Learning to fear obstructed breathing: Comparing interoceptive and exteroceptive cues

The present study investigated interoceptive fear conditioning (IFC) to an interoceptive and exteroceptive conditional stimulus (CS) with a severe respiratory load applied for 30 s as the unconditional stimulus (US). CSs were another, weak respiratory load in the intero-IFC study (N = 74), and a neutral picture in the extero-IFC study (N = 42). CSs preceded the US in the paired groups, whereas the unpaired groups received the same number of unpaired CSs and USs. We measured startle blink EMG, self-reported fear and respiration. In the intero-IFC study, the CS-load was associated with larger startle blinks and a smaller decrease in respiratory rate and tidal volume in the paired compared to the unpaired group. In the extero-IFC study, the CS-picture evoked an increase in tidal volume and self-reported fear only in the paired group. In addition, startle potentiation during the CS-picture was greater for the paired than for the unpaired group.