Fear to approach; identifying behavioural and neurological mechanisms underlying excessive avoidance behaviour.

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Excessive avoidance has been marked as a transdiagnostic symptom involved in both depressive and anxiety disorders. Recent findings have indicated that these avoidance behaviours are a better indication of poor prognosis than other measures. Real-life approach-avoidance decisions rely on a complex consideration of potential rewarding and potential threatening consequences. However, preceding research on approach-avoidance decisions is often centred around the threat component of the decision-making. To obtain a deeper understanding of the shared mechanisms that are underlying depressive and anxiety disorders, we assessed the behavioural and neurological correlates of avoidance behaviours in a two-study research project. For this purpose, we used two different, yet similar, approach-avoidance decision-making paradigms, being the fearful avoidance task (FAT) and the passive-active approach-avoidance task (PAT). Both paradigms effectively evoked an approach-avoidance conflict due to the inclusion of competing threat and reward levels. Using whole-brain searchlight Multi-Variate Pattern Analysis (MVPA), we identified an approach-avoidance decision-making network consisting of the precuneus, postcentral gyrus, precentral gyrus, medial prefrontal cortex, and medial orbitofrontal cortex (study 1, N = 27). Additionally, focussing on the reward components of complex decision-making, we assessed whether anhedonia, a symptom characterized by attenuated reward sensitivity, could explain individual differences in approach-avoidance decision-making (study 2, N = 15). Considering the small sample size, we identified that higher anhedonia is paired with more avoidance (non-significant). Taken all together, we have showed that approach-avoidance decision-making relies on a complex cognitive consideration of potential threat and reward, implicating a network of various brain regions related to emotional experience, decisionmaking, motor preparation, goal-directed behaviour, and reward and threat assessment. Keywords: MVPA, Avoidance, Decision Making, Anhedonia, Anxiety, Depression
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