title: Abnormal decision-making in generalized anxiety disorder: Aversion of risk or stimulus-reinforcement impairment?
abstract: There is preliminary data indicating that patients with generalized anxiety disorder (GAD) show impairment on decision-making tasks requiring the appropriate representation of reinforcement value. The current study aimed to extend this literature using the passive avoidance (PA) learning task, where the participant has to learn to respond to stimuli that engender reward and avoid responding to stimuli that engender punishment. Six stimuli engendering reward and six engendering punishment are presented once per block for 10 blocks of trials. Thirty-nine medication-free patients with GAD and 29 age-, IQ and gender matched healthy comparison individuals performed the task. In addition, indexes of social functioning as assessed by the Global Assessment of Functioning (GAF) scale were obtained to allow for correlational analyzes of potential relations between cognitive and social impairments. The results revealed a Group-by-Error Type-by-Block interaction; patients with GAD committed significantly more commission (passive avoidance) errors than comparison individuals in the later blocks (blocks 7,8, and 9). In addition, the extent of impairment on these blocks was associated with their functional impairment as measured by the GAF scale. These results link GAD with anomalous decision-making and indicate that a potential problem in reinforcement representation may contribute to the severity of expression of their disorder.
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Teng
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Marcela
authors.initials: M
authors.lastname: Otero
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Marilla
authors.initials: M
authors.lastname: Geraci
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: R J R
authors.initials: RJ
authors.lastname: Blair
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Pine
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Grillon
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
authors.forename: Karina S
authors.initials: KS
authors.lastname: Blair
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000503:physiopathology*; D001362:Avoidance Learning; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D003657:Decision Making / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D011678:Punishment; D012054:Reinforcement, Psychology; D012201:Reward
keywords: Decision-making; GAD; Global assessment of functioning; Passive avoidance; Punishment; Reward; Stimulus-reinforcement learning
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