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Elevated costly avoidance in anxiety disorders: Patients show little downregulation of acquired avoidance in face of competing rewards for approach
Author(s) -
Pittig Andre,
Boschet Juliane M.,
Glück Valentina M.,
Schneider Kristina
Publication year - 2021
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.23119
Subject(s) - anxiety , avoidance behaviour , psychology , avoidance response , harm avoidance , arousal , aversive stimulus , avoidance learning , expectancy theory , psychopathology , avoidance coping , clinical psychology , developmental psychology , psychiatry , temperament , personality , social psychology , coping (psychology) , neuroscience
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.