Developing digital interventions for a post-Covid world: A smartphone-based approach-avoidance training to reduce alcohol craving

Harmful alcohol use is a major public health issue. In-person treatment has been hindered by the restrictions necessary during the Covid-19 pandemic. This study examined the effects of an at-home smartphone-based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20-30-min smartphone-based approach-avoidance training (AAT) on image-induced craving at a 1-day follow-up. Sixty-two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1-week follow-up were compared to an active control group. Experiment 1 showed a significant reduction in image-induced craving for the training group at 1-day follow-up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1-week follow-up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone-based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1-week follow-up.

Think positive! Resolving human motion ambiguity in the presence of disease threat

Recently, approach-avoidance tendencies and visual perception biases have been increasingly studied using bistable point-light walkers (PLWs). Prior studies have found a facing-the-viewer bias when one is primed with general threat stimuli (e.g. angry faces), explained by the "error management theory", as failing to detect a threat as approaching is riskier than the opposite. Importantly, no study has explored how disease threat - linked to the behavioural immune system - might affect this bias. This study aimed to explore whether disease-signalling cues can alter how we perceive the motion direction of ambiguous PLWs. Throughout 3 experiments, participants indicated the motion direction of a bistable PLW previously primed with a control or disease-signalling stimuli - that is, face with a surgical mask (Experiment 1), sickness sound (Experiment 2), or face with a disease cue (Experiment 3). Results showed that sickness cues do not significantly modulate the perception of approach-avoidance behaviours. However, a pattern emerged in Experiments 2 and 3, suggesting that sickness stimuli led to more facing away percepts. Unlike other types of threat, this implies that disease-related threat stimuli might trigger a distinct perceptual bias, indicating a preference to avoid a possible infection source. Nonetheless, this finding warrants future investigations.

Developmental shift in testosterone influence on prefrontal emotion control

A paradox of testosterone effects is seen in adolescents versus adults in social emotional approach-avoidance behavior. During adolescence, high testosterone levels are associated with increased anterior prefrontal (aPFC) involvement in emotion control, whereas during adulthood this neuro-endocrine relation is reversed. Rodent work shows that, during puberty, testosterone transitions from a neuro-developmental to a social-sexual activating hormone. In this study, we explored whether this functional transition is also present in human adolescents and young adults. Using a prospective longitudinal design, we investigated the role of testosterone on neural control of social emotional behavior during the transitions from middle to late adolescence and into young adulthood. Seventy-one individuals (tested at ages 14, 17, and 20 years) performed an fMRI-adapted approach-avoidance (AA) task involving automatic and controlled actions in response to social emotional stimuli. In line with predictions from animal models, the effect of testosterone on aPFC engagement decreased between middle and late adolescence, and shifted into an activational role by young adulthood-impeding neural control of emotions. This change in testosterone function was accompanied by increased testosterone-modulated amygdala reactivity. These findings qualify the testosterone-dependent maturation of the prefrontal-amygdala circuit supporting emotion control during the transition from middle adolescence into young adulthood.

Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial

BACKGROUND

A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs.

OBJECTIVE

We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention.

METHODS

We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions.

RESULTS

The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=-0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition.

CONCLUSIONS

The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials.

TRIAL REGISTRATION

German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007.

Avoidance tendencies toward cannabis stimuli in a college sample

Individuals with addictions often exhibit approach bias, or the relatively automatic action tendency to approach rather than avoid addiction-related stimuli. The current study used a cannabis-Approach-Avoidance Task (AAT) to assess approach-avoidance tendencies toward cannabis stimuli among 211 undergraduate college students with varying levels of cannabis use. Frequency and severity of cannabis use was assessed using the Cannabis Use Disorder Identification Test - Short Form (CUDIT-R). The sample did not demonstrate a significant approach or avoidance bias toward cannabis stimuli; instead, participants were significantly slower to approach and avoid cannabis stimuli relative to neutral stimuli. Individuals with problematic cannabis use who met criteria for a possible cannabis use disorder (CUD) based on CUDIT-R criteria were significantly slower to avoid but not to approach cannabis stimuli compared to individuals with nonuse and non-problematic use. Moreover, increased frequency and severity of cannabis use was significantly associated with increased reaction times to avoid cannabis stimuli. Findings appear to differ from some previous studies examining approach-avoidance tendencies toward cannabis, suggesting that the role of cognitive biases in cannabis use is complex and should be further investigated.

Approach and Avoidance Beyond Verbal Measures: A Quantitative Meta-Analysis of Human Conditioned Place Preference Studies

Adaptive approach and avoidance in responses to reward and threat are fundamental to prevent harm and to ensure well-being. In contrast, maladaptive approach or avoidance behavior likely contributes to anxiety or substance abuse disorders, respectively. Therefore, there is a need to assess such behavior in humans objectively. Conditioned place preference (CPP) is a well-established animal paradigm investigating approach-avoidance mechanisms, i.e., context-associated appetitive/aversive effects of unconditioned stimuli. Recently, the retranslation of this paradigm for human research started. This meta-analysis provides the first systematic overview of this developing field. A total of 17 studies published before June 2020 fulfil our inclusion criteria: (1) Usage of a rewarding agent, (2) implementation of either virtual or real environments, (3) human subjects, and (4) report of standardized outcome measures. These studies were evaluated and analyzed following the DIAD model and the PRISMA guidelines, respectively, and specific subanalyses were preformed to identify modulating factors of CPP effects (e.g., Virtual Reality applications, biased/unbiased). Overall, a significant medium effect size for the behavioral measure of dwell time (g =.62, p <.001, 95%-CI =.43-.81) and a significant small effect size for verbal self-ratings (g =.33, p <.001, 95%-CI =.04-.63) were observed, although across-study results were characterized by substantial heterogeneity (l² > 65%). These results indicate great potential for CPP to study approach-avoidance behavior in humans, directly in analogy to animal studies. We provide guidelines for future CPP research to improve comparability of studies and to facilitate new insights into anxiety disorders and drug abuse.

Implicit approach-avoidance tendencies toward food and body stimuli absent in individuals with anorexia nervosa, bulimia nervosa, and healthy controls

OBJECTIVE

Body and food-related information are thought to activate cognitive biases and contribute to the maintenance of eating disorders (ED). Approach-avoidance biases may play an important role in the maintenance of dietary restriction and excessive food intake. Therefore, the present study aimed to examine approach-avoidance biases toward food and body stimuli in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC).

METHODS

The study included 42 individuals with AN, 24 individuals with BN, and 38 HCs. We used two implicit Approach-Avoidance Tasks (AAT) to assess approach-avoidance biases: participants completed a Food-AAT (high-calorie vs. low-calorie food) and a Body-AAT (thin vs. normal weight bodies). Additionally, explicit ratings of food and body stimuli were assessed.

RESULTS

There were no significant Group × Stimulus × Direction interactions in the implicit Food-AAT or implicit Body-AAT. In explicit ratings, individuals with AN and BN reported less urge to eat and more regret if they ate high-calorie and low-calorie food; individuals with AN and BN rated normal weight bodies as less normal weight, less attractive and less desirable than HCs. There were no group differences in explicit ratings of the thin body.

DISCUSSION

We did not find evidence for biased approach-avoidance tendencies toward food or body stimuli in individuals with AN or BN. Future studies are necessary to understand conflicting findings regarding approach-avoidance biases toward food and body stimuli in individuals with ED.

Exploring the Space-Calorie Association: Preliminary Evidence from Reaction Time Performance

The present study was designed to investigate the representation of calorie levels in space. Previously an association between numerical magnitude and space has been established, namely, the Spatial Numerical Association of Response Codes (SNARC) effect. The spatial-numerical association reveals representation of smaller and larger numbers by the left and right sides, respectively. In addition, previous studies showed that spatial arrangement of foods in space affects the food selection behavior. In three experiments, the presence of an association between calorie magnitude and space was tested to understand how it could potentially affect food selection behavior. Reaction times were recorded to investigate the speed of information processing. In Experiment 1, locations of low and high calorie food stimuli were (in)congruent in terms of the space-calorie association. In Experiment 2, endogenous spatial cues were used to bias attention to investigate if this bias would lead to formation of the space-calorie association. Finally, Experiment 3 investigated whether green and red colors evoke approach or avoidance behavior and prevent formation of the space-calorie association. In all experiments, results revealed lack of an association between space and calorie, that is, presenting low/high calorie items on the left/right hemispace, respectively, did not modulate the processing speed.

Conflict Test Battery for Studying the Act of Facing Threats in Pursuit of Rewards

Survival depends on the ability of animals to avoid threats and approach rewards. Traditionally, these two opposing motivational systems have been studied separately. In nature, however, they regularly compete for the control of behavior. When threat- and reward-eliciting stimuli (learned or unlearned) occur simultaneously, a motivational conflict emerges that challenges individuals to weigh available options and execute a single behavioral response (avoid or approach). Most previous animal models using approach/avoidance conflicts have often focused on the ability to avoid threats by forgoing or delaying the opportunity to obtain rewards. In contrast, behavioral tasks designed to capitalize on the ability to actively choose to execute approach behaviors despite threats are scarce. Thus, we developed a behavioral test battery composed of three conflict tasks to directly study rats confronting threats to obtain rewards guided by innate and conditioned cues. One conflict task involves crossing a potentially electrified grid to obtain food on the opposite end of a straight alley, the second task is based on the step-down threat avoidance paradigm, and the third one is a modified version of the open field test. We used diazepam to pharmacologically validate conflict behaviors in our tasks. We found that, regardless of whether competing stimuli were conditioned or innate, a low diazepam dose decreased risk assessment and facilitated taking action to obtain rewards in the face of threats during conflict, without affecting choice behavior when there was no conflict involved. Using this pharmacologically validated test battery of ethologically designed innate/learned conflict tasks could help understand the fundamental brain mechanisms underlying the ability to confront threats to achieve goals.

Approach-Avoidance Decisions Under Threat: The Role of Autonomic Psychophysiological States

Acutely challenging or threatening situations frequently require approach-avoidance decisions. Acute threat triggers fast autonomic changes that prepare the body to freeze, fight or flee. However, such autonomic changes may also influence subsequent instrumental approach-avoidance decisions. Since defensive bodily states are often not considered in value-based decision-making models, it remains unclear how they influence the decision-making process. Here, we aim to bridge this gap by discussing the existing literature on the potential role of threat-induced bodily states on decision making and provide a new neurocomputational framework explaining how these effects can facilitate or bias approach-avoid decisions under threat. Theoretical accounts have stated that threat-induced parasympathetic activity is involved in information gathering and decision making. Parasympathetic dominance over sympathetic activity is particularly seen during threat-anticipatory freezing, an evolutionarily conserved response to threat demonstrated across species and characterized by immobility and bradycardia. Although this state of freezing has been linked to altered information processing and action preparation, a full theoretical treatment of the interactions with value-based decision making has not yet been achieved. Our neural framework, which we term the Threat State/Value Integration (TSI) Model, will illustrate how threat-induced bodily states may impact valuation of competing incentives at three stages of the decision-making process, namely at threat evaluation, integration of rewards and threats, and action initiation. Additionally, because altered parasympathetic activity and decision biases have been shown in anxious populations, we will end with discussing how biases in this system can lead to characteristic patterns of avoidance seen in anxiety-related disorders, motivating future pre-clinical and clinical research.

Worry much? Preventive health behaviours related to worry across countries amid COVID-19

This study examined the relationship between worry and health behaviours using an online survey of 69,033 respondents from 32 countries. We hypothesized that past health behaviours predicted worry experienced, which in turn predicted future health behaviours, and included a metric of cultural distance from the US. Past behaviours such as maintaining physical distance predicted higher worry, whereas worry reduced the likelihood of going outside. Being culturally dissimilar to the US was associated with lower worry. However, cultural distance was not associated with future health behaviours. We analyse worry as an approach-avoidance motivator of health behaviours from a cross-cultural perspective, to facilitate effective health communication strategies.

Brain Activation Imaging in Emotional Decision Making and Mental Health: A Review-Part 2

In this report, we integrate the principles described in part 1 and describe an operational model for emotional decision making that incorporates brain activation data along with subjective experience correlates. This model takes the form of a state machine that carries out transitions between a finite set of 16 possible states of emotional and decision-making response. By considering a 4 × 4 grid of possible states based on left and right activation, in primary (sensation) and secondary (perception/comprehension) response, the range of responses is completely specified. The transition probabilities within this repertoire of possible response states can be used to characterize an individual (or any system) in terms of its likelihood to respond in a particular fashion. The possible value of this model in psychiatry, psychology, and counseling is introduced and discussed.

Brain Activation Imaging in Emotional Decision Making and Mental Health: A Review-Part 1

In part 1 of this article, we describe an approach and methodology that bridges 2 worlds: the internal, subjective experience of emotions and thoughts, and the external world of brain electrical activity. Using a novel event-related brain activation imaging method, we demonstrate that within single trials, short-term mental processes, on the order of 100 ms, can be clearly related to observed brain activation in controlled experiments. We use an ipsative assessment validation process that combines self-report with real-time EEG recordings to provide a combined picture of both the mental and the brain activity, during short-term reactions, emotions, and decisions regarding controlled information. Part 2 provides a detailed description of the emerging emotional decision-making model.

Ventromedial Prefrontal Cortex Activity and Sympathetic Allostasis During Value-Based Ambivalence

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for "mobilization" whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis.

Developing a non-verbal, self-report assessment tool of action tendencies: The Depicted Action Tendencies (DAT) instrument

The objectives of this series of studies were to develop and evaluate a visual self-report measure, the Depicted Action Tendencies (DAT), for the assessment of action tendencies, and to examine relations between action tendencies and emotions. In three independent studies, 938 participants evaluated drawings depicting individuals engaged in actions, reflecting four classes of action tendencies; the tendency to approach reward, approach threat, avoid threat, and avoid reward. The DAT instrument showed specificity in terms of associations with emotions and verbal action-tendency items with minimal overlap between drawings (Study 1). The specificity of the drawings extended to settings in which participants recalled events from their lives (Study 2 and 3). The findings suggest that the drawings can capture different action tendencies in contexts labeled with the same emotion and provide initial support for the DAT instrument as a valid and reliable measure of action tendencies. We believe the DAT instrument offers potential value both in experimental and clinical settings. Given its pictorial format, the DAT is easy to comprehend and may represent a valuable instrument for assessing action tendencies in a quick manner at the momentary level. It may also be useful to individuals with limited linguistic skills or difficulties in verbalizing sensations and feelings.

Ambivalent Food Craving and Psychobiological Characteristics in Individuals With Weight Suppression

This study investigated the effects of psychobiological characteristics of non-obese women with a high level of weight suppression (H-WS) on explicit-implicit and approach-avoidance response toward food cues, depending on hunger-satiety states. The 634 participants were divided into two groups according to their weight history. If the difference between their highest weight over the last year and their current weight (a difference sustained at least for 1 year) was more than 5%, they were assigned to the "H-WS" group (N = 25). If the difference in weight was less than 5%, they were assigned to the "low level of weight suppression" (L-WS) group (N = 29). Explicit approach and avoidance toward food were measured by self-report questionnaires. Implicit approach and avoidance toward food cues were measured using an eye-tracker. Fasting blood samples were obtained to measure fasting serum leptin levels. After this, participants consumed a standard breakfast to control the satiety level. After breakfast, explicit-implicit approach-avoidance responses were repeatedly measured at the satiety states. Self-reported body shape concerns, drive for thinness, ambivalent food craving, and bulimic behavior were also assessed. The results showed that the H-WS group had lower leptin levels, and higher body shape concerns, drive for thinness, ambivalent food craving, and bulimic behaviors compared to the L-WS group. At the explicit level, the H-WS group reported lower approach and higher avoidance to food compared to the L-WS group, regardless of hunger-satiety state. Whereas, at the implicit level, the H-WS group showed higher approach during satiety rather than during hunger states. Regardless of the hunger-satiety state, there were no significant group differences with regard to implicit avoidance between the two groups. Thus, we confirmed that a high level of avoidance toward foods was observed in the H-WS group at the explicit level but not at the implicit level. Moreover, in contrast with a high level of explicit avoidance toward palatable foods, inhibition for implicit approach toward high-calorie foods seemed to be blunted after food consumption in the H-WS group. These inconsistencies may be associated with ambivalent food craving and vulnerability to bulimic behavior among H-WS individuals.

The Modulatory Role of Cortisol in the Regulation of Sexual Behavior in Young Males

The proneness to be sexually aroused, to perform sexual acts, or to be sexually disinhibited during a particular mood varies across individuals. However, the physiological mechanisms underlying this specific and variable relationship between mood and sex-related processes are poorly understood. We propose that cortisol may act as an important moderator in this as it has shown to influence sexual arousal and to play a neuromodulatory role during emotion regulation. Here, we conducted a functional magnetic resonance imaging study in a sample of young males to investigate whether cortisol modulates the neural response during the approach of sexual stimuli in an approach-avoidance task and whether this potential relationship explains the individual differences in sexual inhibition and in mood-related sexual interest and activity. We revealed that cortisol associates with the anteromedial prefrontal cortex activation during the approach towards sexual stimuli. Moreover, this anteromedial prefrontal cortex response was dependent on individual differences in sexual inhibition and the improvements of negative mood as a result of sexual activity. The anteromedial prefrontal cortex is already known to process bottom-up information, reward, and risk estimation. The neuromodulatory role of cortisol within this region during sexual approach may represent a previously unknown yet key element in the regulation of sexual behavior in young males.

Approach and Avoidance Behavior in Female Patients With Borderline Personality Disorder

Objectives

Borderline personality disorder (BPD) is portrayed by unstable relationships, fears of abandonment and heightened sensitivity to social rejection. Research has shown that these characteristics may lead to inappropriate social behavior including altered approach-avoidance behavior. However, it has remained unclear how social exclusion may affect approach-avoidance behavior in patients with BPD.

Design

We assessed social approach-avoidance behavior and the impact of social exclusion in a sample of 38 patients with BPD and 40 healthy control participants.

Methods

We used an explicit joystick-based approach-avoidance task (AAT) after playing a virtual ball-tossing game (Cyberball), which simulates the exclusion of the participant by two other players. In the AAT, participants were required to push or pull emotional stimuli, more specifically happy and angry facial expressions, with either direct or averted gaze direction.

Results

Patients with BPD approached happy stimuli less and showed overall less differential approach-avoidance behavior toward individuals expressing positive or negative facial emotions compared to healthy participants, who showed more approach behavior for happy compared to angry facial expressions. Moreover, borderline symptom severity correlated inversely with the AAT score for happy facial expressions and positively with subjective unpleasantness during social exclusion as well as rejection sensitivity. However, social exclusion did not influence approach-avoidance tendencies.

Conclusion

Patients with BPD showed altered approach-avoidance behavior, which might affect social interactions in the patient’s everyday lives and may therefore impede social interaction.

Striosomes Mediate Value-Based Learning Vulnerable in Age and a Huntington's Disease Model

Learning valence-based responses to favorable and unfavorable options requires judgments of the relative value of the options, a process necessary for species survival. We found, using engineered mice, that circuit connectivity and function of the striosome compartment of the striatum are critical for this type of learning. Calcium imaging during valence-based learning exhibited a selective correlation between learning and striosomal but not matrix signals. This striosomal activity encoded discrimination learning and was correlated with task engagement, which, in turn, could be regulated by chemogenetic excitation and inhibition. Striosomal function during discrimination learning was disturbed with aging and severely so in a mouse model of Huntington's disease. Anatomical and functional connectivity of parvalbumin-positive, putative fast-spiking interneurons (FSIs) to striatal projection neurons was enhanced in striosomes compared with matrix in mice that learned. Computational modeling of these findings suggests that FSIs can modulate the striosomal signal-to-noise ratio, crucial for discrimination and learning.

A mobile approach-avoidance task

Approach and avoidance tendencies have helped explain phenomena as diverse as addiction (Mogg, Field, & Bradley, 2005), phobia (Rinck & Becker, 2007), and intergroup discrimination (Bianchi, Carnaghi, & Shamloo, 2018; Degner, Essien, & Reichardt, 2016). When the original approach-avoidance task (AAT; Solarz, 1960) that measures these tendencies was redesigned to run on regular desktop computers, it made the task much more flexible but also sacrificed some important behavioral properties of the original task-most notably its reliance on physical distance change (Chen & Bargh, 1999). Here, we present a new, mobile version of the AAT that runs entirely on smartphones and combines the flexibility of modern tasks with the behavioral properties of the original AAT. In addition, it can easily be deployed in the field and, next to traditional reaction time measurements, includes the novel measurement of response force. In two studies, we demonstrate that the mobile AAT can reliably measure known approach-avoidance tendencies toward happy and angry faces both in the laboratory and in the field.

Perceived Competence, Achievement Goals, and Return-To-Sport Outcomes: A Mediation Analysis

The purpose of this study was to explore the potential mediating effect of achievement goals on perceived competence and return-to-sport outcomes among college athletes sustaining a sport injury. Altogether, 75 male and female college athletes from the United States who returned to sport after having missed competition for an average of 3 weeks due to injury, completed valid and reliable inventories measuring perceived competence, achievement goals, and return-to-sport outcomes. Results indicated that task-approach goals significantly mediated the relationship between perceived competence and a renewed sport perspective. These data suggest the importance of promoting competence beliefs and a task-oriented focus among athletes returning to sport following athletic injury. From a practical standpoint, clinicians can foster competence perceptions by integrating progressive physical tests assessing functionality and sport-specific skills/abilities. Furthermore, these data suggest that coaches, physical therapists, and significant others may do well to use language that orients injured athletes towards attaining success as opposed to avoiding failure, to emphasize effort, task completion, and correct form, and to avoid comments that compare athletes to others or to their preinjury standards of performance. From a theoretical standpoint, our mediation findings extend previous achievement goal research into the sport injury domain, further highlighting the importance of task-approach goals.

Goal-Conflict EEG Theta and Biased Economic Decisions: A Role for a Second Negative Motivation System

Economic decision biases can reflect emotion and emotion dysfunction. Economic paradigms thus provide a solid framework for analysis of brain processes related to emotion and its disorders. Importantly for economic decisions, goal-conflict activates different negative motivational processes than pure loss; generating negative decision biases linked to anxiety and fear, respectively. Previously, right frontal goal-conflict specific EEG rhythmicity (GCSR) was shown to reflect anxiety processing. Here, we assessed GCSR in a forced-choice, economic decision-making task. Ninety participants were tested in three key conditions where gain:loss ratios of left mouse clicks were set to 75:25 (GAIN), 50:50 (CONFLICT) and 25:75 (LOSS). Right clicks produced no monetary consequences and skipped the current trial. The participants were not told the different conditions but could learn about them by associating the background stimulus color with the specific payoff. Goal-conflict was defined as the mathematical contrast of activity in CONFLICT minus the average of that in GAIN and LOSS. Replicating previous findings with somewhat different conditions, right frontal GCSR was detected. Importantly, greater right frontal GCSR significantly predicted a preference for economic safety in CONFLICT but not in GAIN or LOSS; but did not predict trait anxiety or neuroticism. We conclude that goal-conflict has unique neuroeconomics effects on choice biases; and that these reflect anxiety processing that is not effectively captured by trait anxiety or neuroticism.

Renewal of fear and avoidance in humans to escalating threat: Implications for translational research on anxiety disorders

Exposure-based treatment for threat avoidance in anxiety disorders often results in fear renewal. However, little is known about renewal of avoidance. This multimodal laboratory-based treatment study used an ABA renewal design and an approach-avoidance (AP-AV) task to examine renewal of fear/threat and avoidance in twenty adults. In Context A, 9 visual cues paired with increases in probabilistic money loss (escalating threats) produced increases in ratings of feeling threatened and loss expectancies and skin-conductance responses (SCR). During the AP-AV task, a monetary reinforcer was available concurrently with threats. Approach produced the reinforcer or probabilistic loss, while avoidance prevented loss and forfeited reinforcement. Escalating threat produced increasing avoidance and ratings. In Context B with Pavlovian extinction, threats signaled no money loss and SCR declined. During the AP-AV task, avoidance and ratings also declined. In a return to Context A with Pavlovian threat extinction in effect during the AP-AV task, renewal was observed. Escalating threat was associated with increasing ratings and avoidance in most participants. SCR did not show renewal. These are the first translational findings to highlight renewal of avoidance in humans. Further research should identify individual difference variables and altered neural mechanisms that may confer increased risk of avoidance renewal.

Microstimulation of primate neocortex targeting striosomes induces negative decision-making

Here, we combined MRI-guided electrical microstimulation and viral tracing to examine the function of a corticostriatal circuit implicated by previous cortical microstimulation as modulating affective judgment and decision-making. Local microstimulation of a small part of the pregenual anterior cingulate cortex (pACC) was found to increase avoidance decisions in a cost-benefit decision-making task (Ap-Av task) in which differing amounts of "good" and "bad" options were given simultaneously. No effect of such stimulation was found when the monkeys performed a task in which both offers were rewarding, but given in different amounts. We asked whether we could identify the targets of such corticostriatal circuits when the cortical microstimulation sites were explicitly identified as affecting approach or avoidance in the Ap-Av task. We explored the pACC and caudal orbitofrontal cortex (cOFC) to look for such sites. For each cortical region, we found sites at which microstimulation induced increased avoidance behavior. After identifying these sites, we injected viral tracers carrying constructs allowing subsequent track-tracing post-mortem. For each site identified behaviorally as increasing avoidance choices, we found strong fiber projections to the anterior striatum with large parts of these targeting striosomes subsequently identified by serial section immunohistochemistry. With fMRI, we demonstrated that microstimulation in an anesthetized monkey at sites pre-identified as affecting Ap-Av choices induced blood oxygen level dependent activation of the anterior striatum, confirming that the microstimulation method that we applied was effective in activating the striatum. These findings outline circuits leading from pACC/cOFC to striosomes and causally modulating decision-making under emotional conflict.

The Neural Basis of Approach-Avoidance Conflict: A Model Based Analysis

Approach-avoidance conflict arises when the drives to pursue reward and avoid harm are incompatible. Previous neuroimaging studies of approach-avoidance conflict have shown large variability in reported neuroanatomical correlates. These prior studies have generally neglected to account for potential sources of variability, such as individual differences in choice preferences and modeling of hemodynamic response during conflict. In the present study, we controlled for these limitations using a hierarchical Bayesian model (HBM). This enabled us to measure participant-specific per-trial estimates of conflict during an approach-avoidance task. We also employed a variable epoch method to identify brain structures specifically sensitive to conflict. In a sample of 28 human participants, we found that only a limited set of brain structures [inferior frontal gyrus (IFG), right dorsolateral prefrontal cortex (dlPFC), and right pre-supplementary motor area (pre-SMA)] are specifically correlated with approach-avoidance conflict. These findings suggest that controlling for previous sources of variability increases the specificity of the neuroanatomical correlates of approach-avoidance conflict.

"Science Manipulates the Things and Lives in Them": Reconsidering Approach-Avoidance Operationalization Through a Grounded Cognition Perspective

Approach and avoidance orientations are key elements of adaptive regulation at the evaluation-behavior interface. On the one hand, continuous evaluations of the world fuel approach-avoidance reactions as a function of the individual's immediate environment. On the other hand, in turn these individual-environment adjustments influence evaluations. A grounded perspective of social cognition, placing the sensorimotor aspects of individual-environment interactions at the core of cognition, has much to offer for the understanding of evaluative processes. Despite the growing enthusiasm for a grounded view of cognition and action in the approach-avoidance literature, its core principles are seldom reflected at the operationalization level. In this paper, we relied on the insights of a grounded perspective to propose more encompassing operationalizations of approach-avoidance orientations and investigate their influence on evaluations. Across six studies, we varied the approach-avoidance operationalizations (upper-body incline, upper-body posture and walking steps) and incrementally considered the grounded assumptions. We failed to obtain the theorized positive effect of approach (as compared to avoidance) on evaluations. Interestingly, further exploratory analyses on two studies conducted in Virtual Reality suggested that the more participants felt being present in the situation, the more the approach-avoidance ecological actions activated the corresponding neuropsychological systems. We discuss these emergent findings in light of grounded cognition and the notion of feeling of presence.

Social Anxiety and Pro-social Behavior Following Varying Degrees of Rejection: Piloting a New Experimental Paradigm

In general, human beings tend to try and reconnect after they have been socially rejected. It is not clear, however, which role the number of rejecters and rejection sensitivity plays. In addition, it is unclear whether the supposed pro-social behaviors are aimed at the rejecters or at innocent individuals. By means of a new paradigm, the present pilot study investigated compensatory behavior of individuals with varying degrees of social anxiety, following varying degrees of rejection. In addition, it was explored toward whom their behavior was directed: rejecters or innocent individuals. Female students (N = 34) were assessed on their degree of social anxiety and then, based on a personal profile they wrote, they were either rejected by 1, 2, or 3 fictional other participants or completely accepted. Afterward, the participants had to explicitly rate the creativity of drawings made by the others and, in a pro-social reward paradigm, awarded the other participants money based on their creativity rating. In addition, implicit social approach tendencies toward photos of rejecters, acceptors, or innocent individuals were assessed by means of an approach-avoidance task. The results confirmed that people with a low degree of social anxiety respond to rejection in a compensatory pro-social manner explicitly as well as implicitly, but that people with a high degree of social anxiety fail to do so. With regard to sources of rejection, only implicit approach-avoidance tendencies reflected a distinction between rejecters and innocent individuals. Theoretical implications are discussed in the light of the small sample size and other limitations.

The Allocation of Valenced Percepts Onto 3D Space

Research on the metaphorical mapping of valenced concepts onto space indicates that positive, neutral, and negative concepts are mapped onto upward, midward, and downward locations, respectively. More recently, this type of research has been tested for the very first time in 3D physical space. The findings corroborate the mapping of valenced concepts onto the vertical space as described above but further show that positive and negative concepts are placed close to and away from the body; neutral concepts are placed midway. The current study aimed at investigating whether valenced perceptual stimuli are positioned onto 3D space akin to the way valenced concepts are positioned. By using a unique device known as the cognition cube, participants placed visual, auditory, tactile and olfactory stimuli on 3D space. The results mimicked the placing of valenced concepts onto 3D space; i.e., positive percepts were placed in upward and close-to-the-body locations and negative percepts were placed in downward and away-from-the-body locations; neutral percepts were placed midway. These pattern of results was more pronounced in the case of visual stimuli, followed by auditory, tactile, and olfactory stimuli. Significance Statement Just recently, a unique device called "the cognition cube" (CC) enabled to find that positive words are mapped onto upward and close-to-the-body locations and negative words are mapped onto downward and away-from-the-body locations; neutral words are placed midway. This way of placing words in relation to the body is consistent with an approach-avoidance effect such that "good" and "bad" things are kept close to and away from one's body. We demonstrate for the very first time that this same pattern emerges when visual, auditory, tactile, and olfactory perceptual stimuli are placed on 3D physical space. We believe these results are significant in that the CC can be used as a new tool to diagnose emotion-related disorders.

Oral kinematics: examining the role of edibility and valence in the in-out effect

Previous research has revealed a stable preference for words with inward consonantal-articulation patterns (from the front to the back of the mouth; e.g. BENOKA), over outward-words (from the back to the front; e.g. KENOBA). Following the oral approach-avoidance account suggesting that the in-out effect is due to the resemblance between consonantal-articulations patterns and ingestion/expectoration, recent findings have shown that when judging inward-outward names for objects with particular oral functions, valence did not modulate the effect while the oral function did. To replicate and examine further the role of edibility and valence in shaping the in-out effect, we asked participants (N = 545) to rate inward and outward names for edible and non-edible products while controlling for valence. Results revealed that the motor-to-affect link was only observed for edible products, regardless of valence.

Inactivation of the Mouse L-Proline Transporter PROT Alters Glutamatergic Synapse Biochemistry and Perturbs Behaviors Required to Respond to Environmental Changes

The endogenous neutral amino acid L-proline exhibits a variety of physiological and behavioral actions in the nervous system, highlighting the importance of accurately regulating its extracellular abundance. The L-proline transporter PROT (Slc6A7) is believed to control the spatial and temporal distribution of L-proline at glutamatergic synapses by rapid uptake of this amino acid into presynaptic terminals. Despite the importance of members of the Slc6 transporter family regulating neurotransmitter signaling and homeostasis in brain, evidence that PROT dysfunction supports risk for mental illness is lacking. Here we report the disruption of the PROT gene by homologous recombination. Mice defective in PROT displayed altered expression of glutamate transmission-related synaptic proteins in cortex and thalamus. PROT deficiency perturbed mouse behavior, such as reduced locomotor activity, decreased approach motivation and impaired memory extinction. Thus, our study demonstrates that PROT regulates behaviors that are needed to respond to environmental changes in vivo and suggests that PROT dysfunctions might contribute to mental disorders showing altered response choice following task contingency changes.

Inhibit My Disinhibition: The Role of the Inferior Frontal Cortex in Sexual Inhibition and the Modulatory Influence of Sexual Excitation Proneness

Sexual behaviour is the result of an interplay between distinct neural inhibitory and excitatory mechanisms. Individual differences in sexual excitation and sexual inhibition are proposed to play an important role in the processes sustaining the regulation of sexual behaviour. While much research has focused on the neural correlates of response inhibition, highlighting a prominent role of the inferior frontal gyrus (IFG), very little is known regarding the neural mechanisms underlying different aspects of sexual inhibition. Here, we experimentally combined functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to: (i) test the functional role of IFG during motivational and cognitive sexual inhibition; and (ii) reveal whether this IFG involvement in sexual inhibitory processes depends on sexual excitation and sexual inhibition as traits. Twenty-two participants performed an Approach-Avoidance (AA) and a Negative Affective Priming (NAP) paradigm to assess motivational and cognitive sexual inhibition respectively. Our fMRI study showed IFG being selectively activated during cognitive but not motivational sexual inhibition. Importantly, the level of this neural activity was modulated by individual sexual excitation scores. Interestingly, a transient disruption of IFG activity using TMS led to an improvement in cognitive, not motivational, sexual inhibition, but only when accounting for individual sexual excitation scores. These findings clearly document that sexual excitation modulates IFG activity levels during cognitive sexual inhibition, and at the same time determines the effects of TMS on IFG by improving cognitive control exclusively for individuals with high sexual excitation scores. These findings provide new insights regarding the functional role of IFG, and underscore the relevance of individual psychological differences in understanding the brain mechanisms underlying socioaffective processes.

Implicit and Explicit Motivational Tendencies to Faces Varying in Trustworthiness and Dominance in Men

Motivational tendencies to happy and angry faces are well-established, e.g., in the form of aggression. Approach-avoidance reactions are not only elicited by emotional expressions, but also linked to the evaluation of stable, social characteristics of faces. Grounded in the two fundamental dimensions of face-based evaluations proposed by Oosterhof and Todorov (2008), the current study tested whether emotionally neutral faces varying in trustworthiness and dominance potentiate approach-avoidance in 50 healthy male participants. Given that evaluations of social traits are influenced by testosterone, we further tested for associations of approach-avoidance tendencies with endogenous and prenatal indicators of testosterone. Computer-generated faces signaling high and low trustworthiness and dominance were used to elicit motivational reactions in three approach-avoidance tasks, i.e., one implicit and one explicit joystick-based paradigm, and an additional rating task. When participants rated their behavioral tendencies, highly trustworthy faces evoked approach, and highly dominant faces evoked avoidance. This pattern, however, did not translate to faster initiation times of corresponding approach-avoidance movements. Instead, the joystick tasks revealed general effects, such as faster reactions to faces signaling high trustworthiness or high dominance. These findings partially support the framework of Oosterhof and Todorov (2008) in guiding approach-avoidance decisions, but not behavioral tendencies. Contrary to our expectations, neither endogenous nor prenatal indicators of testosterone were associated with motivational tendencies. Future studies should investigate the contexts in which testosterone influences social motivation.

Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers

According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.

Testosterone biases the amygdala toward social threat approach

Testosterone enhances amygdala reactions to social threat, but it remains unclear whether this neuroendocrine mechanism is relevant for understanding its dominance-enhancing properties; namely, whether testosterone biases the human amygdala toward threat approach. This pharmacological functional magnetic-resonance imaging study shows that testosterone administration increases amygdala responses in healthy women during threat approach and decreases it during threat avoidance. These findings support and extend motivational salience models by offering a neuroendocrine mechanism of motivation-specific amygdala tuning.

Individual differences in approach-avoidance aptitude: some clues from research on Parkinson's disease

Approach and avoidance are two basic behavioral aptitudes of humans whose correct balance is critical for successful adaptation to the environment. As the expression of approach and avoidance tendencies may differ significantly between healthy individuals, different psychobiological factors have been posited to account for such variability. In this regard, two main issues are still open that refers to (i) the role played by dopamine neurotransmission; and (ii) the possible influence of cognitive characteristics, particularly executive functioning. The aim of the present paper was to highlight the contribution of research on Parkinson's disease (PD) to our understanding of the above issues. In particular, we here reviewed PD literature to clarify whether neurobiological and neuropsychological modifications due to PD are associated to changes in approach-avoidance related personality features. Available data indicate that PD patients may show and approach-avoidance imbalance as documented by lower novelty-seeking and higher harm-avoidance behaviors, possibly suggesting a relationship with neurobiological and neurocognitive PD-related changes. However, the literature that directly investigated this issue is still sparse and much more work is needed to better clarify it.

Individual differences in bodily freezing predict emotional biases in decision making

Instrumental decision making has long been argued to be vulnerable to emotional responses. Literature on multiple decision making systems suggests that this emotional biasing might reflect effects of a system that regulates innately specified, evolutionarily preprogrammed responses. To test this hypothesis directly, we investigated whether effects of emotional faces on instrumental action can be predicted by effects of emotional faces on bodily freezing, an innately specified response to aversive relative to appetitive cues. We tested 43 women using a novel emotional decision making task combined with posturography, which involves a force platform to detect small oscillations of the body to accurately quantify postural control in upright stance. On the platform, participants learned whole body approach-avoidance actions based on monetary feedback, while being primed by emotional faces (angry/happy). Our data evidence an emotional biasing of instrumental action. Thus, angry relative to happy faces slowed instrumental approach relative to avoidance responses. Critically, individual differences in this emotional biasing effect were predicted by individual differences in bodily freezing. This result suggests that emotional biasing of instrumental action involves interaction with a system that controls innately specified responses. Furthermore, our findings help bridge (animal and human) decision making and emotion research to advance our mechanistic understanding of decision making anomalies in daily encounters as well as in a wide range of psychopathology.

Translating Social Motivation into Action: Contributions of Need for Approval to Children's Social Engagement

This research examined how children's need for approval (NFA) from peers predicted social behavior (prosocial behavior, aggression, social helplessness) and peer responses (acceptance, victimization, exclusion). Children (N = 526, M age = 7.95, SD = .33) reported on need for approval and teachers reported on social engagement. Approach NFA (motivation to gain approval) predicted more positive engagement and less conflictual engagement and disengagement. Conversely, avoidance NFA (motivation to avoid disapproval) predicted less positive engagement and more conflictual engagement and disengagement. Some results differed by gender. This study suggests that social motivation contributes to children's peer relationships, providing a specific target for interventions to optimize social health.

Manipulating the contribution of approach-avoidance to the perturbation of economic choice by valence

Economic choices are strongly influenced by whether potential outcomes entail gains or losses. We examined this influence of outcome valence in an economic risk task. We employed three experiments based on our task, each of which provided novel findings, and which together better characterize and explain how outcome valence influences risky choice. First, we found that valence perturbed an individual's choices around that individual's base-level of risk-taking, a base-level consistent across time, and context. Second, this perturbation by valence was highly context dependent, emerging when valence was introduced as a dimension within a decision-making setting, and being reversed by a change in task format (causing more gambling for gains than losses and the reverse). Third, we show this perturbation by valence is explicable by low-level approach-avoidance processes, an hypothesis not previously tested by a causal manipulation. We revealed such an effect, where individuals were less disposed to choose a riskier option with losses when they had to approach (go) as opposed to avoid (nogo) that option. Our data show valence perturbs an individual's choices independently of the impact of risk, and causally implicate approach-avoidance processes as important in shaping economic choice.

Alcohol-related biases in selective attention and action tendency make distinct contributions to dysregulated drinking behaviour

AIMS

To assess whether alcohol-related biases in selective-attention and action tendency uniquely or concurrently predict the ability to regulate alcohol consumption.

DESIGN AND PARTICIPANTS

Two groups of undergraduate social drinkers (total n = 55) who differed in their ability to regulate their alcohol consumption completed a novel Selective-Attention/Action-Tendency Task (SA/ATT), which assessed separately alcohol-related biases in selective attention and action tendency.

SETTING

University of Western Australia, Australia.

MEASUREMENT

Dysregulated drinking was operationalized as a self-reported high level of alcohol consumption on the Alcohol Consumption Questionnaire, and a high desire to reduce consumption on the Brief Readiness to Change Algorithm. Selective attention and action tendency were assessed using the SA/ATT, working memory was assessed using the operation-span task and participant characteristics were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES).

FINDINGS

Results indicated that (i) there was no significant association between alcohol-related biases in selective attention and action tendency, r = 0.16, P = 0.274, and (ii) biases towards alcohol, in both selective attention, β = 1.01, odds ratio = 2.74, P = 0.022, and action tendency, β = 1.24, odds ratio = 3.45, P = 0.015, predicted independent variance in dysregulated-drinker status.

CONCLUSION

Biases in selective attention and action tendency appear to be distinct mechanisms that contribute independently to difficulty regulating alcohol consumption. Treatment components that could be combined to target both mechanisms could enhance treatment outcomes for alcohol-use disorders.