The role of avoidance of emotional material in the anxiety disorders

Many psychotherapeutic traditions have conceptualized clinical levels of anxiety as resulting from the avoidance of threatening or emotional material. In this paper, we examine behavioral models of avoidance of emotions and emotional material, integrating findings that support established behavioral theories of emotional avoidance and anxiety, and that extend these theories to further explain the intense, intrusive, and interfering nature of clinical anxiety. Research on the suppression and avoidance of emotional material suggests that emotional avoidance and thought suppression may not only hinder the learning process and maintain anxious responding, but may also (a) paradoxically heighten anxious responding to threatening cues and (b) interfere with emotion functionality, thereby further impeding adaptive responding. Findings are discussed in terms of future research and implications for clinical treatment of anxiety disorders.     

The role of the cs and avoidance period duration in discriminated avoidance conditioning

In an experiment investigating the effect of CS duration on discriminated bar-press conditioning, subjects were assigned to one warning period duration (1.5, 5.0 or 15.0 sec.) on the first day of avoidance training, and to one of the three durations on the second day of training. On each day avoidance behaviour was greatly influenced by the duration of the CS (warning) period, but the duration on day I had no effect on the second day's avoidance performance. Groups receiving no CS during training, although provided an avoidance contingency, showed little conditioning, but produced highly significant amounts of intertrial responding. In a second experiment, subjects receiving CS on day I were shifted to no CS on day II. Avoidance performance on day II was not significantly different from the day II performance of subjects in Experiment I having two training sessions with the CS present or absent on both days.     

The relation between anxiety disorder and experiential avoidance in inpatient adolescents

The current study aimed to examine the relation between experiential avoidance and anxiety disorders, as well as the usefulness of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y; Greco, Lambert, & Baer, 2008) in detecting anxiety disorder in a sample of adolescent inpatients. First, the relation between experiential avoidance and anxiety among inpatient adolescents was investigated from categorical and dimensional points of view, making use of self-report and parent report, as well as clinical interview, while controlling for depression and externalizing problems. Second, we sought to establish the clinical utility value of the AFQ-Y by determining the sensitivity, specificity, and clinical cutoff score of this measure in predicting anxiety disorder. To this end, a sample of inpatient adolescents (N = 111) with a mean age of 16.14 (SD = 1.39) years completed the AFQ-Y, alongside interview- and questionnaire-based measures of psychopathology. Results showed a significant relation between anxiety disorder and experiential avoidance, independent of depression. Receiver operating characteristics analysis revealed that the AFQ-Y has moderate accuracy (area under the curve = .815, SE = .047, p < .001) in discriminating adolescents with a diagnosis of any anxiety disorder (cutoff score 26.5; sensitivity = .74, specificity = .76). Given the comorbidity of anxiety and depression in this sample, this cutoff is not indicative of pure anxiety disorder but may be helpful in predicting those with emotional disorders in general.     

The role of anger in generalized anxiety disorder

Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The aim of study was to examine the relationship between specific dimensions of anger and GAD. Participants (N?=?381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002, Behavior Therapy, 33, 215-233), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger 1999, State-Trait Anger Expression Inventory-2: STAXI-2 professional manual, Odessa, FL: Psychological Assessment Resources) and the Aggression Questionnaire (AQ; Buss & Perry 1992, Journal of Personality and Social Psychology, 63, 452-459). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e. GAD analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger and hostility. The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r's ranging from .10 to .46). Multivariate analyses of variance revealed that GAD analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (η(2)?=?.098); high levels of trait anger and internalized anger expression contributed the most to GAD group membership. GAD analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (η(2)?=?.156); high levels of anger (affective component of aggression) and hostility contributed the most to GAD group membership. Within the GAD analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R (2)?=?.124 and .198, respectively). Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD.     

A contemporary behavior analysis of anxiety and avoidance

Despite the central status of avoidance in explaining the etiology and maintenance of anxiety disorders, surprisingly little behavioral research has been conducted on human avoidance. In the present paper, first we provide a brief review of the empirical literature on avoidance. Next, we describe the implications of research on derived relational responding and the transformation of functions for a contemporary behavioral account of avoidance, before providing several illustrative research examples of laboratory-based analogues of key clinical treatment processes. Finally, we suggest some challenges and opportunities that lie ahead for behavioral research on anxiety and avoidance.     

Anticipatory anxiety and avoidance in panic disorder with agoraphobia

The present study utilized the responses of 34 patients with panic disorder with agoraphobia to investigate the occurrence and anticipation of panic attacks in relation to the avoidance of specific situations from the Fear Questionnaire [Marks & Mathews (1979) Behaviour Research and Therapy, 17, 263-267]. Results indicated that self-reports of avoidance of specific situations were often significantly correlated with the anticipation of panic but rarely with the occurrence of panic. The occurrence and anticipation of panic were also frequently associated with social phobic situations in addition to agoraphobic situations.     

The role of glutamate in anxiety and related disorders

Anxiety, stress, and trauma-related disorders are a major public health concern in the United States. Drugs that target the gamma-aminobutyric acid or serotonergic system, such as benzodiazepines and selective serotonin reuptake inhibitors, respectively, are the most widely prescribed treatments for these disorders. However, the role of glutamate in anxiety disorders is becoming more recognized with the belief that drugs that modulate glutamatergic function through either ionotropic or metabotropic glutamate receptors have the potential to improve the current treatment of these severe and disabling illnesses. Animal models of fear and anxiety have provided a method to study the role of glutamate in anxiety. This research has demonstrated that drugs that alter glutamate transmission have potential anxiolytic action for many different paradigms including fear-potentiated startle, punished responding, and the elevated plus maze. Human clinical drug trials have demonstrated the efficacy of glutamatergic drugs for the treatment of obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social phobia. Recent data from magnetic resonance imaging studies provide an additional link between the glutamate system and anxiety. Collectively, the data suggest that future studies on the mechanism of and clinical efficacy of glutamatergic agents in anxiety disorders are appropriately warranted.     

The causal role of interpretive bias in anxiety reactivity

Elevated anxiety vulnerability is associated with a tendency to interpret ambiguous stimuli as threatening, but the causal basis of this relationship has not been established. Recently, procedures have been developed to systematically manipulate interpretive bias, but the impact of such manipulation on anxiety reactivity to a subsequent stressor has not yet been examined. In the present study, training procedures were used to induce interpretive biases favoring the threatening or nonthreatening meanings of ambiguous information in a sample of 48 undergraduate students. Following this interpretive training, participants' emotional reactions to a stressful video were assessed. The finding that the manipulation of interpretive bias modified emotional reactivity supports the hypothesis that interpretive bias can indeed play a causal role in anxiety vulnerability.     

Peer conflict avoidance: associations with loneliness, social anxiety, and social avoidance

Failure to resolve peer conflict is associated with children's reports of loneliness, social anxiety, and social avoidance. Although these relationships are well established, researchers have not examined the association between the avoidance of peer conflict and various adjustment characteristics. The current study examined the association between avoidance of conflict and measures of loneliness, social anxiety, and social avoidance for 59 pupils in Grade 4 (31 boys and 28 girls) and 47 in Grade 8 (22 boys and 25 girls). Volunteers indicated that conflict avoidance based on autonomy, e.g., independence issues, and interpersonal issues, e.g., closeness and cohesion, was associated with scores on loneliness for boys and girls, respectively. Conflict avoidance for emotional and physical well-being and fear of punishment was associated with increased reports of loneliness and social anxiety for children in Grade 4.     

Social anxiety and cognitive expectancy of aversive outcome in avoidance conditioning

Fear conditioning studies have shown that social anxiety is associated with enhanced expectancy of aversive outcome. However, the relation between cognitive expectancy and social anxiety has never been tested in avoidance conditioning paradigms. We compared 48 low (LSA) and high socially anxious individuals (HSA) on subjective expectancy of aversive outcome during an avoidance conditioning task. Displays of neutral faces were coupled with an aversive outcome (US): a shout and a shock. Participants could avoid the US by pressing a correct button from a button box. First, HSA showed higher US expectancy than LSA during the initial phase of avoidance conditioning, supporting the view that socially anxious individuals have an expectancy bias when social situations are ambiguous. Second, when the avoidance response became unavailable, LSA showed lower US expectancy than HSA, suggesting that low socially anxious individuals are prone to a positive bias when perceived threat is high. A lack of such positive bias in socially anxious individuals may lead to higher susceptibility to safety behavior interpretations. Together, these findings support the role of cognitive processes in avoidance conditioning and underscore the relevance to encounter avoidance learning when studying social anxiety.     

风险回避行为中的“红色图形效应”

以往研究发现,风险回避领域存在着一种经典的"图形效应"(即图形会比数字激发出个体更强的风险回避行为)。但以往研究通常只采用灰色或黑色来呈现风险信息。基于近来关于红色效应的探讨,本研究试图将颜色因素引入到图形效应中以探讨不同颜色下的图形效应特点。结果发现,相比于蓝色,红色能激发出个体更强的风险回避行为,且颜色对图形效应具有调节作用,即与蓝色相比,红色条件下出现了增强的图形效应,即"红色图形效应"。有关结果说明,红色作为一种危险警示颜色可以激发出个体更强的风险回避行为,且会诱发更大的图形效应。     

Evidence for expectancy as a mediator of avoidance and anxiety in a laboratory model of human avoidance learning

A laboratory model was developed to study human avoidance learning. Participants could avoid an electric shock signalled by a 5-s conditioned stimulus (CS) by pressing one of a set of response buttons. Self-reported shock expectancy and skin conductance were recorded during a subsequent 10-s interval before shock. Shock expectancy declined when the correct avoidance response was learned and returned when the response was unavailable. Learning transferred to another shock CS. Parallel effects were observed on skin conductance once performance anxiety was controlled by requiring responding on all trials. Learning was faster when the Pavlovian contingencies were trained before introduction of the instrumental response. The results support a cognitive model of anxiety in which performance of an avoidance response reduces expectancy of an aversive outcome and thereby reduces anxiety.     

Evidence for expectancy as a mediator of avoidance and anxiety in a laboratory model of human avoidance learning

A laboratory model was developed to study human avoidance learning. Participants could avoid an electric shock signalled by a 5-s conditioned stimulus (CS) by pressing one of a set of response buttons. Self-reported shock expectancy and skin conductance were recorded during a subsequent 10-s interval before shock. Shock expectancy declined when the correct avoidance response was learned and returned when the response was unavailable. Learning transferred to another shock CS. Parallel effects were observed on skin conductance once performance anxiety was controlled by requiring responding on all trials. Learning was faster when the Pavlovian contingencies were trained before introduction of the instrumental response. The results support a cognitive model of anxiety in which performance of an avoidance response reduces expectancy of an aversive outcome and thereby reduces anxiety.     

Self-esteem,anxiety, and the avoidance of self-focused attention

The present study was designed to provide converging support for the hypothesis that individuals with low self-esteem (low SEs) find self-focused attention more anxiety provoking, relative to people with high self-esteem (high SEs). Subjects were premeasured for their self-esteem and given a brief opportunity to “practice” two tasks that they believed they would be required to perform in a later part of the experiment. One task was practiced in front of a self-focusing stimulus—a large mirror (mirror task)—whereas the other was not (no-mirror task). Subjects evaluated the tasks after they had practiced each one. Consistent with the notion that self-focused attention is more anxiety provoking for individuals with lower self-esteem, it was observed that: (1) relative to high SEs, lowmedium SEs rated the mirror, but not the no-mirror, task as less enjoyable, and (b) low-medium, but not high, SEs preferred to avoid the mirror task for the alleged upcoming part of the experiment. Subjects high in dispositional private selfconsciousness also wanted to avoid the mirror task, particularly if they were also low in self-esteem. Contrary to prediction, success-failure feedback from a previous task had no effect on subjects' task preferences. Theoretical explanations and implications are discussed.