From the Laureate Institute for Brain Research, Tulsa, Okla., USA
From the Laureate Institute for Brain Research, Tulsa, Okla., USA.
J Psychiatry Neurosci. 2023 Jun 20;48(3):E217-E231. doi: 10.1503/jpn.220226. Print 2023 May-Jun.
Decision-making under approach-avoidance conflict (AAC; e.g., sacrificing quality of life to avoid feared outcomes) may be affected in multiple psychiatric disorders. Recently, we used a computational (active inference) model to characterize information processing differences during AAC in individuals with depression, anxiety and/or substance use disorders. Individuals with psychiatric disorders exhibited increased decision uncertainty (DU) and reduced sensitivity to unpleasant stimuli. This preregistered study aimed to determine the replicability of this processing dysfunction.
A new sample of participants completed the AAC task. Individual-level computational parameter estimates, reflecting decision uncertainty and sensitivity to unpleasant stimuli ("emotion conflict"; EC), were obtained and compared between groups. Subsequent analyses combining the prior and current samples allowed assessment of narrower disorder categories.
The sample in the present study included 480 participants: 97 healthy controls, 175 individuals with substance use disorders and 208 individuals with depression and/or anxiety disorders. Individuals with substance use disorders showed higher DU and lower EC values than healthy controls. The EC values were lower in females, but not males, with depression and/or anxiety disorders than in healthy controls. However, the previously observed difference in DU between participants with depression and/or anxiety disorders and healthy controls did not replicate. Analyses of specific disorders in the combined samples indicated that effects were common across different substance use disorders and affective disorders.
There were differences, although with small effect size, in age and baseline intellectual functioning between the previous and current sample, which may have affected replication of DU differences in participants with depression and/or anxiety disorders.
The now robust evidence base for these clinical group differences motivates specific questions that should be addressed in future research: can DU and EC become behavioural treatment targets, and can we identify neural substrates of DU and EC that could be used to measure severity of dysfunction or as neuromodulatory treatment targets?
在趋近-回避冲突（AAC；例如，为避免恐惧的结果而牺牲生活质量）下的决策可能会受到多种精神障碍的影响。最近，我们使用计算（主动推理）模型来描述患有抑郁症、焦虑症和/或物质使用障碍的个体在 AAC 期间的信息处理差异。患有精神障碍的个体表现出更高的决策不确定性（DU）和对不愉快刺激的敏感性降低。这项预先注册的研究旨在确定这种处理功能障碍的可复制性。
一组新的参与者完成了 AAC 任务。获得了反映决策不确定性和对不愉快刺激的敏感性（“情绪冲突”；EC）的个体计算参数估计值，并在组间进行比较。随后对以前和当前的样本进行分析，以评估更窄的疾病类别。
本研究的样本包括 480 名参与者：97 名健康对照者、175 名物质使用障碍者和 208 名抑郁症和/或焦虑症患者。物质使用障碍者的 DU 值较高，EC 值较低。与健康对照组相比，患有抑郁症和/或焦虑症的女性的 EC 值较低，但男性的 EC 值没有差异。然而，以前观察到的抑郁症和/或焦虑症患者与健康对照组之间的 DU 差异没有得到复制。在合并样本中对特定疾病的分析表明，这些效应在不同的物质使用障碍和情感障碍中是普遍存在的。
尽管存在较小的效应量差异，但以前和当前样本之间在年龄和基线智力功能方面存在差异，这可能影响了抑郁症和/或焦虑症患者 DU 差异的复制。
这些临床群体差异的现有证据基础为未来研究提出了具体的问题：DU 和 EC 能否成为行为治疗的目标，我们能否确定 DU 和 EC 的神经基础，这些基础可用于衡量功能障碍的严重程度或作为神经调节治疗的目标？
