Avoidant decision-making in social anxiety disorder: A laboratory task linked to in vivo anxiety and treatment outcome

Self-esteem mediates the relationship between the parahippocampal gyrus and decisional procrastination at resting state

When faced with a conflict or dilemma, we tend to postpone or even avoid making a decision. This phenomenon is known as decisional procrastination. Here, we investigated the neural correlates of this phenomenon, in particular the parahippocampal gyrus (PHG) that has previously been identified in procrastination studies. In this study, we applied an individual difference approach to evaluate participants' spontaneous neural activity in the PHG and their decisional procrastination levels, assessed outside the fMRI scanner. We discovered that the fractional amplitude of low-frequency fluctuations (fALFF) in the caudal PHG (cPHG) could predict participants' level of decisional procrastination, as measured by the avoidant decision-making style. Importantly, participants' self-esteem mediated the relationship between the cPHG and decisional procrastination, suggesting that individuals with higher levels of spontaneous activity in the cPHG are likely to have higher levels of self-esteem and thus be more likely to make decisions on time. In short, our study broadens the PHG's known role in procrastination by demonstrating its link with decisional procrastination and the mediating influence of self-esteem, underscoring the need for further exploration of this mediation mechanism.

Tackling Costly Fearful Avoidance Using Pavlovian Counterconditioning

Avoidance behavior constitutes a major transdiagnostic symptom that exacerbates anxiety. It hampers fear extinction and predicts poor therapy-outcome. Pavlovian counterconditioning with a reward could alleviate avoidance better than traditional extinction by reducing negative valence of the feared situation. However, previous studies are scarce and did not consider that pathological avoidance is often costly and typically evolves from an approach-avoidance conflict. Therefore, we used an approach-avoidance conflict paradigm to model effects of counterconditioning on costly avoidance (i.e., avoidance that leads to missing out on rewards). Results from our preregistered Bayesian Mixed Model analyses in 51 healthy participants (43 females) indicated that counterconditioning was more effective in reducing negative valuation and decreasing costly avoidance than traditional extinction. This study supports application of a simple counterconditioning technique, shows that its efficacy transfers to more complex avoidance situations, and suggests treatment may benefit from increasing reward drive in combination with extinction to overcome avoidance. Application in a clinical sample is a necessary next step to assess clinical utility of counterconditioning.

Age-group differences in trust-related decision-making and learning

Facial impressions contribute to evaluations of trustworthiness. Older adults are especially vulnerable to trust violations, incurring risks for deception and exploitation. Using the newly developed social Iowa Gambling Task (S-IGT), we examined age-group differences in the impact of facial trustworthiness on decision-making and learning. In the congruent condition (CS-IGT), advantageous decks were paired with trustworthy faces and disadvantageous decks with untrustworthy faces. In the incongruent condition (IS-IGT), this pairing was reversed. Younger (n = 143) and older (n = 129) participants completed either the standard Iowa Gambling Task (IGT), CS-IGT, or IS-IGT. Both age groups preferred trustworthy faces in their initial choices. Older adults performed worse than younger adults across all tasks over time. Further, compared to younger adults, older adults performed worse on the IS-IGT, suggesting that incongruent facial cues interfered with older adults' performance, which aligns with reduced sensitivity to negative social reputations in aging. Multilevel modeling also indicated that age-group differences were most pronounced across all tasks in the last 40 trials. Together these findings suggest that differences between younger and older adults in experience-dependent decision-making are magnified in social contexts that involve a "wolf in sheep's clothing," which may reflect age-related difficulties in integrating incongruent information.

Gray matter abnormalities in patients with major depressive disorder and social anxiety disorder: a voxel-based meta-analysis

BACKGROUND

Major depressive and social anxiety disorders have a high comorbidity rate and similar cognitive patterns. However, their unique and shared neuroanatomical characteristics have not been fully identified.

METHODS

Voxel-based morphometric studies comparing gray matter volume between patients with major depressive disorder/social anxiety disorder and healthy controls were searched using 4 electronic databases from the inception to March 2022. Stereotactic data were extracted and subsequently tested for convergence and differences using activation likelihood estimation. In addition, based on the result of the meta-analysis, behavioral analysis was performed to assess the functional roles of the regions affected by major depressive disorder and/or social anxiety disorder.

RESULTS

In total, 34 studies on major depressive disorder with 2873 participants, and 10 studies on social anxiety disorder with 1004 subjects were included. Gray matter volume conjunction analysis showed that the right parahippocampal gyrus region, especially the amygdala, was smaller in patients compared to healthy controls. The contrast analysis of major depressive disorder and social anxiety disorder revealed lower gray matter volume in the right lentiform nucleus and medial frontal gyrus in social anxiety disorder and lower gray matter volume in the left parahippocampal gyrus in major depressive disorder. Behavioral analysis showed that regions with lower gray matter volume in social anxiety disorder are strongly associated with negative emotional processes.

CONCLUSIONS

The shared and unique patterns of gray matter volume abnormalities in patients with major depressive and social anxiety disorder may be linked to the underlying neuropathogenesis of these mental illnesses and provide potential biomarkers. PROSPERO registration number: CRD42021277546.

The action dynamics of approach-avoidance conflict during decision-making

Approach-avoidance conflict is observed in the competing motivations towards the benefits and away from the costs of a decision. The current study investigates the action dynamics of response motion during such conflicts in an attempt to characterise their dynamic resolution. An approach-avoidance conflict was generated by varying the appetitive consequences of a decision (i.e., point rewards and shorter participation time) in the presence of simultaneous aversive consequences (i.e., shock probability). Across two experiments, approach-avoidance conflict differentially affected response trajectories. Approach trajectories were less complex than avoidance trajectories and, as approach and avoidance motivations neared equipotentiality, response trajectories were more deflected from the shortest route to the eventual choice. Consistency in the location of approach and avoidance response options reduced variability in performance enabling more sensitive estimates of dynamic conflict. The time course of competing influences on response trajectories including trial-to-trial effects and conflict between approach and avoidance were estimated using regression analyses. We discuss these findings in terms of a dynamic theory of approach-avoidance that we hope will lead to insights of practical relevance in the field of maladaptive avoidance.

Desire for control and the integrated motivational-volitional model of suicidal behavior: Results from a pilot investigation of adults in the United Kingdom

BACKGROUND

Suicidal behavior remains a pressing problem in the United Kingdom. Continued theory development is a critical step toward designing effective prevention.

AIMS

The present study tested a novel element to suicide theory, the Desire for Control, for its direct and moderating roles within the Integrated Motivational-Volitional (IMV) Model of Suicidal Behavior.

METHOD

An online-administered cross-sectional suicide risk survey study (n = 116) was conducted among adults living in the United Kingdom.

RESULTS

Mean suicidal ideation scores were in the non-clinical range. DOC Leadership and Destiny Control were associated with good mental health. DOC Decision Avoidance was associated with poor mental health. DOC Decision Avoidance also acted as a motivational moderator in which the entrapment-suicidal thinking link was worse among those high in decisional avoidance.

CONCLUSION

DOC represents a novel, valuable addition to suicide theory and may inform suicide-specific psychotherapeutic intervention. Additional research is needed to full understand the role of DOC and its factor structures in the IMV.

The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine

Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.

Situation selection and modification in social inhibition: a person-centered approach

OBJECTIVES

The current study aimed to identify patterns of situation selection and modification behaviors using a person-centered approach, and to examine to what extent the trait social inhibition (SI) is associated with these patterns of situation-targeted emotion regulation.

METHODS

The sample comprised 504 participants (M_age= 21.5, SD = 8.2; 82% women), who completed questionnaires on situation selection and modification behaviors, and the social inhibition questionnaire (SIQ15). A three-step latent profile analysis (LPA) was performed to (A) identify existing latent profiles of situation avoidance and approach and situation modification behaviors, and (B) to examine the association of SI and facets with the latent class posteriors.

RESULTS

LPA revealed the presence of four profiles that differed in how situation selection and modification were applied. SI, behavioral inhibition, and social withdrawal were significantly associated with a higher odds of belonging to the profile characterized by avoidance selection and modification. Interpersonal sensitivity was associated with using more conversational modification behaviors, which may illustrate that interpersonal sensitive individuals are motivated to approach, but use avoidance behaviors to prevent confrontation.

CONCLUSIONS

SI individuals particularly rely on avoidance selection and modification behaviors, which may be considered maladaptive emotion regulation.

Behavioral Test (BAT-Back): Preliminary Evidence for a Successful Predictor of Treatment Outcome After Exposure Treatment for Chronic Low Back Pain

OBJECTIVES

Although several questionnaires assessing fear of movement exist, it is still a challenge to identify individuals who might benefit more from exposure for chronic pain than from other psychological approaches and vice versa. Psychological approaches to chronic pain cannot advance toward the often called-for "tailored approaches" because of limited knowledge about treatment predictors. Our aim was to evaluate the additional predictive value of avoidance behavior based on behavioral observation.

METHODS

This study examined pretreatment self-report and behavioral measures as predictors of treatment outcome for n=43 patients experiencing disabling chronic low back pain, who took part in a randomized controlled trial in which they received 10 to 15 sessions of exposure treatment. Only patients with elevated fear avoidance based on self-report measures were included. Data were analyzed using regression analyses and classification and regression trees.

RESULTS

Regression analyses showed that higher avoidance behavior at pretreatment as measured by the Behavioral Avoidance Test-Back Pain (BAT-Back) significantly predicted reduction in global disability (with a small to medium effect), but not in specific disability. Self-report measures failed to predict treatment success for both outcome measures. Classification and regression trees divide subgroups who might benefit from exposure treatment through a BAT-Back score of >22 for Pain Disability Index.

DISCUSSION

There is some preliminary evidence that pretreatment avoidance behavior might be an indicator for reduction in global disability after exposure treatments in patients experiencing disabling chronic low back pain and elevated fear avoidance. We identified preliminary cutoff scores that need further investigation.

Better safe than wealthy: Dysfunctional risk avoidance in spider-fearful individuals

Previous research has documented that fearful individuals avoid fear-relevant cues even if they incur costs in doing so. Paradigms that were previously used to study avoidance in the lab, manipulated reward contingencies in favor of selecting either fear-relevant or neutral cues, e.g., spiders versus butterflies. We, thus, developed a paradigm where the chance of monetary gains was linked with increasing probability of a fear-relevant or a neutral outcome. To this end, we modified the well-established Balloon Analogue Risk Task (BART) to include fear-relevant outcomes. Individuals with and without fear of spiders (N = 35) were offered the chance to inflate balloons, with more pumps resulting in larger gains. However, if the balloon exploded, this resulted in a loss of money - and at the same time in the presentation of a picture, either a fear-relevant spider or a neutral butterfly (emotional Balloon Analogue Risk Task; eBART). We operationalized risk aversion as the number of pumps and dysfunctionality of decision strategy as the amount of money that participants earned. In addition, decisional conflict was measured by response times for each decision. The data indicate, that spider-fearful individuals were generally more risk-averse and much more so in trials with fear-relevant stimuli as part of the negative outcome. Overall, this resulted in smaller amount of money that spider-fearful individuals earned compared to spider non-fearful individuals. Interestingly, spider-fearful compared to spider non-fearful individuals generally responded more hesitantly on all trials, and more so when they feared to encounter a spider. This research introduces a new paradigm and provides ecologically valid evidence for costly avoidance behavior in spider-fearful individuals. The eBART may be a promising new research tool to examine risk avoidance with emotionally relevant stimuli.

Normatively Irrelevant Affective Cues Affect Risk-Taking under Uncertainty: Insights from the Iowa Gambling Task (IGT), Skin Conductance Response, and Heart Rate Variability

Being able to distinguish between safe and risky options is paramount in making functional choices. However, deliberate manipulation of decision-makers emotions can lead to risky behaviors. This study aims at understanding how affective reactions driven by normatively irrelevant affective cues can interfere with risk-taking. Good and Bad decks of the Iowa Gambling Task have been manipulated to make them unpleasant through a negative auditory manipulation. Anticipatory skin conductance response (SCR) and heart rate variability (HRV) have been investigated in line with the somatic marker hypothesis. Results showed fewer selections from Good decks when they were negatively manipulated (i.e., Incongruent condition). No effect of the manipulation was detected when Bad decks were negatively manipulated (i.e., Congruent condition). Higher anticipatory SCR was associated with Bad decks in Congruent condition. Slower heart rate was found before selections from Good decks in Control and Congruent condition and from Bad decks in Incongruent condition. Differences in heart rate between Bad and Good decks were also detected in Congruent condition. Results shed light on how normatively irrelevant affective cues can interfere with risk-taking.

Stress Makes the Difference: Social Stress and Social Anxiety in Decision-Making Under Uncertainty

Stress and anxiety can both influence risk-taking in decision-making. While stress typically increases risk-taking, anxiety often leads to risk-averse choices. Few studies have examined both stress and anxiety in a single paradigm to assess risk-averse choices. We therefore set out to examine emotional decision-making under stress in socially anxious participants. In our study, individuals (N = 87) high or low in social anxiety completed an expanded variation of the Balloon Analogue Risk Task (BART). While inflating a balloon to a larger degree is rewarded, a possible explosion leads to (a) a loss of money and (b) it is followed by an emotional picture (i.e., a calm vs. an angry face). To induce stress before this task, participants were told that they would have to deliver a speech. We operationalized risk-taking by the number of pumps during inflation and its functionality by the amount of monetary gain. In addition, response times were recorded as an index of decisional conflict. Without the stressor, high socially anxious compared to low socially anxious participants did not differ in any of the dependent variables. However, under stress, the low socially anxious group took more risk and earned more money, while high socially anxious individuals remained more cautious and did not change their risk-taking under social stress. Overall, high socially anxious individuals made their decisions more hesitantly compared to low socially anxious individuals. Unexpectedly, there were no main effects or interactions with the valence of the emotional faces. This data shows that stress affects socially anxious individuals differently: in low socially anxious individuals stress fosters risk-taking, whereas high socially anxious individuals did not alter their behavior and remained risk-averse. The novel eBART is a promising research tool to examine the specific factors that influence decision-making.

The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder

Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients' ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment outcome.

Individual differences in costly fearful avoidance and the relation to psychophysiology

Excessive avoidance behaviour is a cardinal symptom of anxiety disorders. Avoidance is not only associated with the benefits of avoiding threats, but also with the costs of missing out on rewards upon exploration. Psychological and psychophysiological mechanisms contributing to these costly avoidance decisions in prospect of mixed outcomes remain unclear. We developed a novel Fearful Avoidance Task (FAT) that resembles characteristics of real-life approach-avoidance conflicts, enabling to disentangle reward and threat effects. Using the FAT, we investigated individual differences in avoidance behaviour and anticipatory psychophysiological states (i.e. startle reflex and skin conductance) in a relatively large sample of 343 (78 females) participants. Avoidance under acute threat of shock depends on a trade-off between perceived reward and threat. Both increased startle and skin conductance in the absence of threat of shock emerged as predictors of increased avoidance (potentially indicative of fear generalization). Increased avoidance was also associated with female sex and trait anxiety, dependent on reward and threat levels. Our findings highlight distinct possible predictors of heightened avoidance and add to mechanistic understanding of how individual propensity for costly avoidance may emerge. Distinct avoidance typologies based on differential reward and threat sensitivities may have different mechanistic origins and thereby could benefit from different treatment strategies.

Sacrificing reward to avoid threat: Characterizing PTSD in the context of a trauma-related approach-avoidance conflict task

Posttraumatic stress disorder (PTSD) is characterized by heightened avoidance, cognitive inflexibility, and impaired reward processing. Maladaptive behavior in PTSD may reflect an imbalance between approach and avoidance, but no research has investigated approach-avoidance conflict (AAC) in PTSD. The current study investigated approach-avoidance behavior in PTSD using a trauma-related AAC (trAAC) task in two independent samples. In Study 1, 43 women with a current diagnosis of PTSD and 18 healthy comparison subjects were recruited from the community. In Study 2, 53 women with trauma exposure and a range of PTSD symptoms were recruited from a correctional institution. Trials were separated into two phases: conflict (the option most likely to win points was most likely to show a trauma-related image) and congruent (the option most likely to win points was least likely to show a trauma-related image). In Study 1, reward obtainment varied with the task manipulation (i.e., fewer points earned during conflict compared to congruent Phase) in PTSD but not healthy subjects. These results indicate that when avoidance is advantageous (congruent phase), individuals with PTSD show increased task performance, whereas when avoidance is maladaptive (conflict phase), individuals with PTSD show increased sacrifice of reward. In Study 2, higher PTSD symptoms predicted decreased reward earning during the conflict phase, again indicating a sacrifice of reward when avoidance is maladaptive. Across both studies, PTSD associated with increased AAC and sacrifice of reward in the presence of trauma-related stimuli. These studies shed light on AAC in PTSD and could inform more targeted therapy approaches. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Costly avoidance in anxious individuals: Elevated threat avoidance in anxious individuals under high, but not low competing rewards

BACKGROUND AND OBJECTIVES

When avoiding threat conflicts with approaching rewards, balanced responses to threat and reward information is required to guide functional behavior. Elevated threat avoidance characterizes anxious psychopathology. However, little is known about the mutual impact of threat and reward information on approach-avoidance behavior and its link to anxiety.

METHODS

High trait-anxious and low-anxious individuals (N = 74) repeatedly choose between two options. A threat/high-reward option was linked to two outcomes: a varying chance to receive an aversive stimulus and a varying high reward. A safe/low-reward option was linked to absence of the aversive stimulus and a low reward.

RESULTS

Avoidance of the threat/high-reward option increased with increasing threat. Despite threat, low-anxious individuals increasingly approached the threat/high-reward option when rewards increased. High- compared to low-anxious individuals showed elevated avoidance, but only in the presence of high competing rewards.

LIMITATIONS

Future research should examine boundary conditions by manipulating type and motivational value of appetitive and aversive outcomes (e.g., food as primary reinforcer).

CONCLUSIONS

These findings suggest that a weaker impact of rewards competing with threat contributes to elevated threat avoidance in anxious psychopathology. Costly avoidance may thus be a factor involved in anxious psychopathology.

A neuroeconomic investigation of 5-HTT/5-HT1A gene variation, social anxiety, and risk-taking behavior

Background and objectives: Although approaches combining behavioral genetics and neuroeconomics have advanced models of addiction, no study has synthesized these methods to elucidate mechanisms of competing risk-approachand risk-avoidance in social anxiety (SA). Grounded in dual-mode models of serotonergic systems and self-regulation, this study investigated associations between SA, serotonin transporter 5-HTT (LPR; rs25531) and receptor 5-HT1A genes, and risk-taking on behavioral and self-report measures.Design and methods: Young adults (N = 309) completed a neuroeconomic task measuring gambling attractiveness (δ), reward probability discrimination (γ), and risk attitudes (α). Risk genotypes included 5-HTT (LPR; rs25531) low-expression variants (SS/SL_G/L_GL_G), and 5-HT1A (rs6295) GG.Results: Path analysis revealed that SA related to increased gambling attractiveness, but only for 5-HT1A risk groups. Although the 5-HTT (LPR; rs25531) risk genotypes and self-reported SA predicted lower social risk-taking, high-SA individuals who exhibited more accurate reward probability discrimination (γ) reported taking increased social risks.Conclusion: In line with dual-mode models, results suggest that SA predicts behavioral risk-approach at the basic decision-making level, along with self-reported social risk-avoidance, modulated by serotonergic genotypes. High-SA individuals with more accurate assessments of reward probabilities may engage in greater social risk-taking, perhaps reflecting an adaptive tendency to approach feared situations.

Verbal instructions override the meaning of facial expressions

Psychological research has long acknowledged that facial expressions can implicitly trigger affective psychophysiological responses. However, whether verbal information can alter the meaning of facial emotions and corresponding response patterns has not been tested. This study examined emotional facial expressions as cues for instructed threat-of-shock or safety, with a focus on defensive responding. In addition, reversal instructions were introduced to test the impact of explicit safety instructions on fear extinction. Forty participants were instructed that they would receive unpleasant electric shocks, for instance, when viewing happy but not angry faces. In a second block, instructions were reversed (e.g., now angry faces cued shock). Happy, neutral, and angry faces were repeatedly presented, and auditory startle probes were delivered in half of the trials. The defensive startle reflex was potentiated for threat compared to safety cues. Importantly, this effect occurred regardless of whether threat was cued by happy or angry expressions. Although the typical pattern of response habituation was observed, defense activation to newly instructed threat cues remained significantly enhanced in the second part of the experiment, and it was more pronounced in more socially anxious participants. Thus, anxious individuals did not exhibit more pronounced defense activation compared to less anxious participants, but their defense activation was more persistent.

Social and monetary incentives counteract fear-driven avoidance: Evidence from approach-avoidance decisions

BACKGROUND AND OBJECTIVES

The reduction of avoidance behavior is a central target in the treatment of anxiety disorders, but it has rarely been studied how approach of fear-relevant stimuli may be initiated. In two studies, the impact of hypothetical monetary and symbolic social incentives on approach-avoidance behavior was examined.

METHODS

In Study 1, individuals high or low on fear of spiders (N = 84) could choose to approach a fear-relevant versus a neutral stimulus, which were equally rewarded. In a subsequent micro-intervention, approaching the fear-relevant stimulus was differentially rewarded either by monetary or social incentives. In Study 2 (N = 76), initial incentives for approach were discontinued to investigate the stability of approach.

RESULTS

Hypothetical monetary and symbolic social incentives reduced or eliminated initial avoidance, even in highly fearful individuals. Approach resulted in a decrease of self-reported aversiveness towards the fear-relevant stimulus. However, even after successful approach, fearful individuals showed significant avoidance behavior when incentives for approach were discontinued.

LIMITATIONS

Future research should investigate the long-term effects of prolonged approach incentives on multiple levels of fear (e.g., self-report, behavioral, physiological). It should also be tested if such an intervention actually improves compliance with exposure based interventions.

CONCLUSIONS

The present findings highlight that incentives are useful to initiate initial approach towards a feared stimulus. Although incentive-based approach may neither fully eliminate avoidance nor negative feelings towards the feared stimulus, such operant interventions may set the stage for more extensive extinction training.

Honoring the Past, Envisioning the Future: ABCT's 50th Anniversary Presidential Address

The theme of the Association for Behavioral and Cognitive Therapies (ABCT) 50^th Anniversary was to honor the past and envision the future. From the wisdom, foresight, and determination of the pioneers of our organization, and the continuous upholding of the scientific method over the last 50 years, cognitive behavioral therapy (CBT) has become the most empirically supported psychological treatment for a wide array of mental health problems. Yet, we still have a long way to go. This address outlines a vision for the future of CBT, which involves greater collaborative science, with all minds working together on the same problem, and greater attention to the risk factors and critical processes that underlie psychopathology and explain treatment change. Such knowledge generation can inform the development of new, more efficient and more effective therapies that are tailored with more precision to the needs of each person. Latest technologies provide tools for a precision focus while at the same time increasing the reach of our treatments to the many for whom traditional therapies are unavailable. Our impact will be greatly enhanced by large samples with common methods and measures that inform a precision approach. We have come a long way since ABCT was founded in 1966, and we are poised to make even larger strides in our mission to enhance health and well-being by harnessing science, our major guiding principle.

Face-to-face: Perceived personal relevance amplifies face processing

The human face conveys emotional and social information, but it is not well understood how these two aspects influence face perception. In order to model a group situation, two faces displaying happy, neutral or angry expressions were presented. Importantly, faces were either facing the observer, or they were presented in profile view directed towards, or looking away from each other. In Experiment 1 (n = 64), face pairs were rated regarding perceived relevance, wish-to-interact, and displayed interactivity, as well as valence and arousal. All variables revealed main effects of facial expression (emotional > neutral), face orientation (facing observer > towards > away) and interactions showed that evaluation of emotional faces strongly varies with their orientation. Experiment 2 (n = 33) examined the temporal dynamics of perceptual-attentional processing of these face constellations with event-related potentials. Processing of emotional and neutral faces differed significantly in N170 amplitudes, early posterior negativity (EPN), and sustained positive potentials. Importantly, selective emotional face processing varied as a function of face orientation, indicating early emotion-specific (N170, EPN) and late threat-specific effects (LPP, sustained positivity). Taken together, perceived personal relevance to the observer-conveyed by facial expression and face direction-amplifies emotional face processing within triadic group situations.

Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten

Zusammenfassung. Theoretischer Hintergrund: Expositionsbasierte Interventionen gehören zu den wirksamsten Methoden bei der Behandlung von Angststörungen. Dennoch legen vergangene Studien nahe, dass Exposition in der verhaltenstherapeutischen Routinepraxis nur selten eingesetzt wird. Barrieren, die eine Anwendung verhindern, wurden bisher nicht systematisch erfasst. Fragestellung und Methode: Hauptziel dieser Studie war eine praxis-orientierte Erhebung systemischer Barrieren und Veränderungswünschen bei der Anwendung von Exposition aus Sicht ambulant tätiger Verhaltenstherapeutinnen und -therapeuten. Mittels postalischer Befragung wurden diese Barrieren sowie die Anwendungshäufigkeit von expositionsbasierten Interventionen erfasst (N = 684). Ergebnisse: Gemäß Selbstbericht wurde bei weniger als der Hälfte der Behandlungen von Angststörungen eine Form der Exposition eingesetzt (46.8 %), wobei die Anwendungshäufigkeit stark zwischen den Behandelnden variierte. Exposition wurde hauptsächlich in der eigenen Praxis, durchschnittlich für eine Dauer von einer Stunde und mit einer wöchentlichen bis zweiwöchentlichen Frequenz eingesetzt. Eine häufigere Anwendung war mit jüngerem Alter, weniger Berufsjahren und mehr expositionsspezifischen Aus- und Weiterbildungsstunden assoziiert. Systemische Barrieren bezogen sich besonders auf finanzielle Aspekte und das Aufwand-Vergütungsverhältnis, Unklarheiten bezüglich Versicherungs- und Abrechnungsaspekten, sowie das begrenzte Stundenkontingent. Schlussfolgerung: Exposition bei Angststörungen scheint nicht so häufig und intensiv eingesetzt zu werden, wie in aktuellen evidenzbasierten Leitlinien empfohlen wird. Diverse systemische Barrieren erschweren die Anwendung in der ambulanten Routineversorgung.

The interaction between state and dispositional emotions in decision making: An ERP study

In this study, to investigate the influence of incidental emotions on decision making in high-anxious individuals, participants were required to perform a monetary gambling task. Behavioral and electroencephalography responses were recorded to explore the stages of option assessment and outcome evaluation during decision making, respectively. Incidental emotions were elicited by facial expression pictures presented on the background, which included four conditions (control, neutral, fearful, and happy). Results showed smaller feedback-related negativity (FRN) amplitudes in high-anxious participants than low-anxious participants in the control, neutral, and fearful conditions, but not in the happy condition, for small outcomes. The P3 amplitudes were larger in high-anxious participants compared to their counterparts in the fearful and happy conditions, but not in the other conditions. In short, the interaction effects between trait anxiety and facial emotions manifested on the outcome evaluation stage of decision making.

The key role of extinction learning in anxiety disorders: behavioral strategies to enhance exposure-based treatments

PURPOSE OF REVIEW

Extinction learning is a major mechanism for fear reduction by means of exposure. Current research targets innovative strategies to enhance fear extinction and thereby optimize exposure-based treatments for anxiety disorders. This selective review updates novel behavioral strategies that may provide cutting-edge clinical implications.

RECENT FINDINGS

Recent studies provide further support for two types of enhancement strategies. Procedural enhancement strategies implemented during extinction training translate to how exposure exercises may be conducted to optimize fear extinction. These strategies mostly focus on a maximized violation of dysfunctional threat expectancies and on reducing context and stimulus specificity of extinction learning. Flanking enhancement strategies target periods before and after extinction training and inform optimal preparation and post-processing of exposure exercises. These flanking strategies focus on the enhancement of learning in general, memory (re-)consolidation, and memory retrieval.

SUMMARY

Behavioral strategies to enhance fear extinction may provide powerful clinical applications to further maximize the efficacy of exposure-based interventions. However, future replications, mechanistic examinations, and translational studies are warranted to verify long-term effects and naturalistic utility. Future directions also comprise the interplay of optimized fear extinction with (avoidance) behavior and motivational antecedents of exposure.