Avoidance is a key symptom of anxiety disorders. Maladaptive avoidance impairs general functioning acutely and maintains chronic anxiety. A better understanding of the mechanisms that elicit and maintain excessive avoidance might provide opportunities to improve treatment. Here, we discuss pathways through which avoidance might get amplified in the context of anxiety disorders: 1) increased threat appraisal; 2) enhanced threat avoidance tendencies; 3) impaired regulation of avoidance; 4) habitual avoidance; and 5) attempts at increasing psychological distance. Novel strategies for reducing avoidance are considered. These include memory reconsolidation interference, retraining of avoidance tendencies, mindfulness training and habit disruption approaches. Throughout the paper, we highlight a number of suggestions for future research on avoidance and how to achieve lasting behavior change.
Traditional theoretical models hold that avoidance reflects the interplay of Pavlovian and instrumental learning. Here we suggest that avoidance tendencies to intrinsically neutral cues may be established by mere Pavlovian association. Following fear conditioning, in which pictures of one object were paired with shock (CS + ) whereas pictures of another object were not (CS -), CS + pictures facilitated avoidance reactions and interfered with approach responses, relative to CSpictures, in a symbolic approach/avoidance reaction time task. This was achieved without any instrumental relation between responses and CS continuation or unconditioned stimulus presentation. Moreover, those avoidance tendencies were sensitive to Pavlovian extinction (they were reduced after repeated presentations of the CS + without shock) and renewal (recovery of conditioned responding upon returning to the initial conditioning context after extinction in a different context). The present results may help us understand the self-perpetuating nature of pathological fear and anxiety.
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