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Effects of Arousal and Stress in Anxiety

Effects of Arousal and Stress on Classical Conditioning

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00026559
Enrollment
1418
Registered
2001-11-12
Start date
2001-01-10
Completion date
2022-07-28
Last updated
2024-01-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Healthy Volunteers

Keywords

Classical Conditioning, Fear Conditioning, Stress, Learning, Normal Volunteers, Healthy Volunteer, Normal Control

Brief summary

This study has several parts. One part will examine the influence of factors such as personality and past experience on reactions to unpleasant stimuli. Others will examine the effect of personality and emotional and attentional states on learning and memory. When confronted with fearful or unpleasant events, people can develop fear of specific cues that were associated with these events as well as to the environmental context in which the events occurred via a process called classical conditioning. Classical conditioning has been used to model anxiety disorders, but the relationship between stress and anxiety and conditioned responses remains unclear. This study will examine the relationship between cued conditioning and context conditioning . This study will also explore the acquisition and retention of different types of motor, emotional, and cognitive associative processes during various tasks that range from mildly arousing to stressful.

Detailed description

Objective: Fear and anxiety are adaptive responses to different types of threats. Fear is a short-duration response evoked by explicit threat cues and anxiety a more sustained state of apprehension evoked by unpredictable threat. This protocol studied fear using Pavlovian fear conditioning in two studies. Studies 1 and 3. Study 2 focused on anxiety. Studies 1 and 3 will be discontinued to focus uniquely on the study of anxiety. Specifically, we will examine the interactions between anxiety induced experimentally using verbal threat and cognitive processes. We will seek to 1) characterize the effect of anxiety on key cognitive processes including working memory and attention control and 2) examine the extent to which performance of cognitive tasks distract from anxiety. Study population: This more-than-minimal-risk protocol will test medically and psychiatrically healthy volunteers aged 18-50. Pregnant or nursing women will be excluded. Method: Fear and anxiety will be measured using the startle reflex to brief and loud sounds. Fear conditioning will be assessed using shock as unconditioned stimulus. Cognitive performance will be examined during periods of unpredictable shock anticipation. Outcome measures: The study will include cognitive performance and measure of aversive states, primarily the startle reflex.

Interventions

Shock Device

DEVICEAuditory Startle Device

Auditory Startle Device

Sponsors

National Institute of Mental Health (NIMH)
Lead SponsorNIH

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes

Inclusion criteria

* INCLUSION CRITERIA: * Males and females * Age 18-50

Exclusion criteria

* Pregnancy * Any current ongoing medical illness * Current Axis I disorders * Past significant psychiatric disorders (e.g., psychotic disorders) according to Diagnostic and Statistical Manual (DSM)-IV * Current alcohol or substance abuse according to DSM-IV criteria * History of alcohol or substance dependence based on DSM-IV criteria within 6 months prior to screening * Current psychotropic medication use * Current or past organic central nervous system disorders, including but not limited to seizure disorder or neurological symptoms of the wrist and arms (e.g., carpal tunnel syndrome). The latter exclusion is for shock studies only. * Positive urine toxicology screen * Employees of National Institute of Mental Health (NIMH) or an immediate family member of a NIMH employee.

Design outcomes

Primary

MeasureTime frameDescription
Nogo Trials Followed by no Button Press250 ms at a rate of one every 2000 msSubjects participated in go/no go (GNG) task condition during periods of threat of shocks and periods of safety when no shock could be administered. During the GNG stimuli were presented on a monitor. In the GNG task, participants were asked to respond to frequent 'go' stimuli ('=') by pressing the '2' on the keypad of a computer keyboard and to withhold their response to infrequent 'nogo' stimuli ('O'). Stimuli were randomly distributed. A correct go hit was a response recorded during these 2000 millisecond (ms) to a go trial. Similarly, a correct nogo omission was a no response during the same period to a nogo trial. Performance was determined for each condition (threat, safe) and trial type (go, nogo) by dividing the number of correct response by the total number of each trial type.
Response to Startle Reflex20-100 ms window following the onset of the startle stimulusThe startle reflex was elicited with a 103-decibel (dB) white noise (40-ms duration) delivered via headphone. The eyeblink component of the startle reflex was recorded binaurally with two AgCl electrodes placed under the left eye. The peak startle/eyeblink reflex magnitude was determined in the 20-100 ms timeframe. The shock was administered either on the left wrist or on the left middle and ring fingers, depending on where the desired intensity was reached. Startle stimuli were delivered between two go trials and go trials that followed a startle stimulus were not included in the analysis. A shock was delivered in two of the four threat blocks in each sequence, just prior to the last go trial, which was not included in the analysis (for a total of 4 shocks). Shock could be administered only in the threat condition and never in the safe condition. The results were analyzed using a Condition (safe, threat) x Task (task, no task) repeated ANOVA.
Subjective Measures of Level of AnxietyEvery 100 sec repeated 8 timesSubjects retrospectively rated their level of anxiety using a scale of 1-10 where 1 = not at all anxious and 10 = extremely anxious at the end of each block of a sequence for a total of eight blocks. A block was defined as a combination of a condition (safe or threat) and a task (task or no task). The results were analyzed using a Condition (safe, threat) x Task (task, no task) repeated ANOVA.
Go Correct Hits Followed by Button Press250 ms at a rate of one every 2000 msSubjects participated in go/no go (GNG) task condition during periods of threat of shocks and periods of safety when no shock could be administered. During the GNG stimuli were presented on a monitor. In the GNG task, participants were asked to respond to frequent 'go' stimuli ('=') by pressing the '2' on the keypad of a computer keyboard and to withhold their response to infrequent 'nogo' stimuli ('O'). Stimuli were randomly distributed. A correct go hit was a response recorded during these 2000 millisecond (ms) to a go trial. Similarly, a correct nogo omission was a no response during the same period to a nogo trial. Performance was determined for each condition (threat, safe) and trial type (go, nogo) by dividing the number of correct response by the total number of each trial type.
Correct-go Reaction Time (RT)2000 ms during trialCorrect go responses were go trials followed by button press. Mean reaction time (RT) was calculated for correct-go to evaluate speed-accuracy trade-off.

Secondary

MeasureTime frameDescription
Measure of Level of Anxiety1-3 weeks before start of studyThe level of anxiety was assessed using the Trait Anxiety Inventory questionnaire. The Trait Anxiety Scale (T-Anxiety) evaluates relatively stable aspects of anxiety proneness, including general states of calmness, confidence, and security. The Trait Anxiety Scale has 20 items. All items are rated on a 4-point scale: 1 = almost never, 2 = sometimes, 3 = often, and 4 = almost always.. The scale has a minimum score of 20 and a maximum score of 80. Higher score indicates greater anxiety. Trait Anxiety score was measured prior to start of the study.
Measure of Attention Control1-3 weeks before start of studySubjects completed the Attention Control Scale (ACS) prior to start of the study. The ACS is a 20-item self-report scale that measures attentional focusing (9 items) and attentional shifting (11 items) rated on a four-point likert scale from 1 - almost never to 4 - always with total score range of 20 to 80. Higher score on ACS reflect better ability to direct and maintain attention.

Countries

United States

Participant flow

Pre-assignment details

All sub-studies were conducted at different time points so subjects had the option to participate in multiple sub-studies

Participants by arm

ArmCount
Sub-study A: Working Memory Task
Participant performed a working memory task in two conditions, under threat of shock and in safety and asked to remember verbal and nonverbal stimuli from the current stimulus on the screen (N-back task)
115
Sub-study C: Sustained Attention to Response Task (SART)
Participant was presented with stimuli and either initiated a response (i.e. go) or inhibited their response (i.e. stop) based on what stimuli were presented
54
Sub-study D: Stroop Task
In the classic Stroop test, the name of a color is printed in a color that conflicts or does not conflict with the word. In the emotional Stroop, the words emotional words. The participant's task was to name the color of the word
39
Pilot Studies
(1) Shocks were delivered via electrodes located on the forearm or fingers while participant performed a working memory or vigilance task or (2) Subject performed cognitive tasks during alternating safe and threat periods
1,210
Total1,418

Baseline characteristics

CharacteristicSub-study A: Working Memory TaskSub-study C: Sustained Attention to Response Task (SART)Sub-study D: Stroop TaskPilot StudiesTotal
Age, Categorical
Healthy volunteers
<=18 years
0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Healthy volunteers
>=65 years
0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Healthy volunteers
Between 18 and 65 years
115 Participants54 Participants39 Participants1210 Participants1418 Participants
Ethnicity (NIH/OMB)
Healthy volunteers
Hispanic or Latino
12 Participants4 Participants1 Participants89 Participants106 Participants
Ethnicity (NIH/OMB)
Healthy volunteers
Not Hispanic or Latino
101 Participants48 Participants38 Participants1103 Participants1290 Participants
Ethnicity (NIH/OMB)
Healthy volunteers
Unknown or Not Reported
2 Participants2 Participants0 Participants18 Participants22 Participants
Race (NIH/OMB)
Healthy volunteers
American Indian or Alaska Native
0 Participants0 Participants0 Participants7 Participants7 Participants
Race (NIH/OMB)
Healthy volunteers
Asian
22 Participants7 Participants3 Participants169 Participants201 Participants
Race (NIH/OMB)
Healthy volunteers
Black or African American
26 Participants20 Participants13 Participants280 Participants339 Participants
Race (NIH/OMB)
Healthy volunteers
More than one race
6 Participants1 Participants1 Participants26 Participants34 Participants
Race (NIH/OMB)
Healthy volunteers
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants3 Participants3 Participants
Race (NIH/OMB)
Healthy volunteers
Unknown or Not Reported
3 Participants3 Participants1 Participants63 Participants70 Participants
Race (NIH/OMB)
Healthy volunteers
White
58 Participants23 Participants21 Participants662 Participants764 Participants
Sex/Gender, Customized
Healthy volunteers
Female
68 Participants38 Participants26 Participants655 Participants787 Participants
Sex/Gender, Customized
Healthy volunteers
Male
47 Participants16 Participants13 Participants554 Participants630 Participants
Sex/Gender, Customized
Healthy volunteers
Unknown
0 Participants0 Participants0 Participants1 Participants1 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
0 / 1150 / 610 / 690 / 1,210
other
Total, other adverse events
0 / 1150 / 610 / 690 / 1,210
serious
Total, serious adverse events
0 / 1150 / 610 / 690 / 1,210

Outcome results

Primary

Correct-go Reaction Time (RT)

Correct go responses were go trials followed by button press. Mean reaction time (RT) was calculated for correct-go to evaluate speed-accuracy trade-off.

Time frame: 2000 ms during trial

Population: Analysis included a subset of 40 health volunteers who participated in a study to examine the effect of anxiety induced by the threat of shock on Go-NoGo performance. Four subjects were excluded in the final analysis.

ArmMeasureGroupValue (MEAN)
Healthy VolunteersCorrect-go Reaction Time (RT)Safe Condition358.5 millisecond
Healthy VolunteersCorrect-go Reaction Time (RT)Threat Condition349.3 millisecond
Primary

Go Correct Hits Followed by Button Press

Subjects participated in go/no go (GNG) task condition during periods of threat of shocks and periods of safety when no shock could be administered. During the GNG stimuli were presented on a monitor. In the GNG task, participants were asked to respond to frequent 'go' stimuli ('=') by pressing the '2' on the keypad of a computer keyboard and to withhold their response to infrequent 'nogo' stimuli ('O'). Stimuli were randomly distributed. A correct go hit was a response recorded during these 2000 millisecond (ms) to a go trial. Similarly, a correct nogo omission was a no response during the same period to a nogo trial. Performance was determined for each condition (threat, safe) and trial type (go, nogo) by dividing the number of correct response by the total number of each trial type.

Time frame: 250 ms at a rate of one every 2000 ms

Population: Analysis included a subset of 40 health volunteers who participated in a study to examine the effect of anxiety induced by the threat of shock on Go/NoGo performance. Four subjects were excluded in the final analysis.

ArmMeasureGroupValue (MEAN)
Healthy VolunteersGo Correct Hits Followed by Button PressSafe Condition90.9 Percentage of correct responses
Healthy VolunteersGo Correct Hits Followed by Button PressThreat Condition91.6 Percentage of correct responses
Primary

Nogo Trials Followed by no Button Press

Subjects participated in go/no go (GNG) task condition during periods of threat of shocks and periods of safety when no shock could be administered. During the GNG stimuli were presented on a monitor. In the GNG task, participants were asked to respond to frequent 'go' stimuli ('=') by pressing the '2' on the keypad of a computer keyboard and to withhold their response to infrequent 'nogo' stimuli ('O'). Stimuli were randomly distributed. A correct go hit was a response recorded during these 2000 millisecond (ms) to a go trial. Similarly, a correct nogo omission was a no response during the same period to a nogo trial. Performance was determined for each condition (threat, safe) and trial type (go, nogo) by dividing the number of correct response by the total number of each trial type.

Time frame: 250 ms at a rate of one every 2000 ms

Population: Analysis included a subset of 40 health volunteers who participated in a study to examine the effect of anxiety induced by the threat of shock on Go-NoGo performance. Four subjects were excluded in the final analysis

ArmMeasureGroupValue (MEAN)
Healthy VolunteersNogo Trials Followed by no Button PressSafe Condition74.4 Percentage of correct responses
Healthy VolunteersNogo Trials Followed by no Button PressThreat Condition81.2 Percentage of correct responses
Primary

Response to Startle Reflex

The startle reflex was elicited with a 103-decibel (dB) white noise (40-ms duration) delivered via headphone. The eyeblink component of the startle reflex was recorded binaurally with two AgCl electrodes placed under the left eye. The peak startle/eyeblink reflex magnitude was determined in the 20-100 ms timeframe. The shock was administered either on the left wrist or on the left middle and ring fingers, depending on where the desired intensity was reached. Startle stimuli were delivered between two go trials and go trials that followed a startle stimulus were not included in the analysis. A shock was delivered in two of the four threat blocks in each sequence, just prior to the last go trial, which was not included in the analysis (for a total of 4 shocks). Shock could be administered only in the threat condition and never in the safe condition. The results were analyzed using a Condition (safe, threat) x Task (task, no task) repeated ANOVA.

Time frame: 20-100 ms window following the onset of the startle stimulus

Population: Analysis included a subset of 40 health volunteers who participated in a study to examine the effect of anxiety induced by the threat of shock on Go-NoGo performance. Four subjects were excluded in the final analysis.

ArmMeasureGroupValue (MEAN)
Healthy VolunteersResponse to Startle ReflexNo Task - Safe condition44.2 milliseconds
Healthy VolunteersResponse to Startle ReflexNo Task - Threat condition57.5 milliseconds
Healthy VolunteersResponse to Startle ReflexTask - Safe condition42.4 milliseconds
Healthy VolunteersResponse to Startle ReflexTask - Threat condition53 milliseconds
Primary

Subjective Measures of Level of Anxiety

Subjects retrospectively rated their level of anxiety using a scale of 1-10 where 1 = not at all anxious and 10 = extremely anxious at the end of each block of a sequence for a total of eight blocks. A block was defined as a combination of a condition (safe or threat) and a task (task or no task). The results were analyzed using a Condition (safe, threat) x Task (task, no task) repeated ANOVA.

Time frame: Every 100 sec repeated 8 times

Population: Analysis included a subset of 40 health volunteers who participated in a study to examine the effect of anxiety induced by the threat of shock on Go-NoGo performance. Four subjects were excluded in the final analysis.

ArmMeasureGroupValue (MEAN)
Healthy VolunteersSubjective Measures of Level of AnxietyNo Task - Safe Condition1.6 Units on a scale
Healthy VolunteersSubjective Measures of Level of AnxietyNo Task - Threat Condition3.4 Units on a scale
Healthy VolunteersSubjective Measures of Level of AnxietyTask - Safe Condition1.6 Units on a scale
Healthy VolunteersSubjective Measures of Level of AnxietyTask - Threat Condition3.6 Units on a scale
Secondary

Measure of Attention Control

Subjects completed the Attention Control Scale (ACS) prior to start of the study. The ACS is a 20-item self-report scale that measures attentional focusing (9 items) and attentional shifting (11 items) rated on a four-point likert scale from 1 - almost never to 4 - always with total score range of 20 to 80. Higher score on ACS reflect better ability to direct and maintain attention.

Time frame: 1-3 weeks before start of study

Population: Analysis included a subset of 60 health volunteers who participated in a study to examine the effect of anxiety induced by threat of shock on the Sustained Attention to Response Task (SART).

ArmMeasureValue (MEAN)Dispersion
Healthy VolunteersMeasure of Attention Control59.9 Units on a scaleStandard Error 0.9
Secondary

Measure of Level of Anxiety

The level of anxiety was assessed using the Trait Anxiety Inventory questionnaire. The Trait Anxiety Scale (T-Anxiety) evaluates relatively stable aspects of anxiety proneness, including general states of calmness, confidence, and security. The Trait Anxiety Scale has 20 items. All items are rated on a 4-point scale: 1 = almost never, 2 = sometimes, 3 = often, and 4 = almost always.. The scale has a minimum score of 20 and a maximum score of 80. Higher score indicates greater anxiety. Trait Anxiety score was measured prior to start of the study.

Time frame: 1-3 weeks before start of study

Population: Analysis included a subset of 60 health volunteers who participated in a study to examine the effect of anxiety induced by threat of shock on the Sustained Attention to Response Task (SART).

ArmMeasureValue (MEAN)Dispersion
Healthy VolunteersMeasure of Level of Anxiety28 Units on a scaleStandard Error 0.8

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026