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Modeling Avoidance in Mood and Anxiety Disorders Using Reinforcement Learning
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Abstract
BACKGROUND: Serious and debilitating symptoms of anxiety are the most common mental health problem worldwide, accounting for around 5% of all adult years lived with disability in the developed world. Avoidance behavior-avoiding social situations for fear of embarrassment, for instance-is a core feature of such anxiety. However, as for many other psychiatric symptoms the biological mechanisms underlying avoidance remain unclear. METHODS: Reinforcement learning models provide formal and testable characterizations of the mechanisms of decision making; here, we examine avoidance in these terms. A total of 101 healthy participants and individuals with mood and anxiety disorders completed an approach-avoidance go/no-go task under stress induced by threat of unpredictable shock. RESULTS: We show an increased reliance in the mood and anxiety group on a parameter of our reinforcement learning model that characterizes a prepotent (pavlovian) bias to withhold responding in the face of negative outcomes. This was particularly the case when the mood and anxiety group was under stress. CONCLUSIONS: This formal description of avoidance within the reinforcement learning framework provides a new means of linking clinical symptoms with biophysically plausible models of neural circuitry and, as such, takes us closer to a mechanistic understanding of mood and anxiety disorders.
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![Figure 1 Experimental paradigm. The trial sequence for each trial-type condition under threat (red) and safe (blue) conditions. There were equal numbers of go to win, go to avoid, no-go to win reward, and no-go to avoid losing trials within each safe and threat block, and these were randomly ordered within each block (note that safe sequence proceeds in the same way as the threat sequence but is curtailed here for brevity). The prepotent pavlovian bias to a win is a go response (approach) and the prepotent pavlovian response to a loss is no-go (avoid); hence in go to win reward and no-go to avoid losing, the bias and task instructions are aligned, but in go to avoid losing and no-go to win reward participants have to learn to overcome their avoidance and approach biases, respectively. The safe and threat blocks were presented in alternating order, counterbalanced across participants. A different set of fractal cues was used for the safe and threat blocks, counterbalanced across participants. At feedback, a face (happy +10 points, fear –10 points) was shown 80% of the time, and no points (i.e., a yellow bar [not shown in the figure]) was shown 20% of the time.](/paper-figures/5825814e139544bf9507615731e76c23/modeling-avoidance-in-mood-and-anxiety-disorders-using-reinforcement-learning-figure-1.jpg)
![Figure 2 Self-report anxiety and task performance. Between groups, (A) our mood and anxiety sample reported significantly higher trait anxiety scores (data missing for two participants in the control group [HC] [green] and one in the mood and anxiety group [ANX] [gray]), while (B) the whole sample reported increased (induced) anxiety, rated retrospectively, under threat relative to safe (Saf) conditions (violin plots; each point represents a subject, background shading represents estimated distribution). (C) Collapsed mean accuracy differs as a function of trial type, but this ignores that (D) performance on the task changed over time, such that the probability of making a response [P(go); as distinct from accuracy in panel (C)] differed as a function of trial type, condition, group, and time (shading represents SEM). Avo, avoid; Thr, threat.](/paper-figures/b342663785964f158b8abbf473773487/modeling-avoidance-in-mood-and-anxiety-disorders-using-reinforcement-learning-figure-2.jpg)


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“Aversion models in rodents are perhaps the closest pre-clinical approximation to avoidance behaviors [56], although limitations regarding clinical validity need to be kept in mind when interpreting results.”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [56]
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“For example, Mkrtchian et al [18] recently demonstrated avoidance as a part of reinforcement learning pathways in individuals with anxiety disorders.”
From Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial (2021) · cites this paper as [18]
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Metadata
- Authors
- Mkrtchian, A., Aylward, J., Dayan, P., Roiser, J. P., & Robinson, O. J.
- Affiliations
- University College London (GB)
- Gatsby Computational Neuroscience Unit (GB)
- Corresponding author
- Robinson, Oliver J.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 82
- Issue
- 7
- Pages
- 532-539
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC5598542
- OpenAlex
- W2587263457
- Cited by
- 151
- References
- 35
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 13 · 2023: 25 · 2022: 13 · 2021: 23 · 2020: 14 · 2019: 15 · 2018: 7 · 2017: 4
- FWCI
- 14.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Biological Psychiatry (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Medical Research Council (MR/K024280/1)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- avoidance behavior, mood disorders, anxiety disorders, reinforcement learning models, go/no-go task, stress, Pavlovian bias, neural circuits
- MeSH terms
- Adolescent, Adult, Anxiety, Avoidance Learning, Bayes Theorem, Decision Making, Female, Humans, Male, Middle Aged, Models, Psychological, Psychiatric Status Rating Scales, Reinforcement, Psychology, Mood Disorders, Young Adult
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