title: Avoidant decision-making in social anxiety disorder: A laboratory task linked to in vivo anxiety and treatment outcome.
abstract: Recent studies on reward-based decision-making in the presence of anxiety-related stimuli demonstrated that approach-avoidance conflicts can be assessed under controlled laboratory conditions. However, the clinical relevance of these decision conflicts has not been demonstrated. To this end, the present study investigated avoidant decisions in treatment-seeking individuals with social anxiety disorder (SAD). In a gambling task, advantageous choices to maximize gains were associated with task-irrelevant angry faces and disadvantageous choices with happy faces. The clinical relevance of avoidant decisions for in vivo anxiety in a social stress situation (public speaking) were examined (n = 44). In a subsample (n = 20), the predictive value for a reduction of avoidance following behavioral therapy was also evaluated. Results indicated a close link between more frequent avoidant decisions and elevated in vivo anxiety. Moreover, individuals who showed a deficit in the goal-directed adjustment of their decisions also showed higher and sustained distress during the social stressor and reported less decrease of avoidance following treatment. The findings highlight the importance of an avoidant decision-making style for the experience of acute distress and the maintenance of avoidance in SAD. Assessing avoidant decision-making may help to predict the response to behavioral treatments.
authors: Department of Psychology, School of Social Sciences, University of Mannheim, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany. Electronic address: andre.pittig@tu-dresden.de.
authors: Andre
authors: A
authors: Pittig
authors: Department of Psychology, School of Social Sciences, University of Mannheim, Germany.
authors: Georg W
authors: GW
authors: Alpers
authors: Department of Psychology, University of California, Los Angeles, USA.
authors: Andrea N
authors: AN
authors: Niles
authors: Department of Psychology, University of California, Los Angeles, USA.
authors: Michelle G
authors: MG
authors: Craske
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology* / Q000628:therapy*; D001362:Avoidance Learning; D002755:Choice Behavior / Q000502:physiology; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000523:psychology / Q000628:therapy; D012201:Reward; D016896:Treatment Outcome
keywords: Avoidance; Decision making; Experimental psychopathology; Facial expressions; Goal-directed behavior; Incentives; Social anxiety disorder