title: Influence of Interoceptive Fear Learning on Visceral Perception.
abstract: OBJECTIVE
  Interoceptive fear learning and generalization have been hypothesized to play a key role in unexplained abdominal and esophageal pain in patients with functional gastrointestinal disorders. However, there is no experimental evidence demonstrating that fear learning and generalization to visceral sensations can be established in humans and alter visceral perception.
  
  
  METHODS
  In a novel fear learning-generalization paradigm, an innocuous esophageal balloon distension served as conditioned stimulus (CS), and distensions at three different pressure levels around the pain detection threshold were used as generalization stimuli. During fear learning, the CS was paired with a painful electrical stimulus (unconditioned stimulus) in the conditioning group (n = 30), whereas in the control group (n = 30), the unconditioned stimulus was delivered alone. Before and after fear learning, visceral perception thresholds for first sensation, discomfort, and pain and visceral discrimination sensitivity were assessed.
  
  
  RESULTS
  Fear learning was established in the conditioning group only (potentiated eye-blink startle to the CS (t(464.06) = 3.17, p = .002), and fear generalization to other stimulus intensities was observed (t(469.12) = 2.97, p = .003; t(464.29) = 4.17, p < .001). The thresholds for first sensation habituated in the control group, whereas it remained constant in the conditioning group (F(1,43) = 9.77, p = .003).
  
  
  CONCLUSIONS
  These data show that fear learning using visceral stimuli induces fear generalization and influences visceral perception. These findings support the idea that in functional gastrointestinal disorder, fear learning and generalization can foster gastrointestinal-specific anxiety and contribute to visceral hypersensitivity.
authors.affiliation: From the Research Group Health Psychology (Zaman, Vlaeyen, Van den Bergh, Van Diest), Faculty of Psychology and Educational Sciences; Translational Research Centre for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine (Weltens, Ly, Van Oudenhove); and Centre for the Psychology of Learning and Experimental Psychopathology (Struyf), Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium; Department Clinical Psychological Science (Vlaeyen), Maastricht University, Maastricht, the Netherlands; Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) (Wiech) and Nuffield Department of Clinical Neurosciences (Wiech), Nuffield Division Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, UK; and Consultation-Liaison Psychiatry (Van Oudenhove), University Psychiatric Centre KU Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Jonas
authors.initials: J
authors.lastname: Zaman
authors.forename: Nathalie
authors.initials: N
authors.lastname: Weltens
authors.forename: Huynh Giao
authors.initials: HG
authors.lastname: Ly
authors.forename: Dieter
authors.initials: D
authors.lastname: Struyf
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
authors.forename: Omer
authors.initials: O
authors.lastname: Van den Bergh
authors.forename: Katja
authors.initials: K
authors.lastname: Wiech
authors.forename: Lukas
authors.initials: L
authors.lastname: Van Oudenhove
authors.forename: Ilse
authors.initials: I
authors.lastname: Van Diest
mesh_terms: D000328:Adult; D003213:Conditioning, Psychological / Q000502:physiology; D003463:Cues; D004558:Electric Stimulation; D005239:Fear / Q000502:physiology / Q000523:psychology*; D005260:Female; D005793:Generalization, Psychological / Q000502:physiology; D006801:Humans; D065812:Interoception / Q000502:physiology*; D007858:Learning / Q000502:physiology*; D008297:Male; D059265:Visceral Pain / Q000503:physiopathology / Q000523:psychology*; D055815:Young Adult