Fear-Pleasure Paradox in Recreational Fear: Neural Correlates and Therapeutic Potential in Depression.

Abstract

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.