Max Planck UCL Centre for Computational Psychiatry and Ageing Research, and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.
Behav Brain Res. 2024 Oct 2;474:115192. doi: 10.1016/j.bbr.2024.115192. Epub 2024 Aug 8.
Generalized anxiety disorder is characterized by disruptions in decision-making, including an enhanced aversion to uncertain outcomes (i.e., risk aversion), which is not specific to negative outcomes (i.e., no loss aversion). It is unknown if this uncertainty bias is a trait-like causal factor contributing to anxiety symptoms, or a state-like feature triggered by anxiety symptoms such as worry chains. Here, in-patients with Major Depression Disorder (MDD), with (N = 16) or without (N = 24) Generalized anxiety (GA) symptoms, and healthy controls (N = 23), completed an economic decision-making task before and after worry induction. They were asked to choose between a certain monetary payoff, and an uncertain gamble, allowing for estimation of risk and loss aversion through a computational prospect-theoretic model. There were no significant differences in risk and loss aversion between any of the three groups at baseline. After worry induction, patients with GA symptoms, compared to those without, showed increased risk aversion. This increase was modulated by the severity of anxiety symptoms. These findings suggest that decision-making disruptions in anxiety disorder may be driven by anxiety symptoms such as worry, rather than causing them. This could shape etiological models, motivate standardization of emotional state in research on decision-making in anxiety disorders, support treatment strategies primarily aimed at worry management, and could guide novel interventions focusing on uncertainty exposure across aversive and appetitive domains.
广泛性焦虑障碍的特征是决策中断，包括对不确定结果（即风险规避）的厌恶增强，而不仅仅是对负面结果（即无损失规避）的厌恶。目前尚不清楚这种不确定性偏差是导致焦虑症状的特质性因果因素，还是由焦虑症状（如担忧链）引发的状态性特征。在这里，患有重度抑郁症（MDD）的住院患者（N=16）或无广泛性焦虑（GA）症状的患者（N=24）和健康对照组（N=23）在进行担忧诱导前后完成了一项经济决策任务。他们被要求在确定的货币收益和不确定的赌博之间进行选择，通过计算前景理论模型来估计风险和损失厌恶。在基线时，三组之间在风险和损失厌恶方面没有显著差异。在进行担忧诱导后，与无 GA 症状的患者相比，有 GA 症状的患者表现出更强的风险规避。这种增加受到焦虑症状严重程度的调节。这些发现表明，焦虑障碍中的决策中断可能是由担忧等焦虑症状驱动的，而不是导致这些症状的原因。这可能会影响病因模型，推动焦虑障碍中决策研究中情绪状态的标准化，支持主要针对担忧管理的治疗策略，并为关注厌恶和偏好领域不确定性暴露的新干预措施提供指导。
