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Recent research indicates that angry facial expressions are preferentially processed and may facilitate automatic avoidance response, especially in socially anxious individuals. However, few studies have examined whether this bias also expresses itself in more complex cognitive processes and behavior such as decision making.We recently introduced a variation of the Iowa Gambling Task which allowed us to document the influence of taskirrelevant emotional cues on rational decision making. The present study used a modified gambling task to investigate the impact of angry facial expressions on decision making in 38 individuals with a wide range of social anxiety. Participants were to find out which choices were (dis-) advantageous to maximize overall gain. To create a decision conflict between approach of reward and avoidance of fear-relevant angry faces, advantageous choices were associated with angry facial expressions, whereas disadvantageous choices were associated with happy facial expressions. Results indicated that higher social avoidance predicted less advantageous decisions in the beginning of the task, i.e., when contingencies were still uncertain. Interactions with specific skin conductance responses further clarified that this initial avoidance only occurred in combination with elevated responses before choosing an angry facial expressions. In addition, an interaction between high trait anxiety and elevated responses to early losses predicted faster learning of an advantageous strategy. These effects were independent of intelligence, general risky decision-making, self-reported state anxiety, and depression. Thus, socially avoidant individuals who respond emotionally to angry facial expressions are more likely to show avoidance of these faces under uncertainty. This novel laboratory paradigm may be an appropriate analog for central features of social anxiety.

Fear motivates different types of defensive behaviors. These behaviors are, however, not mere byproducts of fear. In this review, we highlight a bi-directional relationship between conditioned fear and instrumental defensive behavior in humans. We discuss mechanisms involved in the link from fear to goal-directed avoidance (e.g., relief, generalization), that may become habitual. These defensive behaviors may in turn reduce, preserve, or amplify fear responding (e.g., protection-from-extinction, behavior-as-information). Multiple factors moderate the bi-directional relationship. Evidence for amplifying and dampening effects of inter-individual differences (e.g., trait anxiety, distress tolerance), intra-individual states (e.g., stress), and external factors (e.g., incentives for competing behavior) on goal-directed and/or habitual defensive behavior is reviewed. However, the exact mechanisms by which these factors moderate the bi-directional relationship are still largely unknown (e.g., modulating avoidance directly vs. indirectly via conditioned fear). Finally, we discuss major implications: First, understanding factors moderating the bi-directional relationship provides insights into risk and resilience factors for anxious psychopathology. Second, specific experimental models and clinical interventions can be mapped onto distinct defensive behaviors (e.g., goal-directed vs. habitual avoidance). More precise matching will help to develop nuanced models and interventions to reduce pathological behaviors and individualize treatments.

Systematic and quantitative reviews on the effects of land-based self-exclusion are scarce. Therefore, the current review aimed to provide a comprehensive summary of (1) the demographic characteristics of land-based self-excluders and changes after exclusion, including (2) gambling behavior, (3) gambling problems, (4) mental symptoms, and (5) mental health. A systematic database and literature search was performed following PRISMA guidelines. Nineteen naturalistic studies met the eligibility criteria. The quality of all included records was rated via adaption of the Newcastle-Ottawa Scale. Results from higher-quality records were more heavily weighted. Self-excluders were predominantly men in their early or middle forties. Changes after exclusion revealed wide ranges in the rates of abstinence (13-81%), rates of gambling reduction (29-92%), and rates of exclusion breaches (8-59%). The records consistently demonstrated significant changes in pathological gambling from before exclusion (61–95%) to after exclusion (13–26%). Up to 73% of self-excluders exhibited symptoms of anxiety, depression, and substance use disorders at program enrollment. Several aspects of mental health improved after exclusion, e.g., quality of life. Problem and pathological gambling are most prevalent in young men, but self-exclusion was most prominent in middle-aged men. The magnitude of effects widely differed between studies despite overall benefits of self-exclusion, and many individuals continued gambling after exclusion. This shortcoming could be minimized using improved access controls and the extension of exclusion to other gambling segments. High rates of pathological gambling and other mental disorders in self-excluders highlight the need for improved early detection and treatment accessibility.

Safety behavior prevents the occurrence of threat, thus it is typically considered adaptive. However, safety behavior in anxiety-related disorders is often costly, and persists even the situation does not entail realistic threat. Individuals can engage in safety behavior to varying extents, however, these behaviors are typically measured dichotomously (i.e., to execute or not). To better understand the nuances of safety behavior, this study developed a dimensional measure of safety behavior that had a negative linear relationship with the admission of an aversive outcome. In two experiments, a Reward group receiving fixed or individually calibrated incentives competing with safety behavior showed reduced safety behavior than a Control group receiving no incentives. This allowed extinction learning to a previously learnt warning signal in the Reward group (i.e., updating the belief that this stimulus no longer signals threat). Despite the Reward group exhibited extinction learning, both groups showed a similar increase in fear to the warning signal once safety behavior was no longer available. This null group difference was due to some participants in the Reward group not incentivized enough to disengage from safety behavior. Dimensional assessment revealed a dissociation between low fear but substantial safety behavior to a safety signal in the Control group. This suggests that low-cost safety behavior does not accurately reflect the fear-driven processes, but also other non-fear-driven processes, such as cost (i.e., engage in safety behavior merely because it bears little to no cost). Pinpointing both processes is important for furthering the understanding of safety behavior.

Avoidance is typically adaptive given it prevents threat. However, avoidance becomes maladaptive when it is executed out of proportion of threat (i.e., excessive or insufficient avoidance), persists in the absence of threat, or excessively generalizes to other innocuous situations. Although there has been an increase in research in these different processes of maladaptive avoidance, the role of inter-individual differences in these avoidance processes receives less research attention, despite its theoretical and clinical importance. In this systematic review, we summarized the role of inter-individual traits that relate to risk or resilient factors for anxiety-related disorders, trauma-and stressor-related disorders, obsessive-compulsive related disorders, pain related disorders, eating-related disorders, and affective disorders. A majority of the inter-individual differences had an apparent mixed or null effect on the different processes of avoidance. We discussed this lack of evidence of inter-individual differences on avoidance due to a lack of methodological and/or analytical consensus in the field, in addition to a lack of integration of recent findings into existing theories. Recommendations for future research are discussed, with a focus on examining the conditions or experimental parameters for certain inter-individual traits to manifest their effects on avoidance, identifying the nuances of methodological and/or inter-individual differences in avoidance, and a call for integrating recent preliminary findings into existing theories.

Background: Anxiety and depressive disorders share common features of mood dysfunctions. This has stimulated interest in transdiagnostic dimensional research as proposed by the Research Domain Criteria (RDoC) approach by the National Institute of Mental Health (NIMH) aiming to improve the understanding of underlying disease mechanisms. The purpose of this study was to investigate the processing of RDoC domains in relation to disease severity in order to identify latent disorder-specific as well as transdiagnostic indicators of disease severity in patients with anxiety and depressive disorders. Methods: Within the German research network for mental disorders, 895 participants (n = 476 female, n = 602 anxiety disorder, n = 257 depressive disorder) were recruited for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) and included in this cross-sectional study. We performed incremental regression models to investigate the association of four RDoC domains on disease severity in patients with affective disorders: Positive (PVS) and Negative Valance System (NVS), Cognitive Systems (CS) and Social Processes (SP). Results: The results confirmed a transdiagnostic relationship for all four domains, as we found significant main effects on disease severity within domain-specific models (PVS: β = −0.35; NVS: β = 0.39; CS: β = −0.12; SP: β = −0.32). We also found three significant interaction effects with main diagnosis showing a disease-specific association. Limitations: The cross-sectional study design prevents causal conclusions. Further limitations include possible outliers and heteroskedasticity in all regression models which we appropriately controlled for. Conclusion: Our key results show that symptom burden in anxiety and depressive disorders is associated with latent RDoC indicators in transdiagnostic and disease-specific ways.