title: Learned Fear of Gastrointestinal Sensations in Healthy Adults.
abstract: Gastrointestinal symptom-specific fear and anxiety are important determinants of gastrointestinal symptom perception. We studied learning of fear toward innocuous gastrointestinal sensations as a putative mechanism in the development of gastrointestinal symptom-specific fear and anxiety.
  
  
  
  Fifty-two healthy subjects (26 women) received 2 types of esophageal balloon distention at a perceptible but nonpainful intensity (conditioned stimulus [CS], the innocuous sensation) and at a painful intensity (unconditioned stimulus [US]). Subjects were assigned randomly to 1 of 2 groups. During the learning phase, the innocuous CS preceded the painful US in the experimental group (n = 26). In the control group (n = 26), on the contrary, the US never followed the CS directly. During a subsequent extinction phase, both groups received only CS distention-the painful US was no longer administered. Indexes of fear learning toward the innocuous CS distention included the skin conductance response, fear-potentiated startle (measured by the eye-blink electromyogram), and self-reported expectancy of the US.
  
  
  
  During the learning phase, only the experimental group learned to fear the innocuous gastrointestinal CS, based on the increase in US expectancy (compared with the control group, P = .04), increased skin conductance response (compared with the control group, P = .03), and potentiated startle reflex (compared with the control group, P = .001) in response to the CS. The differences between the experimental and control groups in US expectancy and skin conductance, but not fear-potentiated startle, disappeared during the extinction phase.
  
  
  
  Fear toward innocuous gastrointestinal sensations can be established through associative learning in healthy human beings. This may be an important mechanism in the development of fear of gastrointestinal symptoms, implicated in the pathophysiology of functional gastrointestinal disorders.
authors.affiliation: Health Psychology, KU Leuven, Leuven, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Ceunen
authors.affiliation: Health Psychology, KU Leuven, Leuven, Belgium.
authors.forename: Jonas
authors.initials: J
authors.lastname: Zaman
authors.affiliation: Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Weltens
authors.affiliation: Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Sarafanova
authors.affiliation: Health Psychology, KU Leuven, Leuven, Belgium.
authors.forename: Vicky
authors.initials: V
authors.lastname: Arijs
authors.affiliation: Health Psychology, KU Leuven, Leuven, Belgium; Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
authors.affiliation: Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Lukas
authors.initials: L
authors.lastname: Van Oudenhove
authors.affiliation: Health Psychology, KU Leuven, Leuven, Belgium. Electronic address: Ilse.VanDiest@kuleuven.be.
authors.forename: Ilse
authors.initials: I
authors.lastname: Van Diest
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D004935:Esophageal Diseases / Q000473:pathology* / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology*; D012677:Sensation / Q000502:physiology*
keywords: Functional Gastrointestinal Disorders; Gastrointestinal Symptom-Specific Fear; Interoceptive Conditioning; Visceral Pain