From the current issue of Cerebral Cortex
Experimental studies of conditioned learning reveal activity changes in the amygdala and unimodal sensory cortex underlying fear acquisition to simple stimuli. However, real-world fears typically involve complex stimuli represented at the category level. A consequence of category-level representations of threat is that aversive experiences with particular category members may lead one to infer that related exemplars likewise pose a threat, despite variations in physical form…
Here, we examined the effect of category-level representations of threat on human brain activation using 2 superordinate categories (animals and tools) as conditioned stimuli…
These findings provide novel evidence that aversive learning can modulate category-level representations of object concepts, thereby enabling individuals to express fear to a range of related stimuli. (Emphasis added)
Translating (cautiously) this research might suggest a few useful, clinical nuggets.
Lets take the example of the “aversive experience” of bending forwards and experiencing back pain. The experience, even if it is context (time, place, people around, sounds and sights etc etc) dependent will belong to a broader category – ‘back movements’, or maybe broader still, ‘movement’.
If the threat associated with bending forwards becomes represented at the category level that this experience belongs to, i.e. ‘movement’, the inference could be made that any movement poses a threat, which might then lead to pain with, any movement.
Clinically, I don’t think this would surprise anyone. Everyday patients are seen who experience pain with, seemingly, unrelated movements – the person who experiences back pain when elevating their arms even a little, or the person with a whiplash associated disorder who experiences neck pain performing lumbar rotation lying supine. Anyone remember “Waddell’s signs”?
Staying in the clinic, the notion of fears and threats being held at the category level might suggest that the fine-grained specificity of exercise, so common in a lot of therapy, misses the mark if the brain is holding more global, broader representations of threats associated with movements. Then again, maybe these exercises introduce movement in a very graded, non-threatening way which allows them to ‘sneak under the pain radar’? Perhaps the explanatory models of various exercise regimes could be updated beyond “strengthening” and “stabilising”?
Maybe patients have Forgotten Everything – the detailed, specific, initial aversive experience And Remember only the broader, more general, category level threat. As a therapist, the job then is to simply remind them that movement is safe and ok. A bit of music always helps of course…
– Tim Cocks