Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Health Care System, Charleston, South Carolina.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Jul;8(7):712-719. doi: 10.1016/j.bpsc.2022.07.010. Epub 2022 Aug 8.
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.
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.
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.
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.
焦虑和相关障碍的治疗方法针对过度的逃避/回避作为核心特征，但目前的方法未能改善许多寻求治疗的个体的逃避/回避习惯。为了支持开发通过更直接地针对机制来提高治疗效果的工具，当前的工作检查了逃避和回避的神经生理学中的潜在区别，并测试了临床焦虑如何影响这些神经生理学。
25 名寻求治疗的个体，具有不同的主要诊断（例如，广泛性焦虑症、创伤后应激障碍）和 20 名非寻求治疗的对照参与者参加了研究。在研究任务中，大约 5.25 秒的线索预测了不愉快的图像，可以通过在图像出现前按下按钮来避免（阻止）、逃避（在图像出现后按下按钮结束）或无法控制。为了检查神经处理和防御反应调节，得出了预期的事件相关电位，并在每个线索中探测了惊跳反射。
观察到多维谱，即 1）仅在回避准备期间可靠地出现预期事件相关电位增强，并且事件相关电位可能反映了感知/工具性控制；2）在回避准备期间抑制惊跳反射，在逃避准备期间相对增强，在无法控制的预期期间进一步增强，从而可能反映出与恐惧相关的激活。然后，寻求治疗的状态不会影响皮质处理，但会调节上下文相关的恐惧（如果排除严重抑郁症患者），即没有抑郁症的寻求治疗的个体在逃避准备期间表现出惊跳反射增强，但在回避准备期间没有。
数据表明焦虑对逃避厌恶准备期间恐惧系统激活的特定影响。这种效应值得进一步研究，作为直接调节特定潜在神经回路的干预措施的精确目标。
