Abstract
Background
Treatments for anxiety and related disorders target exaggerated escape/avoidance as
a core feature, but current methods fail to improve escape/avoidance habits for many
treatment-seeking individuals. To support developing tools that increase treatment
efficacy by targeting mechanisms more directly, the current work examined potential
distinctions in the neurophysiologies of escape and avoidance and tested how clinical
anxiety affects these neurophysiologies.
Methods
Twenty-five treatment-seeking individuals with varied principal diagnoses (e.g., generalized
anxiety disorder, posttraumatic stress disorder) and 20 non-treatment-seeking control
subjects participated. In the study task, approximately 5.25-second cues predicted
aversive images that could be avoided (blocked by a button press before image onset),
escaped (ended by a button press after image onset), or not controlled. To examine
neural processing and defensive response modulation, anticipatory event-related potentials
were derived, and startle reflexes were probed throughout each cue.
Results
Multidimensional profiles were observed such that 1) anticipatory event-related potential
enhancement was only reliable during avoidance preparation, and event-related potentials
potentially reflected perceived/instrumental control; and 2) startle reflexes were
inhibited during avoidance preparation, relatively enhanced during escape preparation,
and further enhanced during uncontrollable anticipation, thus potentially reflecting
fear-related activation. Treatment-seeking status, then, did not affect cortical processing,
but it did moderate context-dependent fear (if individuals with severe depression
were excluded) such that treatment-seeking individuals without depression showed exaggerated
startle during escape, but not avoidance, preparation.
Conclusions
Data suggest a specific effect of anxiety on fear system activation during preparation
to escape aversion. This effect warrants further investigation as a precision target
for interventions that directly modulate the specific underlying neural circuitry.
Keywords
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Article info
Publication history
Published online: August 08, 2022
Accepted:
July 19,
2022
Received in revised form:
June 28,
2022
Received:
March 16,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
