Take no risk!-Persistent avoidance after interoceptive fear conditioning

Maladaptive fear and avoidance of interoceptive threat are central to many anxiety and somatic disorders, often persisting even after exposure therapy and thereby contributing to relapse. While fear conditioning paradigms have mostly focused on avoidance in response to external threats (e.g., electric shocks), less is known about avoidance in response to interoceptive threat. Therefore, the present study investigated fear acquisition of interoceptive threat and subsequent avoidance behavior. Healthy participants (n = 35) underwent a differential fear conditioning paradigm in which one cue (CS+) predicted restricted breathing (US), whereas another (CS-) signaled safety. In the subsequent avoidance phase, participants were informed that they could prevent the US by pressing a button. During the consecutive response prevention phase, the avoidance option was no longer available. Finally, an avoidance test assessed the persistence of avoidance after extinction. No US was delivered during avoidance and response prevention phases. Results suggests that participants successfully learned to discriminate between CS+ and CS-, as reflected in US expectancy, fear ratings, startle eyeblink response and skin conductance responses. Although participants consistently reported greater fear of the CS + than the CS-, differential responding in psychophysiological measures was no longer observed following the introduction of the avoidance option. Participants demonstrated high levels of avoidance to CS+ and CS-, with avoidance persisting even after extinction with response prevention. The findings indicate a "better-safe-than-sorry" strategy despite awareness of threat contingencies. The generalization and persistence of avoidance may contribute to the development and maintenance of anxiety and somatic disorders.