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Stimulus-reinforcement-based decision making and anxiety: impairment in generalized anxiety disorder (GAD) but not in generalized social phobia (GSP)

Published online by Cambridge University Press:  22 December 2008

J. DeVido ,
M. Jones ,
M. Geraci ,
N. Hollon ,
R. J. R. Blair ,
D. S. Pine  and
K. Blair
J. DeVido
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
M. Jones
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
M. Geraci
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
N. Hollon
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
R. J. R. Blair
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
D. S. Pine
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
K. Blair*
Affiliation:
Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
*
*Address for correspondence: K. Blair, Ph.D., Mood and Anxiety Program, National Institute of Mental Health, 15K North Drive, MSC 2670, Bethesda, MD 20892, USA. (Email: peschark@mail.nih.gov)
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Abstract

Background

Generalized social phobia (GSP) involves the fear/avoidance of social situations whereas generalized anxiety disorder (GAD) involves an intrusive worry about everyday life circumstances. It remains unclear whether these, highly co-morbid, conditions represent distinct disorders or alternative presentations of a single underlying pathology. In this study, we examined stimulus-reinforcement-based decision making in GSP and GAD.

Method

Twenty unmedicated patients with GSP, 16 unmedicated patients with GAD and 19 age-, IQ- and gender-matched healthy comparison (HC) individuals completed the Differential Reward/Punishment Learning Task (DRPLT). In this task, the subject chooses between two objects associated with different levels of reward or punishment. Thus, response choice indexes not only reward/punishment sensitivity but also sensitivity to reward/punishment level according to between-object reinforcement distance.

Results

We found that patients with GAD committed a significantly greater number of errors than both the patients with GSP and the HC individuals. By contrast, the patients with GSP and the HC individuals did not differ in performance on this task.

Conclusions

These results link GAD with anomalous non-affective-based decision making. They also indicate that GSP and GAD are associated with distinct pathophysiologies.

Keywords

Decision makinggeneralized anxiety disordergeneralized social phobia
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1153 - 1161
Copyright
Copyright © 2008 Cambridge University Press

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References

Becker, ES, Rinck, M, Margraf, J, Roth, WT (2001). The emotional Stroop effect in anxiety disorders: general emotional or disorder specificity? Journal of Anxiety Disorders 15, 147–159.CrossRefGoogle ScholarPubMed
Birbaumer, N, Grodd, W, Diedrich, O, Klose, U, Erb, M, Lotze, M, Schneider, F, Weiss, U, Flor, H (1998). fMRI reveals amygdala activation to human faces in social phobics. Neuroreport 9, 1223–1226.CrossRefGoogle ScholarPubMed
Blair, K, Geraci, M, DeVido, J, McCaffrey, D, Chen, G, Vythilingam, M, Ng, P, Hollon, N, Jones, M, Blair, RJ, Pine, DS (2008 a). Neural response to self- and other referential praise and criticism in generalized social phobia. Archives of General Psychiatry 65, 1176–1184.CrossRefGoogle ScholarPubMed
Blair, KS, Leonard, A, Morton, J, Blair, RJR (2006 a). Impaired decision making on the basis of both reward and punishment information in individuals with psychopathy. Personality and Individual Differences 41, 155–165.CrossRefGoogle Scholar
Blair, KS, Marsh, AA, Morton, J, Vythilingham, M, Jones, M, Mondillo, K, Pine, DS, Drevets, WC, Blair, RJR (2006 b). Choosing the lesser of two evils, the better of two goods: specifying the roles of ventromedial prefrontal cortex and dorsal anterior cingulate cortex in object choice. Journal of Neuroscience 26, 11379–11386.CrossRefGoogle ScholarPubMed
Blair, KS, Shaywitz, J, Smith, BW, Rhodes, R, Geraci, M, Jones, M, McCaffrey, D, Vythilingam, M, Finger, E, Mondillo, K, Jacobs, M, Charney, D, Blair, RJR, Drevets, WC, Pine, DS (2008 b). Response to emotional expressions in generalized social phobia (GSP) and generalized anxiety disorder (GAD): evidence for separate disorders. American Journal of Psychiatry 165, 1193–1202.Google Scholar
Blanco, C, Schneier, FR, Schmidt, A, Blanco-Jerez, CR, Marshall, RD, Sanchez-Lacay, A, Liebowitz, MR (2003). Pharmacological treatment of social anxiety disorder: a meta-analysis. Depression and Anxiety 18, 29–40.CrossRefGoogle ScholarPubMed
Boone, ML, McNeil, DW, Masia, CL, Turk, CL, Carter, LE, Ries, BJ, Lewin, MR (1999). Multimodal comparisons of social phobia subtypes and avoidant personality disorder. Journal of Anxiety Disorders 13, 271–292.CrossRefGoogle ScholarPubMed
Borkovec, TD, Shadick, RN, Hopkins, M (1991). The Nature of Normal and Pathological Worry. Guilford Press: New York, NY.Google Scholar
Botvinick, MM, Cohen, JD, Carter, CS (2004). Conflict monitoring and anterior cingulate cortex: an update. Trends in Cognitive Science 8, 539–546.CrossRefGoogle ScholarPubMed
Brown, TA, DiNardo, PA, Barlow, DH (1994). Anxiety Disorders Interview Schedule for DSM-IV – Adult Version. The Psychological Corporation: San Antonio, TX.Google Scholar
Bruce, SE, Machan, JT, Dyck, I, Keller, MB (2001). Infrequency of ‘pure’ GAD: impact of psychiatric comorbidity on clinical course. Depression and Anxiety 14, 219–225.CrossRefGoogle ScholarPubMed
Charney, DS (2004). Discovering the neural basis of human social anxiety: a diagnostic and therapeutic imperative. American Journal of Psychiatry 161, 1–2.CrossRefGoogle ScholarPubMed
Chen, YP, Ehlers, A, Clark, DM, Mansell, W (2002). Patients with generalized social phobia direct their attention away from faces. Behaviour Research and Therapy 40, 677–687.CrossRefGoogle ScholarPubMed
Coelho, HF, Cooper, PJ, Murray, L (2007). A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample. Journal of Affective Disorders 100, 103–113.CrossRefGoogle Scholar
Coles, ME, Heimberg, RG (2005). Recognition bias for critical faces in social phobia: a replication and extension. Behaviour Research and Therapy 43, 109–120.CrossRefGoogle ScholarPubMed
Craske, MG, Rapee, RM, Jackel, L, Barlow, DH (1989). Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls. Behaviour Research and Therapy 27, 397–402.CrossRefGoogle ScholarPubMed
First, M, Spitzer, R, Gibbon, M, Williams, J (1997). Structured Clinical Interview for DSM-IV. American Psychiatric Press: Washington, DC.Google Scholar
Heinrichs, N, Hofmann, SG (2001). Information processing in social phobia: a critical review. Clinical Psychology Review 21, 751–770.CrossRefGoogle ScholarPubMed
Hoehn-Saric, R, Schlund, MW, Wong, SH (2004). Effects of citalopram on worry and brain activation in patients with generalized anxiety disorder. Psychiatry Research 131, 11–21.CrossRefGoogle ScholarPubMed
Knutson, B, Cooper, JC (2005). Functional magnetic resonance imaging of reward prediction. Current Opinion in Neurology 18, 411–417.CrossRefGoogle ScholarPubMed
Liebowitz, MR, Ninan, PT, Schneier, FR, Blanco, C (2005). Integrating neurobiology and psychopathology into evidence-based treatment of social anxiety disorder. CNS Spectrums 10 (Suppl. 13), 1–11; discussion 12–13; quiz 14–15.Google Scholar
Lorberbaum, JP, Kose, S, Johnson, MR, Arana, GW, Sullivan, LK, Hamner, MB, Ballenger, JC, Lydiard, RB, Brodrick, PS, Bohning, DE, George, MS (2004). Neural correlates of speech anticipatory anxiety in generalized social phobia. Neuroreport 15, 2701–2705.Google Scholar
Mathew, SJ, Coplan, JD, Gorman, JM (2001). Neurobiological mechanisms of social anxiety disorder. American Journal of Psychiatry 158, 1558–1567.Google Scholar
McClure, EB, Adler, A, Monk, CS, Cameron, J, Smith, S, Nelson, EE, Leibenluft, E, Ernst, M, Pine, DS (2007). fMRI predictors of treatment outcome in pediatric anxiety disorders. Psychopharmacology 191, 97–105.Google Scholar
Mogg, K, Mathews, A, Weinman, J (1987). Memory bias in clinical anxiety. Journal of Abnormal Psychology 96, 94–98.CrossRefGoogle ScholarPubMed
Mogg, K, Philippot, P, Bradley, BP (2004). Selective attention to angry faces in clinical social phobia. Journal of Abnormal Psychology 113, 160–165.CrossRefGoogle ScholarPubMed
Monk, CS, Nelson, EE, McClure, EB, Mogg, K, Bradley, BP, Leibenluft, E, Blair, RJ, Chen, G, Charney, DS, Ernst, M, Pine, DS (2006). Ventrolateral prefrontal cortex activation and attentional bias in response to angry faces in adolescents with generalized anxiety disorder. American Journal of Psychiatry 163, 1091–1097.CrossRefGoogle ScholarPubMed
Newman, JP, Kosson, DS (1986). Passive avoidance learning in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology 95, 252–256.CrossRefGoogle ScholarPubMed
Nutt, DJ (2001). Neurobiological mechanisms in generalized anxiety disorder. Journal of Clinical Psychiatry 62 (Suppl. 11), 22–27.Google ScholarPubMed
O'Doherty, J, Rolls, ET, Francis, S, Bowtell, R, McGlone, F (2001). Representation of pleasant and aversive taste in the human brain. Journal of Neurophysiology 85, 1315–1321.CrossRefGoogle ScholarPubMed
Phan, KL, Fitzgerald, DA, Nathan, PJ, Tancer, ME (2006). Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia. Biological Psychiatry 59, 424–429.CrossRefGoogle ScholarPubMed
Pine, DS, Cohen, P, Gurley, D, Brook, J, Ma, Y (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry 55, 56–64.Google Scholar
Rickels, K, Rynn, M (2002). Pharmacotherapy of generalized anxiety disorder. Journal of Clinical Psychiatry 63 (Suppl. 14), 9–16.Google ScholarPubMed
Roemer, L, Orsillo, SM, Barlow, DH (2002). Anxiety and its Disorders. The Nature and Treatment of Anxiety and Panic. Guilford Press: New York, NY.Google Scholar
Sachs, G, Anderer, P, Doby, D, Saletu, B, Dantendorfer, K (2003). Impaired conditional discrimination learning in social phobia. Neuropsychobiology 47, 66–72.CrossRefGoogle ScholarPubMed
Schneier, FR (2003). Social anxiety disorder. British Medical Journal 327, 515–516.CrossRefGoogle ScholarPubMed
Snodgrass, JG, Vanderwart, M (1980). A standardized set of 260 pictures: norms for name agreement, familiarity, and visual complexity. Journal of Experimental Psychology: Human Learning and Memory 6, 174–215.Google ScholarPubMed
Stein, DJ, Westenberg, HG, Liebowitz, MR (2002). Social anxiety disorder and generalized anxiety disorder: serotonergic and dopaminergic neurocircuitry. Journal of Clinical Psychiatry 63 (Suppl. 6), 12–19.Google ScholarPubMed
Stein, MB, Kean, YM (2000). Disability and quality of life in social phobia: epidemiologic findings. American Journal of Psychiatry 157, 1606–1613.Google Scholar
Straube, T, Mentzel, HJ, Glauer, M, Miltner, WH (2004). Brain activation to phobia-related words in phobic subjects. Neuroscience Letters 372, 204–208.Google Scholar
Turk, CL, Heimberg, RG, Luterek, JA, Mennin, DS, Fresco, DM (2005). Emotion dysregulation in generalized anxiety disorder: a comparison with social anxiety disorder. Cognitive Therapy and Research 29, 89–106.CrossRefGoogle Scholar
Vriends, N, Becker, ES, Meyer, A, Michael, T, Margraf, J (2007). Subtypes of social phobia: are they of any use? Journal of Anxiety Disorders 21, 59–75.CrossRefGoogle ScholarPubMed
Whalen, PJ, Johnstone, T, Somerville, LH, Nitschke, JB, Polis, S, Alexander, AL, Davidson, RJ, Kalin, NH (2007). A functional magnetic resonance imaging predictor of treatment response to venlafaxine in generalized anxiety disorder. Biological Psychiatry 63, 858–863.CrossRefGoogle ScholarPubMed
Wu, JC, Buchsbaum, MS, Hershey, TG, Hazlett, E, Sicotte, N, Johnson, JC (1991). PET in generalized anxiety disorder. Biological Psychiatry 29, 1181–1199.CrossRefGoogle ScholarPubMed