# Are Fear Learning Processes Altered in Obsessive‐Compulsive Disorder, Social Anxiety, and Specific Phobia? Insights From the Late Positive Potential, Fear‐Potentiated Startle, and Ratings

## TL;DR

This study explores how fear learning processes differ in anxiety disorders and finds that symptom dimensions like anxious arousal and depression significantly influence these processes.

## Contribution

The study introduces a transdiagnostic approach to fear learning in anxiety disorders, emphasizing the role of symptom dimensions over traditional categorical comparisons.

## Key findings

- Anxious arousal is linked to heightened fear responses during acquisition and generalization phases.
- Depressive symptoms are associated with increased fear expectations during extinction.
- Transdiagnostic symptom dimensions influence fear learning more than disorder-specific group differences.

## Abstract

Fear learning processes are often considered underlying mechanisms in the development and maintenance of anxiety‐ and stress‐related disorders. However, limited attention has been paid to whether these changes are shared across disorders or certain symptoms. In this context, transdiagnostic research on symptom dimensions is especially relevant, as it addresses the significant symptom overlap and heterogeneity observed in these disorders. In the current study, we investigated the late positive potential, fear‐potentiated startle, and subjective ratings (US‐expectancy) in a transdiagnostic sample (N = 156) including participants with obsessive‐compulsive disorder (OCD; n = 38), social anxiety disorder (SAD; n = 39), specific phobia (SP; n = 40), and control participants (n = 39). Anxious arousal, anxious apprehension, and depressive symptoms were examined as relevant core symptom dimensions to these disorders. A differential fear learning paradigm using geometrical forms was employed, including a habituation, acquisition, generalization, and extinction phase. We observed successful fear acquisition across all outcomes, which generalized to the stimulus most similar to the CS+, the GS+. During extinction, fear responses to the CS+ remained significantly elevated compared to the CS−. Group comparison revealed that patients with SAD rated US‐expectancy for the CS− higher during acquisition. On a dimensional level, anxious arousal was associated with increased US‐expectancy and startle response for the CS+ during acquisition and increased US‐expectancy for the GS+ during generalization. Depressive symptoms were linked to an overall higher US‐expectancy during extinction. These findings suggest that individual differences in symptom dimensions, particularly anxious arousal and depressive symptoms, appear to influence fear learning and extinction processes across disorders. This underscores the potential of adopting transdiagnostic approaches in future research and clinical interventions and highlights that the frequently co‐occurring comorbid depressive symptoms impact fear extinction, and therefore, should be considered in the treatment of anxiety disorders to enhance therapeutic outcomes.

This study investigates fear and safety learning across different anxiety‐ and stress‐related disorders (obsessive‐compuslive disorder, social anxiety disorder, and specific phobia) while also considering core symptom dimensions to address symptom overlap and heterogeneity. Results indicate that a dimensional approach across disorders is more effective than categorical comparisons, with transdiagnostic dimensions—especially anxious arousal and depressive symptoms—significantly influencing fear learning and extinction. This highlights the importance of adopting transdiagnostic approaches in future research and clinical interventions.