Impaired safety signal learning may be a biomarker of PTSD

A dysregulated fear response is one of the hallmark clinical presentations of patients suffering from posttraumatic stress disorder (PTSD). These patients show over-generalization of fear and in tandem an inability to inhibit fear responses in the presence of safety. Here, we summarize our recent findings using a conditional discrimination paradigm, which assesses safety signal processing (AX+/BX−) in combat and civilian PTSD populations. Overall, PTSD subjects demonstrate a lack of safety signal learning and an inability to modulate the fear responses with safety cues. We then review studies of the neurobiology of fear expression and inhibition in humans and non-humans, in order to provide a background for preliminary studies using reverse translation procedures in which the same AX+/BX− paradigm was used in rhesus macaques.This article is part of a Special Issue entitled ‘Post-Traumatic Stress Disorder’.

► Fear-potentiated startle is a highly useful translational measure of fear in PTSD.
► Conditional discrimination (AX+/BX−) assesses fear expression and inhibition of fear.
► Impaired fear inhibition is observed in combat and civilian trauma-related PTSD.
► Impaired fear inhibition is specific to PTSD rather than comorbid depression.
► Reverse translation of AX+/BX− can give insight into neurobiology of fear inhibition.