Elevated costly avoidance in anxiety disorders: Patients show little downregulation of acquired avoidance in face of competing rewards for approach

Pittig A, Boschet JM, Gluck VM, Schneider K (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Depression and Anxiety Wiley-Blackwell

Book Volume: 38

Pages Range: 361-371

Journal Issue: 3

DOI: 10.1002/da.23119

Abstract

Background: Pathological avoidance is a transdiagnostic characteristic of anxiety disorders. Avoidance conditioning re-emerged as a translational model to examine mechanisms and treatment of avoidance. However, its validity for anxiety disorders remains unclear. Methods: This study tested for altered avoidance in patients with anxiety disorders compared to matched controls (n = 40/group) using instrumental conditioning assessing low-cost avoidance (avoiding a single aversive outcome) and costly avoidance (avoidance conflicted with gaining rewards). Autonomic arousal and threat expectancy were assessed as indicators of conditioned fear. Associations with dimensional symptom severity were examined. Results: Patients and controls showed frequent low-cost avoidance without group differences. Controls subsequently inhibited avoidance to gain rewards, which was amplified when aversive outcomes discontinued. In contrast, patients failed to reduce avoidance when aversive and positive outcomes competed (elevated costly avoidance) and showed limited reduction when aversive outcomes discontinued (persistent costly avoidance). Interestingly, elevated costly avoidance was not linked to higher conditioned fear in patients. Moreover, individual data revealed a bimodal distribution of costly avoidance: Some patients showed persistent avoidance, others showed little to no avoidance. Persistent versus low avoiders did not differ in other task-related variables, response to gains and losses in absence of threat, sociodemographic data, or clinical characteristics. Conclusions: Findings suggest that anxious psychopathology is associated with a deficit to inhibit avoidance in presence of competing positive outcomes. This offers novel perspectives for research on mechanisms and treatment of anxiety disorders.

Authors with CRIS profile

Andre Pittig Professorship for Translational Psychotherapy

Related research project(s)

Decision conflicts in anxiety: Experimental mechanisms of approach-avoidance conflicts and their clinical relevance for anxiety disorders (DCA) May 1, 2018 - May 1, 2021

Involved external institutions

Julius-Maximilians-Universität Würzburg DE Germany (DE)

How to cite

APA:

Pittig, A., Boschet, J.M., Gluck, V.M., & Schneider, K. (2021). Elevated costly avoidance in anxiety disorders: Patients show little downregulation of acquired avoidance in face of competing rewards for approach. Depression and Anxiety, 38(3), 361-371. https://doi.org/10.1002/da.23119

MLA:

Pittig, Andre, et al. "Elevated costly avoidance in anxiety disorders: Patients show little downregulation of acquired avoidance in face of competing rewards for approach." Depression and Anxiety 38.3 (2021): 361-371.

BibTeX: Download