Table 1.
Summary of studies examining affect-modulated startle reactivity in various internalizing disorders except PTSD.
| Category | Study | Experimental Paradigm | Diagnostic Instrument | Subjects | Comorbid Diagnosis? | Medication* | Key result(s) |
|---|---|---|---|---|---|---|---|
| Phobias | Vrana et al. (1992) | Startle during imagery; pre- and post-treatment assessments | DSM-IIIR | 2 SP | None noted | A | Reduced FPS after treatment |
| de Jong et al. (1991) | Startle during live exposure; pre- and post-treatment assessments | Spider Questionnaire | 41 SP | None noted | A | Reduced FPS after treatment | |
| de Jong et al. (1996) | Startle during live exposure; pre- and post-treatment assessments | DSM-IV | 20 SP | None noted | A | Reduced FPS after treatment | |
| Hamm et al. (1997) | Affective-picture startle paradigm | Snake, Spider, and Mutilation Questionnaire | 48 SP 16 controls | None noted | A | FPS for phobic scenes: SP > Controls | |
| Globisch et al. (1999) | Affective-picture startle paradigm | Snake and Spider Questionnaire | 38 SP; 48 controls | None noted | A | FPS for phobic scenes: SP > Controls | |
| McTeague et al. (2009) | Startle during imagery | ADIS-IV | 75 SO; 75 controls | 25 circumscribed SO; 50 generalized SO; 27 generalized SO with mood disorder; 4 circumscribed SO with mood disorder | D | - General startle reactivity greater for all patients than controls - Generalized SO group showed potentiation across all scenes - However, generalized SO and MD showed potentiation only for personalized fear scenes - Medication use had no effect on results |
|
| de Jong et al. (1993) | Startle during live exposure; pre- and post-treatment assessments | Spider Questionnaire | 37 SP | None noted | A | SP did not show valence-modulated startle | |
| Merckelbach et al. (1995) | Startle during backward-masked 30 ms slides | DSM-IIIR | 17 SP; 12 controls | None noted | A | No differences in FPS between groups | |
| Panic Disorder with or without Agoraphobia | Melzig et al. (2007) | Startle under adaptation, threat of shock, darkness and safe conditions | ADIS-IV | 26 outpatients with PD; 22 controls | 17 AGO; 11 MD; 3 SP; 1 SO; 1 somatoform | D | - PD with MD did not show threat-potentiated startle while PD alone did - Trend toward greater startle in PD alone than controls (p = .08) - PD using SSRIs showed greater startle during adaptation than all other subjects |
| Cuthbert et al. (2003) | Startle during imagery | ADIS-R | 28 SP; 30 SO; 26 PD w/ AGO; 22 PTSD; 24 controls; 3 past BP | 26% SO; 17% SP; 27% GAD; comorbid mood disorder (MD or DYS) lowest for SP (11%) and highest for PD (42%) and PTSD (55%) | D | - Startle potentiation in SP, SO and controls, but not in PD - PD trend toward larger general startle (startle during inter-trial intervals) than SP, SO and controls - Medication use had no effect on results |
|
| Lang et al. (2007) | Startle during imagery | ADIS-IV | 30 SP; 36 SO; 27 PD w/ AGO; 26 GAD; 40 controls | 52% MD | D | - FPS: SP > SO > PD w/ AGO > GAD - Trait anxiety inversely related to FPS - Medication use had no effect on results |
|
| Grillon et al. (2008) | Startle during anticipation of aversive stimuli | SCID-I | 24 PD; 24 controls | 5 SO; MD excluded | B | PD patients showed greater startle reactivity to intertrial interval probes in unpredictable aversive condition than neutral condition; Controls showed no such effect | |
| Grillon et al. (1994) | Startle during threat of shock | ADIS-R | 34 PD; 49 controls | 5 PD w/o AGO; 26 PD w/ AGO; 1 SO; 2 GAD | A | Younger patients (< 40 y.o.) with PD showed larger startle during threat periods; Older patients did not | |
| Depression | Allen et al. (1999) | Affect-picture startle | SCID-R | 14 inpatient with current MD; 14 nondepressed | Details not noted though article mentions subjects had other diagnoses | C | - General startle reactivity for MD less than controls - Severely MD subjects showed startle potentiation during pleasant pictures |
| Dichter et al. (2004) | Affect-picture startle; assessed effect of Bupropion on startle | DSM-IV and Hamilton Rating Scale for Depression | 14 outpatient MD; 16 nondepressed | 3 with some anxiety disorder | D | - Valence-modulated startle absent in MD - Medication use had no effect on results |
|
| Forbes et al. (2005) | Affect-picture startle | A variety of instruments using DSM-III, DSM-III-R, or DSM-IV criteria | 38 MD; 38 BP; both groups had childhood-onset depression; 60 controls | 68.4% (76.3% MD) with lifetime history of anxiety disorder, and 12.3% (5.6% MD) with ASPD | D | - MD showed blink inhibition during pleasant scenes relative to neutral, and no potentiation for unpleasant versus neutral scenes - Lack of startle modulation associated with history of repeated depressive episodes - Medication use had no effect on results |
|
| Kaviani et al. (2004) | Affect-movie clips startle | DSM-IV | 22 inpatients with MD; 22 controls | None noted | C | - Controls and low MD showed valence-modulated startle; high MD did not - Effect related to anhedonia scores |
|
| Cuthbert et al. (2003) | Startle during imagery | ADIS-R | 28 SP; 30 SO; 26 PD w/ AGO; 22 PTSD; 24 controls | 26% SO; 17% SP; 27% GAD; comorbid mood disorder (MD or DYS) lowest for SP (11%) and highest for PD (42%) and PTSD (55%) | D | - No differences in FPS for subjects with and without comorbid MD - However, greater general startle (startle during inter-trial intervals) for comorbid MD than without - Medication use had no effect on results |
|
| Lang et al. (2007) | Startle during imagery | ADIS-IV | 30 SP; 36 SO; 27 PD w/ AGO; 26 GAD; 40 controls | 52% MD | D | - FPS in those with comorbid MD less than those without comorbid MD - Medication use had no effect on results |
|
| Other anxiety disorders | Kumari et al. (2001) | Affect-movie clips startle | DSM-IV | 10 inpatient OCD; 10 controls | None noted | C | Increased general startle reactivity in OCD |
| Buhlman et al. (2007) | Startle probe alone | SCID | 20 outpatient OCD; 21 controls | 4 SO; 3 body dysmorphic disorder; 2 MD; 2 DYS; 2 SP; 1 GAD; 1 PD w/ AGO; 1 trichotillomania | D | - Trend toward higher general startle reactivity in OCD (p = .07) - Unmedicated participants did not differ from controls |
|
| Lang et al. (2007) | Startle during imagery | ADIS-IV | 30 SP; 36 SO; 27 PD w/ AGO; 26 GAD; 40 controls | 52% MD | D | - FPS: SP > SO > PD w/ AGO > GAD - Trait anxiety inversely related to FPS - Medication use had no effect on results |
|
| Ray et al. (2009) | Startle probes during probes alone, tasks engaging ANS and attention, and relaxation and rumination/worr y periods | ADIS-IV | 9 GAD; 9 controls | None noted | B | GAD showing greater general startle than controls across entire task except for probe alone period at beginning of task | |
| Grillon et al. (in press) | Startle during anticipation of aversive stimuli | SCID and for PTSD patients, CAPS | 16 PTSD; 18 GAD; 34 controls | PTSD patients: 4 current MD; 2 past MD; 2 past SA GAD patients: 3 SO; 1 current MD; 1 past SA; 1 SP |
B | - No differences in FPS among groups PTSD patients: -Context-potentiated startle during unpredictable periods > predictable > neutral Controls and GAD: -Context-potentiated startle during predictable periods > unpredictable & > neutral |
Note:
Under Diagnostic Instruments: ADIS-IV = Anxiety Disorder Interview Schedule for DSM-IV; ADIS-R = Anxiety Disorders Interview Schedule–Revised; SCID = Structured Clinical Interview for DSM-IV axis I disorders; SCID-R = Structured Clinical Interview for DSM-III-R
Under Comorbid Diagnosis: AA = Alcohol Abuse/Dependence; AGO = Agoraphobia; ASPD = Antisocial Personality Disorder; BP = Bipolar Disorder; DYS = Dysthymia = DYS; GAD = Generalized Anxiety Disorder; MD = Major depression; OCD = Obsessive Compulsive Disorder; PD = Panic Disorder; PTSD = Post-traumatic stress disorder; SA = Substance Abuse/Dependence; SO = Social Phobia; SP = Specific Phobia
Under Key Result(s): FPS = Fear-Potentiated Startle
*
Medication use was classified as follows:
- A = None noted
- B = Medication-free
- C = Medication use specified, but effect of medication not assessed
- D = Medication use specified and effect of medication assessed
Medication usage varied widely and included multiple classes of drugs such as anti-anxiety, antidepressant, and neuroleptic medication. For the sake of simplicity, we treated all classes of drugs the same and collapsed them into a generic medication category. Additionally, some studies also noted subjects stopping medication use for some arbitrary period prior to the experiment (e.g., 2 weeks, 4 weeks, etc.). In such cases, we elected to classify these subjects as “medication-free” for the purposes of that particular study.