The neuropsychology of fear learning and fear regulation.

In the current review article it is suggested that fear is a central emotional state that can be activated by external threat cues. The subcortical defensive system cannot only be activated by intrinsically aversive events but shows also strong plasticity enabling previously innocuous stimuli to get access to the fear system after they were paired with painful outcomes. On the other hand, aversive conditioning does not only result in the acquisition of a defensive disposition, the organism also learns on a pure cognitive level that one stimulus predicts the occurrence of another stimulus. It is suggested here that potentiation of the acoustic startle reflex is a rather specific measure for fear acquisition, while skin conductance discrimination indexes contingency learning. It is shown that the acquisition of fear-potentiated startle does not require cortical processing of the conditioned stimulus. Moreover, data indicate that conditioned startle potentiation is abolished in patients with unilateral lesions of the amygdala. Finally, conditioned startle potentiation can be obtained without contingency awareness, which on the other hand is necessary for skin conductance conditioning to occur. It is suggested that the learning of stimulus relations is mediated by the hippocampus and that conditioned startle potentiation is also mediated by the hippocampus in trace conditioning.