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Excessive avoidance is characteristic for anxiety disorders, even when approach would lead to positive outcomes. The process of how such approach-avoidance conflicts are resolved is not sufficiently understood. We examined the temporal dynamics of approach-avoidance in intense fear of spiders. Highly fearful and non-fearful participants chose repeatedly between a fixed no spider/low reward and a spider/high reward option with varying fear (probability of spider presentation) and reward information (reward magnitude). By sequentially presenting fear and reward information, we distinguished whether decisions are dynamically driven by both information (sequential-sampling) or whether the impact of fear information is inhibited (cognitive control). Mouse movements were recorded to assess temporal decision dynamics (i.e., how strongly which information impacts decision preference at which timepoint). Highly fearful participants showed stronger avoidance despite lower gains (i.e., costly avoidance). Time-continuous multiple regression of their mouse movements yielded a stronger impact of fear compared to reward information. Importantly, presenting either information first (fear or reward) enhanced its impact during the early decision process. These findings support sequential sampling of fear and reward information, but not inhibitory control. Hence, pathological avoidance may be characterized by biased evidence accumulation rather than altered cognitive control.

Intrusive memories represent a core symptom of posttraumatic stress disorder (PTSD). Accordingly, experimental, and clinical research has heavily focused on advancing our understanding of intrusions, and by doing so tried to develop approaches to reduce them, with visual and verbal processes being key targets in this context. This narrative review presents an overview of both visual and verbal approaches aiming at manipulating intrusion frequency. Specifically, tasks are described that either facilitate or interfere with verbal or visual processes, and results of these manipulations in analogue and clinical studies are summarized. Overall, results showed that facilitating verbal processes can reduce the frequency of intrusions, while facilitating visual processes can lead to both increases and decreases in intrusion frequency. Visual interference tasks can also reduce intrusions, however the specific task used seems to be important. Studies on verbal interference tasks, however, present a rather heterogenous picture. Based on these results, possible mechanisms underlying reductions or increases in intrusions in response to these tasks are discussed, e.g., (re)consolidation, rumination, (re)appraisal, and suggestions for (mechanism-driven) follow-up research in both experimental and clinical settings as well as recommendations for clinical interventions are presented.