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娱乐性恐惧中的恐惧-愉悦悖论:抑郁症中的神经关联及治疗潜力
Received 18 March 2025
Accepted for publication 14 June 2025
Published 27 June 2025 Volume 2025:18 Pages 1509—1518
DOI https://doi.org/10.2147/PRBM.S529004
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Mei-Chun Cheung
Yuting Zhan,1 Xu Ding2
1Department of Psychology, School of Education and Teach, Ningxia University, Yinchuan City, Ningxia Province, 750021, People’s Republic of China; 2School of Nursing, Shandong Academy of Medical Sciences, Shandong First Medical University, Tai’an City, Shandong Province, 271016, People’s Republic of China
Correspondence: Xu Ding, Email xuding@sams.edu.cn
Background: Recreational fear, voluntary exposure to frightening stimuli in safe contexts (eg, horror films), elicits both distress and pleasure. Although paradoxical enjoyment of fear has been documented in healthy populations, its neural and psychological mechanisms, and potential therapeutic value for depression, remain unclear.
Methods: In a mixed‐methods design, Study 1 (N = 216) assessed psychological and physiological responses to standardized fear stimuli across a continuum of depressive symptoms, using heart rate variability, salivary cortisol, and validated self‐report measures. Study 2 (N = 84) employed functional MRI to characterize brain activation during and after exposure to the same stimuli in individuals with mild‐to‐moderate depression.
Results: An inverted‐U‐shaped curve linked fear intensity to enjoyment, with depression severity significantly moderating this relationship (β = – 0.42, p < 0.001): higher symptom levels required stronger stimuli for peak pleasure. Depressed participants showed greater ventromedial prefrontal cortex activation and attenuated amygdala responses, suggesting enhanced engagement of regulatory circuits. fMRI analyses also revealed transient normalization of default‐mode and salience‐network connectivity following fear exposure (t(83) = 3.87, p < 0.001, d = 0.84).
Conclusion: Controlled recreational fear may transiently engage emotion‐regulatory networks and modify maladaptive connectivity patterns in depression, offering a novel adjunctive strategy. These findings are preliminary and correlational; future studies should examine causal effects and long‐term clinical impact.
Keywords: recreational fear, depression, emotion regulation, neuroimaging, default mode network, salience network, controlled exposure