Ventromedial prefrontal cortex activity differentiates sick from healthy faces: Associations with inflammatory responses and disease avoidance motivation.

BACKGROUND: Humans are able to discern the health status of others using olfactory and visual cues, and subsequently shift behavior to make infection less likely. However, little is known about how this process occurs. The present study examined the neural regions involved in differentiating healthy from sick individuals using visual cues. METHODS: While undergoing a functional magnetic resonance imaging scan, participants (N = 42) viewed facial photos of 30 individuals (targets) who had been injected with an inflammatory challenge--low-dose endotoxin (i.e., sick) or placebo (i.e., healthy), and rated how much they liked each face. We examined regions implicated in processing either threat (amygdala, anterior insula) or cues that signal safety (ventromedial prefrontal cortex [VMPFC]), and how this activity related to their liking of targets and cytokine levels (interleukin-6, tumor necrosis factor-α) exhibited by the targets. RESULTS: Photos of sick faces were rated as less likeable compared to healthy faces, and the least liked faces were those individuals with the greatest inflammatory response. While threat-related regions were not significantly active in response to viewing sick faces, the VMPFC was more active in response to viewing healthy (vs. sick) faces. Follow-up analyses revealed that participants tended to have lower VMPFC activity when viewing the least liked faces and the faces of those with the greatest inflammatory response. CONCLUSIONS: This work builds on prior work implicating the VMPFC in signaling the presence of safe, non-threatening visual stimuli, and suggests the VMPFC may be sensitive to cues signaling relative safety in the context of pathogen threats.

A Safe Haven: Investigating Social-Support Figures as Prepared Safety Stimuli.

Although fear-conditioning research has demonstrated that certain survival-threatening stimuli, namely prepared fear stimuli, are readily associated with fearful events, little research has explored whether a parallel category exists for safety stimuli. We examined whether social-support figures, who have typically benefited survival, can serve as prepared safety stimuli, a category that has not been explored previously. Across three experiments, we uncovered three key findings. First, social-support figures were less readily associated with fear than were strangers or neutral stimuli (in a retardation-of-acquisition test). Second, social-support stimuli inhibited conditional fear responses to other cues (in a summation test), and this inhibition continued even after the support stimulus was removed. Finally, these effects were not simply due to familiarity or reward because both familiar and rewarding stimuli were readily associated with fear, whereas social-support stimuli were not. These findings suggest that social-support figures are one category of prepared safety stimuli that may have long-lasting effects on fear-learning processes.

Exploring the effect of loneliness on fear: Implications for the effect of COVID-19-induced social disconnection on anxiety.

The consequences of the COVID-19 pandemic have resulted in many disruptions to daily life, including an abrupt increase in social disconnection. As measures were put in place to combat the spread of COVID-19, people across the globe began living in states of limited social contact, fostering feelings of social isolation and loneliness. Previous literature suggests that these increases in social disconnection can have profound effects on both physical and mental health, perhaps especially in the case of fear disorders. The combination of feeling disconnected from others and the high level of daily threat experienced due to COVID-19 created conditions under which dysfunctional and persistent fears were especially likely to develop. Building on current understanding of the harmful effects of social disconnection on well-being in general as well as specific implications for fear, here we present findings from three preliminary investigations that are the first to directly examine the effects of loneliness on how fears are learned and maintained. The Results of this work show that loneliness impairs the process by which fears are extinguished, which is central to both the regulation of fear and treatment of fear disorders, and provide insight into potential avenues to mitigate such effects.

Warm hands, warm hearts: An investigation of physical warmth as a prepared safety stimulus.

Recent work has demonstrated that social support figures seem to be particularly robust inhibitors of the Pavlovian fear response. Specifically, social support figures appear to act as prepared safety stimuli, stimuli that have played an important role in mammalian survival and are thus less easily associated with threat and more able to inhibit the fear response. Given some of the shared behavioral and neural consequences of both social support and physical warmth, as well as the importance of physical warmth for mammalian survival, we conducted a series of examinations designed to examine whether physical warmth is also a prepared safety stimulus. In two studies conducted in human adults, we examined whether a physically warm stimulus was less readily associated with threat (compared to soft or neutral stimuli; Study 1) and was able to inhibit the fear response elicited by other threatening cues (compared to neutral stimuli; Study 2). Results showed that physical warmth resisted association with threat (Study 1) and not only inhibited the fear response but also led to lasting inhibition even after the warm stimulus was removed (Study 2). Together, these studies indicate that physical warmth, like social support, meets the requirements of being a prepared safety stimulus, and they pave the way for future work to clarify the properties that enable cues in this category to naturally inhibit fear responding. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reclassifying the Unique Inhibitory Properties of Social Support Figures: A Roadmap for Exploring Prepared Fear Suppression.

Recent work has revealed that social support cues are powerful inhibitors of the fear response. They are endowed with a unique combination of inhibitory properties, enabling them to both inhibit fear in the short term and reduce fear in the long term. While these findings had previously been thought to suggest that social support cues belong to a category of prepared safety stimuli, mounting evidence clearly shows that the mechanisms underlying safety signaling cannot account for the unique effects of social support cues. Here, we propose a reclassification of social support cues as members of a prepared fear suppressor category. We present an argument for the prepared fear suppressor classification, discuss potential mechanisms underlying the unique effects of prepared fear suppressors, and outline next steps to build an understanding of this category and its clinical implications. This review is meant to serve as a roadmap for exploring this novel category of prepared fear suppressors, whose never-before-seen range of inhibitory effects makes them an important and impactful discovery with implications for both fear learning theory and clinical application.

An Argument for Reconsidering the Role of Social Support in Treating Anxiety Disorders.

Reminders of loved ones have long been avoided during extinction-based treatments because of their assumed status as safety signals, which, by inhibiting fear in the moment, impair the long-term outcomes of fear extinction. Yet, recent work has demonstrated that in contrast to standard safety signals, social support reminders actually enhance fear extinction and lead to lasting reduction of fear, suggesting that they may have beneficial effects during exposure therapy that have before-now been overlooked. Here, we argue for a revision of the assumption that social support is detrimental to fear extinction processes and propose that future work should focus on the potential of social support reminders to improve treatment outcomes in those with anxiety disorders.

Unpacking the buffering effect of social support figures: Social support attenuates fear acquisition.

Social support is associated with positive health outcomes, and research has demonstrated that the presence, or even just a reminder, of a social-support figure can reduce psychological and physiological responses to threats. However, the mechanisms underlying this effect are unclear, and no previous work has examined the impact of social support on basic fear learning processes, which have implications for threat responding. This study examined whether social support inhibits the formation of fear associations. After conducting a fear-conditioning procedure in which social-support stimuli were paired with conditional stimuli during fear acquisition, we found that the threat of shock was not associated with conditional stimuli paired with images of social-support figures, but was associated with stimuli paired with images of strangers. These findings indicate that social support prevents the formation of fear associations, reducing the amount of learned fears people acquire as they navigate the world, consequently reducing threat-related stress.