Avoidance behavior as a result of one-sided exertion of cognitive control in specific phobia

The project investigates the role of cognitive control in anxiety disorder related avoidance behavior and its capacity to predict treatment outcome. Avoidance behavior in anxious patients can be viewed as one-sided exertion of cognitive control, i.e. preferring immediate but short-term fear/anxiety reduction over long-term benefits such as a daily life without excessive fear, neglecting possible new and better behavior alternatives in favor of well-known behavior, or employing habitual behavior without proper consideration of the current situation or consequences of the behavior. All these behaviors can be viewed as typical cognitive control dilemmas, namely the anticipation-discounting, exploitation-exploration, and stability-flexibility dilemma. We propose fear/anxiety-related avoidance behavior to be the result of a dysfunctional and one-sided style of exercising cognitive control. Using specific phobia as a model disorder with clear-cut avoidance behavior in response to a specific stimulus, we will conduct a series of behavioral and MRI experiments and compare phobia patients to healthy subjects to investigate the following questions: To which degree do phobia patients discount future rewards more rapidly, show more exploitation than exploration behavior, and respond more habitual rather than goal-directed compared to healthy controls, and is the proposed one-sided exertion of cognitive control domains specifically tied to phobogenic stimuli rather than being generalized? Are these changes in cognitive control characterized by neural network dysfunctions (via MRI investigation) and reflected in real-life behaviors (via experience sampling)? After this cross-sectional case-control comparison, specific phobia subjects will undergo single-session exposure therapy. This prospective-longitudinal interventional design will allow investigating whether and to what degree behavioral and neural measures of one-sided exertion of cognitive control predict treatment success.

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