Neural systems underlying approach and avoidance in anxiety disorders

Robin L Aupperle, Martin P Paulus, Robin L Aupperle, Martin P Paulus

Abstract

Approach-avoidance conflict is an important psychological concept that has been used extensively to better understand cognition and emotion. This review focuses on neural systems involved in approach, avoidance, and conflict decision making, and how these systems overlap with implicated neural substrates of anxiety disorders. In particular, the role of amygdala, insula, ventral striatal, and prefrontal regions are discussed with respect to approach and avoidance behaviors. Three specific hypotheses underlying the dysfunction in anxiety disorders are proposed, including: (i) over-representation of avoidance valuation related to limbic overactivation; (ii) under- or over-representation of approach valuation related to attenuated or exaggerated striatal activation respectively; and (iii) insufficient integration and arbitration of approach and avoidance valuations related to attenuated orbitofrontal cortex activation. These dysfunctions can be examined experimentally using versions of existing decision-making paradigms, but may also require new translational and innovative approaches to probe approach-avoidance conflict and related neural systems in anxiety disorders.

Figures

Figure 1.. This figure summarizes the neural…
Figure 1.. This figure summarizes the neural systems proposed to be integral for approach and avoidance processing as well as decision making, including the amygdala, insula, ventral striatum, and medial prefrontal (mPFC) and orbitofrontal cortex (OFC). Also represented are the proposed imbalance or enhancement of approach-avoidance signals that may underlie anxiety disorders.

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