Tackling Fearful Avoidance using Counter-Conditioning: A Causal Test for the Role of Appetitive Motivation in Fearful Avoidance

Abstract

Anxiety disorders are prevalent in the population and are costly for society, while current treatment is not optimal yet. A central symptom of anxiety is avoidance behaviour, with excessive avoidance being related to poor clinical outcomes. Appetitive motivation could play a role in decreasing avoidance behaviour by increasing positive valuation of the feared object. However, studies that causally test this are lacking. This study used an approach-avoidance conflict paradigm with a training based on counterconditioning in between tests to study the effects of appetitive motivation on avoidance and negative valuation. One stimulus was followed by eating a cookie (CS+), and one was followed by nothing (CS-). To investigate the mechanisms driving behaviour, the Post-Auricular Reflex was measured as reflective of ‘liking’ and the Eye-blink startle as a defensive measure. Results showed that the CC-training was effective in reducing the negative valuation and decreasing avoidance behaviour for the CS+. There was no difference in the PAR and Eye-blink magnitudes of the CS-Types after the training. This study showed the importance of appetitive motivation for avoidance behaviour, indicating that treatment could benefit from focussing on increasing appetitive motivation to overcome avoidance.