A review of the modulation of the startle reflex by affective states and its application in psychiatry

OBJECTIVE To provide an overview of startle reflex methodologies applied to the examination of emotional and motivational states in humans and to review the findings in different forms of psychopathology. METHODS Pertinent articles were searched mostly via MEDLINE and PsycINFO. RESULTS The startle reflex is a non-invasive translational tool of research that bridges the gap between animal and human investigations. Startle is used to study fear and anxiety, affective disturbances, sensitization, motivational states, and homeostasis. CONCLUSIONS The startle reflex is highly sensitive to various factors that are of interest in the studies of emotional disorders and has promoted new areas of investigations in psychiatry. However, research in psychiatry is still in its infancy and most findings await replication. Future progress will benefit from the development of innovative and powerful designs tailored to investigate specific disorders. SIGNIFICANCE The startle reflex has utility as a research tool to examine trauma-related disorders, fear learning, drug addiction, and to contrast affective states and emotional processing across diagnostic groups, but its usefulness as a diagnostic tool is limited.

[1]  T. Buchanan,et al.  Altered emotion-modulated startle in young adults with a family history of alcoholism. , 2002, Alcoholism, clinical and experimental research.

[2]  C. Bradshaw,et al.  The effects of some antidepressant drugs on prepulse inhibition of the acoustic startle (eyeblink) response and the N1/P2 auditory evoked response in man , 2000, Journal of psychopharmacology.

[3]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[4]  P. Lang,et al.  Affective judgment and psychophysiological response: Dimensional covariation in the evaluation of pictorial stimuli. , 1989 .

[5]  R. Davidson,et al.  Temporal stability of the emotion-modulated startle response. , 2000, Psychophysiology.

[6]  A. Hamm,et al.  Sensitization and aversive conditioning: Effects on the startle reflex and electrodermal responding , 1993, Integrative physiological and behavioral science : the official journal of the Pavlovian Society.

[7]  L. Pohorecky,et al.  Assessment of the development of tolerance to ethanol using multiple measures. , 1986, Alcoholism, clinical and experimental research.

[8]  C. Grillon,et al.  Methadone patients exhibit increased startle and cortisol response after intravenous yohimbine , 2001, Psychopharmacology.

[9]  Michael Davis,et al.  Lesions of the bed nucleus of the stria terminalis block sensitization of the acoustic startle reflex produced by repeated stress, but not fear-potentiated startle , 1998, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[10]  Michael Davis,et al.  Sensitization of the acoustic startle reflex by footshock. , 1989, Behavioral neuroscience.

[11]  A. Beck,et al.  Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. , 1996, Journal of personality assessment.

[12]  S. Shiffman,et al.  Current models of nicotine dependence: what is known and what is needed to advance understanding of tobacco etiology among youth. , 2000, Drug and alcohol dependence.

[13]  P. Pauli,et al.  Dependence on Smoking and the Acoustic Startle Response in Healthy Smokers , 1998, Pharmacology Biochemistry and Behavior.

[14]  S. Rauch,et al.  Response and Habituation of the Human Amygdala during Visual Processing of Facial Expression , 1996, Neuron.

[15]  Michael Davis Diazepam and flurazepam: Effects on conditioned fear as measured with the potentiated startle paradigm , 1979, Psychopharmacology.

[16]  Annette M. Schmid,et al.  Pleasure-attenuation of startle is disrupted by lesions of the nucleus accumbens. , 1996, Neuroreport.

[17]  A. Mathews,et al.  Selective processing of concern-related information in depression. , 1997, The British journal of clinical psychology.

[18]  J. Kagan,et al.  Further evidence of an association between behavioral inhibition and anxiety disorders: Results from a family study of children from a non-clinical sample , 1991 .

[19]  Michael Davis,et al.  Are different parts of the extended amygdala involved in fear versus anxiety? , 1998, Biological Psychiatry.

[20]  G. Alheid Amygdala and extended amygdala , 1995 .

[21]  C. Grillon,et al.  Affective reactivity of language and the startle response in schizophrenia , 1995, Biological Psychiatry.

[22]  D. Klein Endogenomorphic depression. A conceptual and terminological revision. , 1974, Archives of general psychiatry.

[23]  H. Hoffman,et al.  Reflex modification in the domain of startle: I. Some empirical findings and their implications for how the nervous system processes sensory input. , 1980, Psychological review.

[24]  M. Balaban,et al.  Affective influences on startle in five-month-old infants: reactions to facial expressions of emotions. , 1995, Child development.

[25]  C. A. Morgan,et al.  Fear-potentiated startle in posttraumatic stress disorder , 1995, Biological Psychiatry.

[26]  Michael Davis,et al.  Quantifying fear potentiated startle using absolute versus proportional increase scoring methods: implications for the neurocircuitry of fear and anxiety , 2002, Psychopharmacology.

[27]  R. Davidson,et al.  Suppression and enhancement of emotional responses to unpleasant pictures. , 2000, Psychophysiology.

[28]  The human startle reflex and alcohol cue reactivity: effects of early versus late abstinence. , 2002 .

[29]  C. Grillon,et al.  Fear-potentiated startle conditioning in humans: explicit and contextual cue conditioning following paired versus unpaired training. , 1997, Psychophysiology.

[30]  A. Ohman,et al.  Fear appears fast: temporal course of startle reflex potentiation in animal fearful subjects. , 1999, Psychophysiology.

[31]  M. Balaban,et al.  Salience of fear/threat in the affective modulation of the human startle blink , 1994, Biological Psychology.

[32]  M. Saladin,et al.  Differential urge and salivary responsivity to alcohol cues in alcohol-dependent patients: a comparison of traditional and stringent classification approaches. , 1999, Experimental and clinical psychopharmacology.

[33]  C. Grillon,et al.  Anxiolytic effects of a novel group II metabotropic glutamate receptor agonist (LY354740) in the fear-potentiated startle paradigm in humans , 2003, Psychopharmacology.

[34]  M. Bradley,et al.  Looking at pictures: affective, facial, visceral, and behavioral reactions. , 1993, Psychophysiology.

[35]  Christian Grillon,et al.  Effects of experimental context and explicit threat cues on acoustic startle in vietnam veterans with posttraumatic stress disorder , 1998, Biological Psychiatry.

[36]  C. Patrick,et al.  Alcohol and fear-potentiated startle: the role of competing cognitive demands in the stress-reducing effects of intoxication. , 1998, Journal of abnormal psychology.

[37]  K. Mueser,et al.  Anhedonia, positive and negative affect, and social functioning in schizophrenia. , 1998, Schizophrenia bulletin.

[38]  J. Gray,et al.  Smoking withdrawal, nicotine dependence and prepulse inhibition of the acoustic startle reflex , 1999, Psychopharmacology.

[39]  Michael Davis,et al.  Pharmacological and anatomical analysis of fear conditioning using the fear-potentiated startle paradigm. , 1986, Behavioral neuroscience.

[40]  K. Spence,et al.  Temporal effects of conditioned fear on the eyelid reflex. , 1958, Journal of experimental psychology.

[41]  M. Irwin,et al.  The history of anxiety symptoms among 171 primary alcoholics. , 1990, Journal of studies on alcohol.

[42]  Physiologic responses to loud tones in Vietnam veterans with posttraumatic stress disorder. , 1995 .

[43]  A. Garakani,et al.  Psychobiology of the acute stress response and its relationship to the psychobiology of post-traumatic stress disorder. , 2002, The Psychiatric clinics of North America.

[44]  R. Hare ACQUISITION AND GENERALIZATION OF A CONDITIONED-FEAR RESPONSE IN PSYCHOPATHIC AND NONPSYCHOPATHIC CRIMINALS. , 1965, The Journal of psychology.

[45]  Michael E. Dawson,et al.  Short Lead Interval Startle Modification , 1999 .

[46]  C. Grillon,et al.  Startle modulation in children at risk for anxiety disorders and/or alcoholism. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  V. Kumari,et al.  Enhanced startle reactions to acoustic stimuli in patients with obsessive-compulsive disorder. , 2001, The American journal of psychiatry.

[48]  Charlotte vanOyen Witvliet,et al.  Emotional imagery, the visual startle, and covariation bias: An affective matching account , 2000, Biological Psychology.

[49]  R. Cohen,et al.  Affective modulation of the startle reflex in schizophrenic patients , 2005, European Archives of Psychiatry and Clinical Neuroscience.

[50]  M. Bradley,et al.  Emotion in the criminal psychopath: startle reflex modulation. , 1993, Journal of abnormal psychology.

[51]  G. Hammond,et al.  Interpretation revealed in the blink of an eye: depressive bias in the resolution of ambiguity. , 2002, Journal of abnormal psychology.

[52]  R. Richardson Shock sensitization of startle: learned or unlearned fear? , 2000, Behavioural Brain Research.

[53]  C. A. Morgan,et al.  Yohimbine — facilitated acoustic startle reflex in humans , 2005, Psychopharmacology.

[54]  P. Lang,et al.  Psychometric description of some specific-fear questionnaires. , 1974 .

[55]  M. Bradley,et al.  Pictures as prepulse: attention and emotion in startle modification. , 1993, Psychophysiology.

[56]  D. Blanchard,et al.  Innate and conditioned reactions to threat in rats with amygdaloid lesions. , 1972, Journal of comparative and physiological psychology.

[57]  A. J. Szumski Conditioned Reflexes and Neuronal Organization , 1970 .

[58]  C. Patrick,et al.  Alcohol and human emotion: a multidimensional analysis incorporating startle-probe methodology. , 1995, Journal of abnormal psychology.

[59]  J. Conger Alcoholism: theory, problem and challenge. II. Reinforcement theory and the dynamics of alcoholism. , 1956, Quarterly journal of studies on alcohol.

[60]  C. A. Morgan,et al.  Exaggerated acoustic startle reflex in Gulf War veterans with posttraumatic stress disorder. , 1996, The American journal of psychiatry.

[61]  C. A. Morgan,et al.  Fear-potentiated startle conditioning to explicit and contextual cues in Gulf War veterans with posttraumatic stress disorder. , 1999, Journal of abnormal psychology.

[62]  M. Casacchia,et al.  Acoustic and electrically elicited startle reaction: similar patterns of habituation and reflex modifications in humans. , 1993, The International journal of neuroscience.

[63]  O. Bonne,et al.  Alprazolam reduces response to loud tones in panic disorder but not in posttraumatic stress disorder , 1998, Biological Psychiatry.

[64]  C. A. Morgan,et al.  Effect of darkness on acoustic startle in Vietnam veterans with PTSD. , 1998, The American journal of psychiatry.

[65]  S. Orr,et al.  Auditory startle response in trauma survivors with posttraumatic stress disorder: a prospective study. , 2000, The American journal of psychiatry.

[66]  H. Hopf,et al.  Changes in the blink responses to combined trigeminal, acoustic and visual repetitive stimulation, studied in the human subject. , 1982, Electroencephalography and clinical neurophysiology.

[67]  M. Dawson,et al.  Modification of the acoustic startle-reflex eyeblink: A tool for investigating early and late attentional processes , 1993, Biological Psychology.

[68]  E R Kandel,et al.  From metapsychology to molecular biology: explorations into the nature of anxiety. , 1983, The American journal of psychiatry.

[69]  C. Patrick,et al.  Affective imagery and the startle response: probing mechanisms of modulation during pleasant scenes, personal experiences, and discrete negative emotions. , 2002, Psychophysiology.

[70]  N C Andreasen,et al.  Negative v positive schizophrenia. Definition and validation. , 1982, Archives of general psychiatry.

[71]  H. Flor,et al.  Stimulus-induced craving and startle potentiation in abstinent alcoholics and controls , 2002, European Psychiatry.

[72]  D L Braff,et al.  Physiological evidence of exaggerated startle response in a subgroup of Vietnam veterans with combat-related PTSD. , 1990, The American journal of psychiatry.

[73]  A. Shalev,et al.  Auditory startle reflex in post-traumatic stress disorder patients treated with clonazepam. , 1992, The Israel journal of psychiatry and related sciences.

[74]  D. Watson,et al.  Development and validation of brief measures of positive and negative affect: the PANAS scales. , 1988, Journal of personality and social psychology.

[75]  Michael Davis,et al.  Acoustic startle, prepulse inhibition, and fear-potentiated startle measured in rhesus monkeys , 2002, Biological Psychiatry.

[76]  K. Miczek,et al.  Persistent suppression of ethanol self-administration by brief social stress in rats and increased startle response as index of withdrawal , 2001, Physiology & Behavior.

[77]  M. Bradley,et al.  Emotion, attention, and the startle reflex. , 1990, Psychological review.

[78]  C. Patrick,et al.  Diazepam blocks fear-potentiated startle in humans. , 1996, Journal of abnormal psychology.

[79]  C. Bradshaw,et al.  Effects of clonidine and diazepam on prepulse inhibition of the acoustic startle response and the N1/P2 auditory evoked potential in man , 2001, Journal of psychopharmacology.

[80]  Michael Davis,et al.  Anxiogenic effects of high illumination levels assessed with the acoustic startle response in rats , 1997, Biological Psychiatry.

[81]  M. Dawson,et al.  The role of awareness in human differential autonomic classical conditioning: the necessary-gate hypothesis. , 1976, Psychophysiology.

[82]  J. Lacey Somatic response patterning and stress : some revisions of activation theory , 1967 .

[83]  L. Hawk,et al.  Addressing the specificity of affective startle modulation: fear versus disgust , 2002, Biological Psychology.

[84]  J. Kehne,et al.  Anxiolytic effects of buspirone and gepirone in the fear-potentiated startle paradigm , 2004, Psychopharmacology.

[85]  Michael Davis,et al.  Lesions of the amygdala, but not of the cerebellum or red nucleus, block conditioned fear as measured with the potentiated startle paradigm. , 1986, Behavioral neuroscience.

[86]  A. Rodríguez-Fornells,et al.  Differential effects of alprazolam on the baseline and fear-potentiated startle reflex in humans: a dose-response study , 2001, Psychopharmacology.

[87]  S. Southwick,et al.  Evidence of acoustic startle hyperreflexia in recently detoxified early onset male alcoholics: modulation by yohimbine and m-Chlorophenylpiperazine (mCPP) , 1997, Psychopharmacology.

[88]  E. Ornitz,et al.  Maturation of startle modulation. , 1986, Psychophysiology.

[89]  Andrew Mathews,et al.  COGNITIVE PROCESSES IN ANXIETY , 1983 .

[90]  H. de Wit,et al.  Role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. , 1984, Psychological review.

[91]  D. Dinges,et al.  Habituation of the startle reflex in posttraumatic stress disorder. , 1989, The Journal of neuropsychiatry and clinical neurosciences.

[92]  K R Merikangas,et al.  Startle potentiation by threat of aversive stimuli and darkness in adolescents: a multi-site study. , 1999, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[93]  C. A. Morgan,et al.  Yohimbine facilitated acoustic startle in combat veterans with post-traumatic stress disorder , 1995, Psychopharmacology.

[94]  P. Lang,et al.  A FEAR SURVEY SCHEDULE FOR USE IN BEHAVIOUR THERAPY. , 1964, Behaviour research and therapy.

[95]  C. Grillon,et al.  Effects of ethanol on the acoustic startle reflex in humans , 1994, Psychopharmacology.

[96]  Michael Davis,et al.  Double Dissociation between the Involvement of the Bed Nucleus of the Stria Terminalis and the Central Nucleus of the Amygdala in Startle Increases Produced by Conditioned versus Unconditioned Fear , 1997, The Journal of Neuroscience.

[97]  S. Orr,et al.  Physiologic responses to loud tones in israeli veterans of the 1973 yom kippur war , 1997, Biological Psychiatry.

[98]  Younglim Lee,et al.  A Primary Acoustic Startle Pathway: Obligatory Role of Cochlear Root Neurons and the Nucleus Reticularis Pontis Caudalis , 1996, The Journal of Neuroscience.

[99]  E. Ornitz,et al.  Startle modulation in children with posttraumatic stress disorder. , 1989, The American journal of psychiatry.

[100]  D. Barlow Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. , 2000 .

[101]  M. Stein,et al.  Familial aggregation of anxiety-related quantitative traits in generalized social phobia: clues to understanding "disorder" heritability? , 2001, American journal of medical genetics.

[102]  C. Braun,et al.  Emotional qualities of odors and their influence on the startle reflex in humans. , 1994, Psychophysiology.

[103]  M. Bradley,et al.  Probing picture perception: activation and emotion. , 1996, Psychophysiology.

[104]  K. Rasmussen,et al.  Nicotine withdrawal: a behavioral assessment using schedule controlled responding, locomotor activity, and sensorimotor reactivity , 2005, Psychopharmacology.

[105]  E. Cook,et al.  Fearfulness and startle potentiation during aversive visual stimuli. , 2007, Psychophysiology.

[106]  C. Grillon,et al.  Comments on the use of the startle reflex in psychopharmacological challenges: impact of baseline startle on measurement of fear-potentiated startle , 2002, Psychopharmacology.

[107]  A. Hamm,et al.  Affective learning: awareness and aversion. , 1996, Psychophysiology.

[108]  A. Cohen,et al.  Affective reactivity of language symptoms, startle responding, and inhibition in schizophrenia. , 2001, Journal of abnormal psychology.

[109]  Frances K. Graham,et al.  Blink reflex modification by selective attention: Evidence for the modulation of ‘automatic’ processing , 1985, Biological Psychology.

[110]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[111]  Michael Davis,et al.  Role of the bed nucleus of the stria terminalis versus the amygdala in fear, stress, and anxiety. , 2003, European journal of pharmacology.

[112]  J. Gore,et al.  Activation of the left amygdala to a cognitive representation of fear , 2001, Nature Neuroscience.

[113]  William A. Hunt,et al.  The startle pattern , 1939 .

[114]  A. van Boxtel,et al.  Optimal EMG signal bandwidth and interelectrode distance for the recording of acoustic, electrocutaneous, and photic blink reflexes. , 1998, Psychophysiology.

[115]  C. Grillon,et al.  Fear-potentiated startle in adolescent offspring of parents with anxiety disordersf , 1998, Biological Psychiatry.

[116]  M. Koch,et al.  Conditioned Pleasure Attenuates the Startle Response in Rats , 1995, Neurobiology of Learning and Memory.

[117]  P. Lang,et al.  The startle probe response: a new measure of emotion? , 1988, Journal of abnormal psychology.

[118]  J. Gray,et al.  PERSONALITY AND AFFECTIVE MODULATION OF THE STARTLE REFLEX , 1995 .

[119]  N. Risch,et al.  Comorbidity and co-transmission of alcoholism, anxiety and depression , 1994, Psychological Medicine.

[120]  D. Schoepp,et al.  The anxiolytic action of mGlu2/3 receptor agonist, LY354740, in the fear-potentiated startle model in rats is mechanistically distinct from diazepam , 2002, Pharmacology Biochemistry and Behavior.

[121]  T. Blumenthal,et al.  Effects of Caffeine and Caffeine-Associated Stimuli on the Human Startle Eyeblink Reflex , 1998, Pharmacology Biochemistry and Behavior.

[122]  S. Paradiso,et al.  Cerebral blood flow changes associated with attribution of emotional valence to pleasant, unpleasant, and neutral visual stimuli in a PET study of normal subjects. , 1999, The American journal of psychiatry.

[123]  A. Arntz,et al.  The startle probe response as an instrument for evaluating exposure effects in spider phobia , 1993 .

[124]  N. Frijda,et al.  Modulation of the acoustic startle response by film-induced fear and sexual arousal. , 1991, Psychophysiology.

[125]  I. Marks Fears and phobias , 1989, PSICOLOGIA.

[126]  Colin M. Macleod,et al.  Anxiety and explicit alcohol-related memory in problem drinkers. , 2002, Addictive behaviors.

[127]  J. Gray,et al.  Effect of clonidine on the human acoustic startle reflex , 1996, Psychopharmacology.

[128]  T. Buchanan,et al.  Exogenous cortisol exerts effects on the startle reflex independent of emotional modulation , 2001, Pharmacology Biochemistry and Behavior.

[129]  C. Grillon,et al.  Contextual fear-potentiated startle conditioning in humans: replication and extension. , 2001, Psychophysiology.

[130]  Christian Grillon,et al.  Gating and habituation of the startle reflex in schizophrenic patients. , 1992 .

[131]  Joseph E LeDoux,et al.  Different projections of the central amygdaloid nucleus mediate autonomic and behavioral correlates of conditioned fear , 1988, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[132]  M. Bradley,et al.  Affective reactions to acoustic stimuli. , 2000, Psychophysiology.

[133]  F. Graham,et al.  Presidential Address, 1974. The more or less startling effects of weak prestimulation. , 1975, Psychophysiology.

[134]  P. Pauli,et al.  Appetitive nature of drug cues confirmed with physiological measures in a model using pictures of smoking , 2000, Psychopharmacology.

[135]  D J Rohsenow,et al.  Relevance of cue reactivity to understanding alcohol and smoking relapse. , 1988, Journal of abnormal psychology.

[136]  S. Orr,et al.  Auditory startle responses in help-seeking trauma survivors , 1997, Psychiatry Research.

[137]  O. Lipp,et al.  Does Affective Learning Exist in the Absence of Contingency Awareness , 2001 .

[138]  U. Dimberg For Distinguished Early Career Contribution to Psychophysiology: Award Address, 1988 , 1990 .

[139]  B. Natelson,et al.  Persistent stress-induced sensitization of adrenocortical and startle responses , 1994, Physiology & Behavior.

[140]  C. Grillon,et al.  A Double Dissociation in the Affective Modulation of Startle in Humans: Effects of Unilateral Temporal Lobectomy , 2001, Journal of Cognitive Neuroscience.

[141]  Michael Davis,et al.  Noradrenergic agonists and antagonists: Effects on conditioned fear as measured by the potentiated startle paradigm , 1979, Psychopharmacology.

[142]  Shock sensitization of startle in rats: the role of contextual conditioning. , 1998, Behavioral neuroscience.

[143]  Roy R. Grinker,et al.  “MEN UNDER STRESS.” , 1945 .

[144]  G. Paxinos The Rat nervous system , 1985 .

[145]  R. Bolles,et al.  Clinical implications of Bolles & Fanselow's pain/fear model , 1980, Behavioral and Brain Sciences.

[146]  C. Grillon,et al.  Fear-potentiated startle: Relationship to the level of state/trait anxiety in healthy subjects , 1993, Biological Psychiatry.

[147]  L. Allan,et al.  Learning and homeostasis : Drug addiction and the McCollough effect , 1998 .

[148]  Norman Alessi Is There a Future for Depression Digital Motion Constructs in Psychiatry? , 2001, Cyberpsychology Behav. Soc. Netw..

[149]  Michael Davis,et al.  Fear-potentiated startle: A neural and pharmacological analysis , 1993, Behavioural Brain Research.

[150]  C. A. Morgan,et al.  Benzodiazepines have no effect on fear-potentiated startle in humans , 2002, Psychopharmacology.

[151]  M. Koch,et al.  The acoustic startle response in rats—circuits mediating evocation, inhibition and potentiation , 1997, Behavioural Brain Research.

[152]  U Dimberg,et al.  Facial electromyography and emotional reactions. , 1990, Psychophysiology.

[153]  A. Beck,et al.  Assessment of depression: the depression inventory. , 1974, Modern problems of pharmacopsychiatry.

[154]  Michael Davis,et al.  Involvement of subcortical and cortical afferents to the lateral nucleus of the amygdala in fear conditioning measured with fear- potentiated startle in rats trained concurrently with auditory and visual conditioned stimuli , 1995, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[155]  C. Grillon,et al.  Baseline and fear-potentiated startle in panic disorder patients , 1994, Biological Psychiatry.

[156]  Z. Ying,et al.  Predictors of an acute antidepressant response to fluoxetine and sertraline. , 1999, International clinical psychopharmacology.

[157]  H. Hoffman,et al.  Attentional factors in the inhibition of a reflex by a visual stimulus. , 1980, Science.

[158]  C. Patrick,et al.  Emotion and psychopathy: startling new insights. , 1994, Psychophysiology.

[159]  C. Curtis,et al.  Acoustic startle reflex in schizophrenia patients and their first-degree relatives: evidence of normal emotional modulation. , 1999, Psychophysiology.

[160]  C. A. Morgan,et al.  Baseline startle amplitude and prepulse inhibition in Vietnam veterans with posttraumatic stress disorder , 1996, Psychiatry Research.

[161]  D. Schoepp,et al.  Anxiolytic and side-effect profile of LY354740: a potent, highly selective, orally active agonist for group II metabotropic glutamate receptors. , 1998, The Journal of pharmacology and experimental therapeutics.

[162]  M. Bradley,et al.  Startle Modification: Affect and the Startle Reflex , 1999 .

[163]  J. Krystal,et al.  Affective Reactivity of Language in Schizophrenia , 1994, The Journal of nervous and mental disease.

[164]  H. Sackeim,et al.  Psychomotor symptoms of depression. , 1997, The American journal of psychiatry.

[165]  E. Cook,et al.  Affective individual differences and startle reflex modulation. , 1991, Journal of abnormal psychology.

[166]  B. Anthony,et al.  Evidence for sensory-selective set in young infants. , 1983, Science.

[167]  D Hell,et al.  Prepulse inhibition deficits in patients with panic disorder , 2002, Depression and anxiety.

[168]  John Trinder,et al.  Affective startle modulation in clinical depression: preliminary findings , 1999, Biological Psychiatry.

[169]  D. Perrett,et al.  A differential neural response in the human amygdala to fearful and happy facial expressions , 1996, Nature.

[170]  C. Grillon,et al.  Darkness facilitates the acoustic startle reflex in humans , 1997, Biological Psychiatry.

[171]  Eyeblink startle responses in spider phobies before and after treatment: A pilot study , 1991 .

[172]  R. Yehuda,et al.  Sensitization of the Hypothalamic‐Pituitary‐Adrenal Axis in Posttraumatic Stress Disorder a , 1997, Annals of the New York Academy of Sciences.

[173]  M. Geyer,et al.  Responding to acoustic startle during chronic ethanol intoxication and withdrawal , 2005, Psychopharmacology.

[174]  K Merikangas,et al.  Fear-potentiated startle in humans: effects of anticipatory anxiety on the acoustic blink reflex. , 1991, Psychophysiology.

[175]  J. S. Brown,et al.  Conditioned fear as revealed by magnitude of startle response to an auditory stimulus. , 1951, Journal of experimental psychology.

[176]  C. Grillon Associative learning deficits increase symptoms of anxiety in humans , 2002, Biological Psychiatry.

[177]  H. Merckelbach,et al.  Startle and spider phobia: Unilateral probes and the prediction of treatment effects , 1996 .

[178]  C. A. Morgan,et al.  Startle reflex abnormalities in women with sexual assault-related posttraumatic stress disorder. , 1997, The American journal of psychiatry.

[179]  J. Kagan,et al.  Behavioral inhibition in children of parents with panic disorder and agoraphobia. A controlled study. , 1988, Archives of general psychiatry.

[180]  Personality and disinhibitory psychopathology: Alcoholism and antisocial personality disorder. , 1994 .

[181]  A. Rodríguez-Fornells,et al.  Effects of alprazolam on the acoustic startle response in humans , 1999, Psychopharmacology.

[182]  C. Schmitt,et al.  Psychophysiological Correlates of Peritraumatic Dissociative Responses in Survivors of Life-Threatening Cardiac Events , 2002, Psychopathology.

[183]  J. Schulkin,et al.  From normal fear to pathological anxiety. , 1998, Psychological review.

[184]  Thomas J. Ross,et al.  Amygdala response to both positively and negatively valenced stimuli , 2001, Neuroreport.

[185]  E. Gorenstein,et al.  Disinhibitory psychopathology: a new perspective and a model for research. , 1980, Psychological review.

[186]  H. Ehrlichman,et al.  Startle reflex modulation during exposure to pleasant and unpleasant odors. , 1995, Psychophysiology.

[187]  B. Wexler,et al.  Affective reactivity of cognitive functioning and family history in schizophrenia , 1996, Biological Psychiatry.

[188]  R. Davidson,et al.  Normative emotion-modulated startle response in individuals at risk for schizophrenia–spectrum disorders , 2002, Schizophrenia Research.

[189]  Michelle G. Craske,et al.  Anxiety Disorders: Psychological Approaches To Theory And Treatment , 1998 .

[190]  C. Bradshaw,et al.  Effects of a controlled-release formulation of trazodone on psychomotor and autonomic functions in healthy volunteers: Comparison with trazodone (conventional formulation), amitriptyline and placebo , 2004, European Journal of Clinical Pharmacology.

[191]  S. Orr,et al.  Physiologic reactivity to startling tones in women with posttraumatic stress disorder. , 1999, Journal of abnormal psychology.

[192]  B. Cuthbert,et al.  Fear and the startle reflex: blink modulation and autonomic response patterns in animal and mutilation fearful subjects. , 1997, Psychophysiology.

[193]  J. Allen,et al.  Valence-dependent modulation of psychophysiological measures: is there consistency across repeated testing? , 2000, Psychophysiology.

[194]  C. Bradshaw,et al.  Comparison of the effects of diazepam on the fear-potentiated startle reflex and the fear-inhibited light reflex in man , 1999, Journal of psychopharmacology.

[195]  Startle Modification: Affective Individual Differences, Psychopathology, and Startle Reflex Modification , 1999 .

[196]  W. K. Berg,et al.  Startle Modification: Startle Elicitation: Stimulus Parameters, Recording Techniques, and Quantification , 1999 .

[197]  S. Herpertz,et al.  Affective responsiveness in borderline personality disorder: a psychophysiological approach. , 1999, The American journal of psychiatry.

[198]  M. Dawson,et al.  Startle reactivity and PTSD symptoms in a community sample of women , 2001, Psychiatry Research.

[199]  Isaac Marks Fears, phobias, and rituals , 1987 .

[200]  S. Vrana,et al.  Startle reflex modification as an outcome measure in the treatment of phobia: Two case studies. , 1992 .

[201]  Christian Grillon,et al.  Startle reactivity and anxiety disorders: aversive conditioning, context, and neurobiology , 2002, Biological Psychiatry.

[202]  Michael Davis,et al.  Sensitization of the startle reflex by footshock: blockade by lesions of the central nucleus of the amygdala or its efferent pathway to the brainstem. , 1989, Behavioral neuroscience.

[203]  Peter J. Lang,et al.  Emotion, novelty, and the startle reflex: habituation in humans. , 1993, Behavioral neuroscience.

[204]  R. Mucha,et al.  Appetitive effects of drug cues modelled by pictures of the intake ritual: generality of cue-modulated startle examined with inpatient alcoholics , 2000, Psychopharmacology.

[205]  Mark K. Greenwald,et al.  Emotional learning, hedonic change, and the startle probe. , 1993, Journal of abnormal psychology.

[206]  S. Orr,et al.  Physiologic responses to loud tones in Israeli patients with posttraumatic stress disorder. , 1992, Archives of general psychiatry.

[207]  F. Vaccarino,et al.  Effects of CCK-4 infusion on the acoustic eye-blink startle and psychophysiological measures in healthy volunteers , 1999, Journal of psychopharmacology.