TY - JOUR
T1 - Coping in the Clinic
T2 - Effects of Clinically Elevated Anxiety on Dynamic Neurophysiological Mechanisms of Escape/Avoidance Preparation
AU - Sege, Christopher T.
AU - Taylor, Danielle L.
AU - Lopez, James W.
AU - Fleischmann, Holly
AU - White, Evan J.
AU - McTeague, Lisa M.
N1 - Funding Information:
This study was supported in part by the National Institute of Mental Health (Grant No. K23 MH123931-01A1 [principal investigator, CTS]) and through support from the Medical University of South Carolina. The National Institute of Mental Health is part of the National Institutes of Health.
Funding Information:
This study was supported in part by the National Institute of Mental Health (Grant No. K23 MH123931-01A1 [principal investigator, CTS]) and through support from the Medical University of South Carolina. The National Institute of Mental Health is part of the National Institutes of Health. The content of this manuscript is the sole responsibility of the authors and does not necessarily represent official views of the NIH or MUSC. The authors report no biomedical financial interests or potential conflicts of interest.
Publisher Copyright:
© 2022 Society of Biological Psychiatry
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Anxiety
KW - EEG
KW - ERP
KW - Escape/Avoidance
KW - Reflex physiology
UR - http://www.scopus.com/inward/record.url?scp=85143498732&partnerID=8YFLogxK
U2 - 10.1016/j.bpsc.2022.07.010
DO - 10.1016/j.bpsc.2022.07.010
M3 - Article
C2 - 35952971
AN - SCOPUS:85143498732
SN - 2451-9022
VL - 8
SP - 712
EP - 719
JO - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
JF - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
IS - 7
ER -