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

You see what you avoid: Fear of spiders and avoidance are associated with predominance of spiders in binocular rivalry

What we see is the result of an efficient selection of cues in the visual stream. In addition to physical characteristics this process is also influenced by emotional salience of the cues. Previously, we showed in spider phobic patients that fear-related pictures gain preferential access to consciousness in binocular rivalry. We set out to replicate this in an independent unselected sample and examine the relationship of this perceptual bias with a range of symptom clusters. To this end, we recruited 79 participants with variable degrees of fear of spiders. To induce binocular rivalry, a picture of either a spider or a flower was projected to one eye, and a neutral geometric pattern to the other eye. Participants continuously reported what they saw. We correlated indices of perceptual dominance (first percept, dominance duration) with individual fear of spiders and with scores on specific symptom clusters of fear of spiders (i.e., vigilance, fixation, and avoidance coping). Overall, higher fear of spiders correlates with more predominace of spider pictures. In addition, this perceptual bias is uniquely associated with avoidance coping. Interestingly, this demonstrates that a perceptual bias, which is not intentionally controlled, is linked with an instrumental coping behavior, that has been implicated in the maintenance of pathological fear.

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.