Periodic Reporting for period 3 - DARE2APPROACH (Dare to Approach: A Neurocognitive Approach to Alleviating Persistent Avoidance in Anxiety Disorders)
Berichtszeitraum: 2022-01-01 bis 2023-06-30
Anxiety disorders are among the most common mental disorders forming a serious burden for the individual, and the society at large. Because avoidance behaviour is a major causal and maintaining factor in anxiety disorders, the central aim of DARE2APPRAOCH is to understand and alleviate persistent avoidance behaviour in anxious individuals. Although avoidance during a threatening situation has the immediate benefit of causing relief, it comes with serious costs in the long run. For instance, as long as a patient with social anxiety avoids social situations, the anxiety cannot extinguish and one misses out on important opportunities, for instance to meet significant others or to obtain a job.
Current interventions for anxiety disorders often fail because we lack understanding of how anxious individuals make approach-avoidance decisions and how their brains weigh the consequences of approach versus avoidance. Moreover, perceived threat elicits psychophysiological changes, such as freezing, that affect approach-avoidance decision making. However, due to a lack of integration between knowledge from decision neuroscience on the one hand and knowledge from the field of emotional-action control on the other hand, current neurocomputational models of approach-avoidance decisions do not consider those bodily states during acute threat. As a consequence, those models are not optimized to inform new interventions into persistent anxiety. Therefore, our objectives are to 1) develop a neurocomputational model of approach-avoidance (AA) decisions that accounts for the psychophysiological states of the decision maker. 2) Next, we aim to define which decision parameters are altered in active and passive avoidance in anxiety. 3) Third we will develop neurocognitively grounded interventions to improve decision making in healthy individuals and 4) fourth, we will apply those interventions to patients with anxiety symptoms.
Current interventions for anxiety disorders often fail because we lack understanding of how anxious individuals make approach-avoidance decisions and how their brains weigh the consequences of approach versus avoidance. Moreover, perceived threat elicits psychophysiological changes, such as freezing, that affect approach-avoidance decision making. However, due to a lack of integration between knowledge from decision neuroscience on the one hand and knowledge from the field of emotional-action control on the other hand, current neurocomputational models of approach-avoidance decisions do not consider those bodily states during acute threat. As a consequence, those models are not optimized to inform new interventions into persistent anxiety. Therefore, our objectives are to 1) develop a neurocomputational model of approach-avoidance (AA) decisions that accounts for the psychophysiological states of the decision maker. 2) Next, we aim to define which decision parameters are altered in active and passive avoidance in anxiety. 3) Third we will develop neurocognitively grounded interventions to improve decision making in healthy individuals and 4) fourth, we will apply those interventions to patients with anxiety symptoms.
The DARE2APPROACH project is currently halfway and progress has been made with respect to all of the three objectives. Team members have developed a theoretical framework and methodology for investigating approach and avoidance decisions under threat (Livermore et al., 2021). First, we have established common neural and psychophysiological correlates for acute threat- related defensive states such as freezing in animals and humans using a cross-disciplinary approach (Schipper et al., 2019). Second, we have developed a new experimental paradigm ‘the Passive-active Approach-avoidance Task (PAT)’ by which we can assess the role of freezing in AA-decisions. Importantly, we have developed novel neurocomputational models which incorporate psychophysiological states to predict AA-decision processes on this task (Klaassen et al., 2021). Fourth, we have developed a novel non-invasive dual-side transcranial alternating current stimulation (tACS) technique to improve control over approach-avoidance behaviour (Bramson et al., 2021). Currently we are applying this technique to highly anxious individuals to test whether it improves control over emotional approach-avoidance actions in those individuals as well. Additionally, the project team has actively reached out to the general public by organizing and participating in various public symposia, for instance on stress-resilience and on fearful avoidance, and has presented during several media appearances, including radio, television, newspapers and a movie.
The DARE2APPROACH project aims to move beyond the state of the art by three critical directions: 1) From fear to avoidance: Providing a comprehensive neurocomputational model of persistent avoidance in anxiety disorders. 2) Improve treatment of anxiety disorders based the newly derived mechanistic neurocognitive insights: Current interventions fail in 50% of the patients; we aim to enhance the efficacy of current treatments by developing neurocognitively grounded interventions that can be combined with existing treatments. 3) The impact of DARE2APPRACH will go beyond improving insight into and interventions for anxiety disorders. The knowledge can also be used for other stress-related disorders, such as affective disorders and for individuals who have to make decisions under threat on a daily basis, such as primary responders, including police officers and fire workers. In sum, when successful, the DARE2APPRAOCH project will yield profound fundamental insight into the brain's capacity to make decisions under acute threat. In the foreseeable future, this will create the opportunity to develop early interventions to increase efficacy and prevent further development of stress-related disorders as well as train decision making in risk professionals.