Have we met before? Neural correlates of emotional learning in women with social phobia

Have we met before? Neural correlates of emotional learning in women with social phobia

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J Psychiatry Neurosci 2014; 39(3): E14-E23

Inga Laeger, MA; Kati Keuper, MA; Carina Heitmann, MA; Harald Kugel, PhD; Christian Dobel, PhD; Annuschka Eden, MA; Volker Arolt, MD; Pienie Zwitserlood, PhD; Udo Dannlowski, MD, PhD*; Peter Zwanzger, MD*

Laeger, Heitmann, Arolt, Dannlowski, Zwanzger — Department of Psychiatry, University of Muenster, Germany; Keuper, Dobel, Eden — Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Germany; Kugel — Department of Clinical Radiology, University of Muenster, Germany; Zwitserlood — Institute for Psychology, University of Muenster, Germany; Dannlowski — Department of Psychiatry, University of Marburg, Germany


Background: Altered memory processes are thought to be a key mechanism in the etiology of anxiety disorders, but little is known about the neural correlates of fear learning and memory biases in patients with social phobia. The present study therefore examined whether patients with social phobia exhibit different patterns of neural activation when confronted with recently acquired emotional stimuli.

Methods: Patients with social phobia and a group of healthy controls learned to associate pseudonames with pictures of persons displaying either a fearful or a neutral expression. The next day, participants read the pseudonames in the magnetic resonance imaging scanner. Afterwards, 2 memory tests were carried out.

Results: We enrolled 21 patients and 21 controls in our study. There were no group differences for learning performance, and results of the memory tests were mixed. On a neural level, patients showed weaker amygdala activation than controls for the contrast of names previously associated with fearful versus neutral faces. Social phobia severity was negatively related to amygdala activation. Moreover, a detailed psychophysiological interaction analysis revealed an inverse correlation between disorder severity and frontolimbic connectivity for the emotional > neutral pseudonames contrast.

Limitations: Our sample included only women.

Conclusions: Our results support the theory of a disturbed cortico limbic interplay, even for recently learned emotional stimuli. We discuss the findings with regard to the vigilance–avoidance theory and contrast them to results indicating an oversensitive limbic system in patients with social phobia.

*Both authors contributed equally to the work.

Submitted May 17, 2013; Revised Sept. 18, 2013; Accepted Oct. 21, 2013.

Acknowledgements: This work was supported by grants of Interdisziplinäres Zentrum für klinische Forschung (IZKF) of the Medical Faculty of Muenster University (grant number Do3/021/10 to CD and PZ) and the SFB TRR 58 subproject C1 to PZ. The named funding sources were not involved in study design, collection, analysis or interpretation of data. We acknowledge support by the Deutsche Forschungsgemeinschaft and the Open Access Publication Fund of the University of Muenster.

Competing interests: None declared.

Contributors: I. Laeger, K. Keuper, H. Kugel, C. Dobel, A. Eden, V. Arolt, P. Zwitserlood, U. Dannlowski and P. Zwanger designed the study. I. Laeger, C. Heitmann and P. Zwanger acquired the data, which I. Laeger, and U. Dannlowski analyzed. I. Laeger, K. Keuper and U. Dannlowski wrote the article, which all authors reviewed and
approved for publication.

DOI: 10.1503/jpn.130091

Correspondence to: P. Zwanzger, Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, D-48149 Muenster, Germany; Peter.Zwanzger@ukmuenster.de