear conditioning is evidenced by greater SCR response to the CS+ when compared with the CS−. Fear extinction refers to repeated exposure to the CS in the absence of the US, which results in diminishing reactivity to previously conditioned stimuli due to an inhibitory neural link that is formed (Myers and Davis 2007). Extinction is therefore operationalized by reduced discrimination of responding to the CS+ and CS− over time, and its retention is evidenced by a maintenance of low differential SCR in response to presentation of CS+ and CS− cues at follow-up.In previous work, our group examined sex differences in skin conductance responses to a fear conditioning paradigm in men and women with PTSD (Inslicht et al. 2013). In that sample, women were premenopausal and underwent conditioning during the follicular phase of the menstrual cycle. We found that women had greater differential fear acquisition compared with men. Other work has indicated that the effects of endogenous gonadal hormones on fear extinction are moderated by PTSD diagnosis, such that women with PTSD demonstrated impaired fear extinction during the midluteal phase of menstruation but not during the early follicular phase (Pineles et al. 2016b). The current study examines the effect of sex, HC use, and PTSD severity on fear conditioning, fear extinction, and extinction retention in medically healthy trauma-exposed premenopausal women on or off HCs and age-matched men across a range of PTSD symptom severity. We used a validated laboratory conditioning paradigm (Inslicht et al. 2021) that occurred over several days in which fear acquisition was separated from extinction by 72 h to avoid influencing consolidation of fear conditioning, and extinction retention was evaluated 1 wk after the fear extinction session to provide a test of durability of extinction over time.Given evidence for impaired fear extinction in PTSD, we hypothesized that participants high in PTSD (men and women combined) would have decreased fear extinction learning and extinction retention compared with those with low PTSD symptom scores. As estradiol appears to enhance learning during stress in women, we predicted that women on HCs would demonstrate higher differential SCR during acquisition and lower differential SCR during extinction and extinction retention than naturally cycling women in the early follicular phase of menstruation and men. Finally, we predicted a PTSD × sex interaction effect for extinction learning and retention; women on HCs with high levels of current PTSD would have enhanced acquisition but decreased extinction learning and retention compared with women with low levels of current PTSD and men.