Could Understanding Uncertain Threat Transform Anxiety Treatment?

Several anxiety disorders, including panic disorder, social anxiety disorder, and specific phobias, share a common underlying trait: increased sensitivity to uncertain threat or fear of the unknown. Researchers from the University of Illinois at Chicago (UIC) highlight that this finding could steer anxiety treatment away from diagnosis-based therapies, focusing instead on treating their common characteristics.

A Shift in Treatment Approach

Stephanie Gorka, research assistant professor of psychiatry and a clinical psychologist in the UIC College of Medicine, states, “We may, one day, open up clinics that focus on treating the underlying common neurobiology of the patient’s symptoms instead of individual diagnoses.” This innovative approach may yield treatments targeting sensitivity to uncertain threats, enhancing care for various anxiety disorders efficiently.

Defining Uncertain Threat

Uncertain threat is characterized by unpredictability in timing, intensity, frequency, or duration, eliciting a generalized feeling of apprehension and hypervigilance. “It’s what we call anticipatory anxiety,” explains Gorka. An example might be the anxiety of not knowing when a doctor will call with test results.

Individuals sensitive to uncertain threats may feel anxious all day, worrying about the potential for something bad happening. Panic disorder exemplifies this, as patients constantly fear that they could experience a panic attack at any moment.

Predictable vs. Unpredictable Threat

Unlike uncertain threats, predictable threats trigger a clear fight-or-flight response, like when a hungry bear approaches. This response typically subsides once the threat resolves.

Research Insights: Sensitivity to Uncertain Threat

Previous research by Gorka and her colleagues suggests that heightened sensitivity to uncertain threat may significantly characterize fear-based internalizing psychopathologies. Most studies mainly address panic disorder, leaving the impact of sensitivity on social anxiety and specific phobias less understood.

Gorka and her team examined data from participants who underwent a startle task in two separate studies at UIC. Participants aged 18 to 65 included 25 with major depressive disorder, 29 with generalized anxiety disorder, 41 with social anxiety disorder, and 24 with a specific phobia. Additionally, 41 control subjects had no current or prior diagnoses of psychopathology.

Methodology: Measuring Responses in Anxiety Treatment

The researchers measured the participants’ eye-blink responses to predictable and unpredictable mild electric shocks to the wrist. To elicit blinking during the shock task, participants heard short acoustic tones via headphones. “No matter who you are or what your mental health status, you are going to blink in response to the tone,” Gorka stated. “It’s a natural reflex, so everyone does it, without exception.”

Researchers used electrodes under participants’ eyes to compare blink strength in response to predictable and unpredictable shocks.

Findings: Distinct Responses Among Disorders in Anxiety Treatment

The results revealed that participants with social anxiety disorder or specific phobias blinked much more strongly during unpredictable shocks compared to those without a mental health diagnosis or participants with major depressive disorder or generalized anxiety disorder.

Dr. K. Luan Phan, professor of psychiatry and director of the mood and anxiety disorders research program, emphasized the implications of these findings: “We classify so many different mood and anxiety disorders, and each has its own set of guidelines for treatment. However, if we focus on treating their shared characteristics, we might achieve better progress.”

Conclusion: A New Frontier in Anxiety Treatment

Understanding that sensitivity to uncertain threat underlies all fear-based anxiety disorders suggests that medications targeting this sensitivity could be developed or used to treat these conditions more effectively. This shift in focus may pave the way for a more unified and efficient approach to anxiety treatment.