Cited by 227Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNeural and Behavioral Psychology StudiesMemory and Neural Mechanisms

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Neural systems underlying approach and avoidance in anxiety disorders

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Robin L., Aupperle, Martin, P. Paulus·2010·Dialogues in Clinical Neuroscience

DOI 10.31887/dcns.2010.12.4/raupperlePMC PMC3181993

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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.

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Paquette, V., Lévesque, J., Mensour, B., Leroux, J.-M., Beaudoin, G., Bourgouin, P., & Beauregard, M. (2003) · NeuroImage · doi:10.1016/s1053-8119(02)00030-7 · Cited by 452
Fear Conditioning in Humans
Critchley, H. D., Mathias, C. J., & Dolan, R. J. (2002) · Neuron · doi:10.1016/s0896-6273(02)00588-3 · Cited by 441
Intolerance of uncertainty and social anxiety
Boelen, P. A., & Reijntjes, A. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.04.007 · Cited by 436
Functional neuroimaging studies of human emotions
Phan, K. L., Wager, T. D., Taylor, S. F., & Liberzon, I. (2004) · CNS Spectrums · doi:10.1017/s1092852900009196 · Cited by 433
Abnormal attention modulation of fear circuit function in pediatric generalized anxiety disorder
McClure, E. B., Monk, C. S., Nelson, E. E., Parrish, J. M., Adler, A., Blair, R. J. R., Fromm, S., Charney, D. S., Leibenluft, E., Ernst, M., et al. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.1.97 · Cited by 431
Dorsal striatum responses to reward and punishment: effects of valence and magnitude manipulations
DELGADO, M. R., LOCKE, H. M., STENGER, V. A., & FIEZ, J. A. (2003) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/cabn.3.1.27 · Cited by 431
Beyond threat: amygdala reactivity across multiple expressions of facial affect
Fitzgerald, D. A., Angstadt, M., Jelsone, L. M., Nathan, P. J., & Phan, K. L. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2005.11.003 · Cited by 427
Facial expressions and complex IAPS pictures: Common and differential networks
Britton, J. C., Taylor, S. F., Sudheimer, K. D., & Liberzon, I. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2005.12.050 · Cited by 425
Neural processing of risk
Mohr, P. N. C., Biele, G., & Heekeren, H. R. (2010) · The Journal of Neuroscience · doi:10.1523/jneurosci.0003-10.2010 · Cited by 411 · cited 4×
“This could be one way in which the brain estimates risk and influences decision making.(29) We propose that insula dysfunction in anxiety disorders could relate to imbalances in difference calculations regarding current and future interoceptive state, which could influence risk estimations and approach-avoidance decis…”
Influential
Effects of lesions of the orbitofrontal cortex on sensitivity to delayed and probabilistic reinforcement
S., M., S., B., M.-Y., H., C., B., E., S., J., D., & I., A. (2002) · Psychopharmacology · doi:10.1007/s00213-001-0983-0 · Cited by 409
Disorder-Specific Neuroanatomical Correlates of Attentional Bias in Obsessive-compulsive Disorder, Panic Disorder, and Hypochondriasis
van den Heuvel, O. A., Veltman, D. J., Groenewegen, H. J., Witter, M. P., Merkelbach, J. W., Cath, D. C., van Balkom, A. J. L. M., van Oppen, P., & van Dyck, R. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.8.922 · Cited by 385 · cited 1×
“In response to symptom provocation or negative emotional stimuli, OFC and dmPFC (and occassionally lOFC and dlPFC) hyperactivation has been identified for GAD,(70,71,102) SAD,(73,75,207) phobia,(85,86,106,145,208) and panic.(80,209,210) Directional effects within the PFC have been mixed for PTSD,(47,79,90,97,211-215)…”
Positive and negative emotional verbal stimuli elicit activity in the left amygdala
Hamann, S., & Mao, H. (2002) · Neuroreport · doi:10.1097/00001756-200201210-00008 · Cited by 385
Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery.
Hopper, J. W., Frewen, P. A., van der Kolk, B. A., & Lanius, R. A. (2007) · Journal of Traumatic Stress · doi:10.1002/jts.20284 · Cited by 376
Anticipatory Activation in the Amygdala and Anterior Cingulate in Generalized Anxiety Disorder and Prediction of Treatment Response
Nitschke, J. B., Sarinopoulos, I., Oathes, D. J., Johnstone, T., Whalen, P. J., Davidson, R. J., & Kalin, N. H. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07101682 · Cited by 375
Amygdala and ventrolateral prefrontal cortex function during anticipated peer evaluation in pediatric social anxiety
Guyer, A. E., Lau, J. Y. F., McClure-Tone, E. B., Parrish, J., Shiffrin, N. D., Reynolds, R. C., Chen, G., Blair, R. J. R., Leibenluft, E., Fox, N. A., et al. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.11.1303 · Cited by 371
Positron emission tomographic imaging of neural correlates of a fear acquisition and extinction paradigm in women with childhood sexual-abuse-related post-traumatic stress disorder
BREMNER, J. D., VERMETTEN, E., SCHMAHL, C., VACCARINO, V., VYTHILINGAM, M., AFZAL, N., GRILLON, C., & CHARNEY, D. S. (2005) · Psychological Medicine · doi:10.1017/s0033291704003290 · Cited by 370
Classical fear conditioning in functional neuroimaging
Büchel, C. (2000) · Current Opinion in Neurobiology · doi:10.1016/s0959-4388(00)00078-7 · Cited by 360
Cerebral Blood Flow in Subjects With Social Phobia During Stressful Speaking Tasks: A PET Study
Tillfors, M., Furmark, T., Marteinsdóttir, Í., Fischer, H., Pissiota, A., Långström, B., & Fredrikson, M. G. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.8.1220 · Cited by 357
Dimensions of perfectionism across the anxiety disorders1An earlier version of this paper was presented in November 1996 at the meeting of the Association for Advancement of Behavior Therapy in New York City.1
Antony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00083-7 · Cited by 356
Somatotopic organisation of the human insula to painful heat studied with high resolution functional imaging
Brooks, J. C. W., Zambreanu, L., Godinez, A., Craig, A. D. (., & Tracey, I. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2005.03.041 · Cited by 355
Human orbitofrontal cortex mediates extinction learning while accessing conditioned representations of value
Gottfried, J. A., & Dolan, R. J. (2004) · Nature Neuroscience · doi:10.1038/nn1314 · Cited by 353
Frontal cortex subregions play distinct roles in choices between actions and stimuli
Rudebeck, P. H., Behrens, T. E., Kennerley, S. W., Baxter, M. G., Buckley, M. J., Walton, M. E., & Rushworth, M. F. S. (2008) · The Journal of Neuroscience · doi:10.1523/jneurosci.3541-08.2008 · Cited by 350
Learning fears by observing others: the neural systems of social fear transmission
Olsson, A., Nearing, K. I., & Phelps, E. A. (2007) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsm005 · Cited by 349 · cited 2×
“Human neuroimaging studies implicate the amygdala in signaling fear- or anxiety-producing stimuli characteristics, including pictures, odors, and faces(56-58) as well as in signaling changes in reinforcing properties of stimuli, such as occurs during fear conditioning(59-61) or instructional and observational learning…”
Brain activity underlying emotional valence and arousal: a response-related fMRI study
Anders, S., Lotze, M., Erb, M., Grodd, W., & Birbaumer, N. (2004) · Human Brain Mapping · doi:10.1002/hbm.20048 · Cited by 341
Activity in the human brain predicting differential heart rate responses to emotional facial expressions
Critchley, H. D., Rotshtein, P., Nagai, Y., O'Doherty, J., Mathias, C. J., & Dolan, R. J. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2004.10.013 · Cited by 340
How cognition modulates affective responses to taste and flavor: top-down influences on the orbitofrontal and pregenual cingulate cortices
Grabenhorst, F., Rolls, E. T., & Bilderbeck, A. (2008) · Cerebral Cortex · doi:10.1093/cercor/bhm185 · Cited by 337
Contextual fear conditioning in humans: cortical–hippocampal and amygdala contributions
Alvarez, R. P., Biggs, A., Chen, G., Pine, D. S., & Grillon, C. (2008) · Journal of Neuroscience · doi:10.1523/jneurosci.1246-08.2008 · Cited by 325 · cited 1×
“Neuroimaging studies in nonclinical populations report OFC and dorsomedial PFC (specifically dorsal and rostral ACC) activation in response to emotional pictures(56,134,172,194) and emotional faces(56,195,196) and provide evidence these regions are important for fear learning.(24,61,62,140,197,198) Animal and human st…”
Association of neural and physiological responses during voluntary emotion suppression
Ohira, H., Nomura, M., Ichikawa, N., Isowa, T., Iidaka, T., Sato, A., Fukuyama, S., Nakajima, T., & Yamada, J. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2005.08.047 · Cited by 318
Explicit and Incidental Facial Expression Processing: An fMRI Study
Gorno‐Tempini, M. L., Pradelli, S., Serafini, M., Pagnoni, G., Baraldi, P., Porro, C. A., Nicoletti, R., Umità, C., & Nichelli, P. (2001) · NeuroImage · doi:10.1006/nimg.2001.0811 · Cited by 313
Amygdala response to both positively and negatively valenced stimuli
Garavan, H., Pendergrass, J. C., Ross, T. J., Stein, E. A., & Risinger, R. C. (2001) · Neuroreport · doi:10.1097/00001756-200108280-00036 · Cited by 312
Anxiety impairs decision-making: Psychophysiological evidence from an Iowa Gambling Task
Miu, A. C., Heilman, R. M., & Houser, D. E. (2008) · Biological Psychology · doi:10.1016/j.biopsycho.2007.11.010 · Cited by 312 · cited 1×
“Individuals with high trait anxiety or specific phobia have reportedly exhibited impairment on the Iowa Gambling Task (IGT), a risk-based decision-making task(Aupperle RL et al, unpublished material).(37,38) GAD has been associated with intact performance on the IGT,(39) but increased errors during differential reward…”
Cerebral Blood Flow Changes Associated With Attribution of Emotional Valence to Pleasant, Unpleasant, and Neutral Visual Stimuli in a PET Study of Normal Subjects
Paradiso, S., Johnson, D. L., Andreasen, N. C., OʼLeary, D. S., Watkins, G. L., Ponto, L. L. B., & Hichwa, R. D. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.10.1618 · Cited by 310
Cortico-limbic-striatal circuits subserving different forms of cost-benefit decision making
Floresco, S. B., Onge, J. R. S., Ghods-Sharifi, S., & Winstanley, C. A. (2008) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/cabn.8.4.375 · Cited by 305
Neural mechanisms of cognitive reappraisal of negative self-beliefs in social anxiety disorder.
Goldin, P. R., Manber-Ball, T., Werner, K., Heimberg, R., & Gross, J. J. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.07.014 · Cited by 305
Neural computations underlying action-based decision making in the human brain
Wunderlich, K., Rangel, A., & O'Doherty, J. P. (2009) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0901077106 · Cited by 301
Neural correlates of declarative memory for emotionally valenced words in women with posttraumatic stress disorder related to early childhood sexual abuse
Bremner, J. D., Vythilingam, M., Vermetten, E., Southwick, S. M., McGlashan, T., Staib, L. H., Soufer, R., & Charney, D. S. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01891-7 · Cited by 299
Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects
Protopopescu, X., Pan, H., Tüscher, O., Cloître, M., Goldstein, M., Engelien, W., Epstein, J., Yang, Y., Gorman, J. M., LeDoux, J. E., et al. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.12.026 · Cited by 296
Neuroanatomical circuits modulating fear and anxiety behaviors
Charney, D. S. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.108.s417.3.x · Cited by 293
The Cognitive Neuroscience of Human Decision Making: A Review and Conceptual Framework
Fellows, L. K. (2004) · Behavioral and Cognitive Neuroscience Reviews · doi:10.1177/1534582304273251 · Cited by 285
Waiting for spiders: Brain activation during anticipatory anxiety in spider phobics
Straube, T., Mentzel, H.-J., & Miltner, W. H. R. (2007) · NeuroImage · doi:10.1016/j.neuroimage.2007.06.023 · Cited by 282
Response to emotional expressions in generalized social phobia and generalized anxiety disorder: evidence for separate disorders
Blair, K., Shaywitz, J., Smith, B. W., Rhodes, R., Geraci, M., Jones, M., McCaffrey, D., Vythilingam, M., Finger, E., Mondillo, K., et al. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07071060 · Cited by 282
Changes in Anterior Cingulate and Amygdala After Cognitive Behavior Therapy of Posttraumatic Stress Disorder
Felmingham, K. L., Kemp, A. H., Williams, L. M., Das, P., Hughes, G., Peduto, A. S., & Bryant, R. A. (2007) · Psychological Science · doi:10.1111/j.1467-9280.2007.01860.x · Cited by 280
Decision-making heterogeneity in obsessive-compulsive disorder: ventromedial prefrontal cortex function predicts different treatment outcomes
Cavedini, P., Riboldi, G., D'Annucci, A., Belotti, P., Cisima, M., & Bellodi, L. (2002) · Neuropsychologia · doi:10.1016/s0028-3932(01)00077-x · Cited by 277
Effect of task conditions on brain responses to threatening faces in social phobics: An event-related functional magnetic resonance imaging study
Straube, T., Kolassa, I., Glauer, M., Mentzel, H.-J., & Miltner, W. H. R. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.09.024 · Cited by 272
Time and decision making: differential contribution of the posterior insular cortex and the striatum during a delay discounting task
Wittmann, M., Leland, D. S., & Paulus, M. P. (2007) · Experimental Brain Research · doi:10.1007/s00221-006-0822-y · Cited by 266
Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery
Britton, J. C., Phan, K. L., Taylor, S. F., Fig, L. M., & Liberzon, I. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.12.025 · Cited by 265
Effects of cognitive-behavioral therapy on brain activation in specific phobia
Straube, T., Glauer, M., Dilger, S., Mentzel, H.-J., & Miltner, W. H. R. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2005.07.007 · Cited by 264
Cognitive influences on the affective representation of touch and the sight of touch in the human brain
McCabe, C., Rolls, E. T., Bilderbeck, A., & McGlone, F. (2008) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsn005 · Cited by 262
A Functional Magnetic Resonance Imaging Study of Deliberate Emotion Regulation in Resilience and Posttraumatic Stress Disorder
New, A. S., Fan, J., Murrough, J. W., Liu, X., Liebman, R. E., Guise, K. G., Tang, C. Y., & Charney, D. S. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.05.020 · Cited by 252
Effects of lesions of the nucleus accumbens core on choice between small certain rewards and large uncertain rewards in rats
Cardinal, R. N., & Howes, N. J. (2005) · BMC Neuroscience · doi:10.1186/1471-2202-6-37 · Cited by 248
Uncertainty during anticipation modulates neural responses to aversion in human insula and amygdala
Sarinopoulos, I., Grupe, D. W., Mackiewicz, K. L., Herrington, J. D., Lor, M., Steege, E. E., & Nitschke, J. B. (2010) · Cerebral Cortex · doi:10.1093/cercor/bhp155 · Cited by 241
How Humans Integrate the Prospects of Pain and Reward during Choice
Talmi, D., Dayan, P., Kiebel, S. J., Frith, C., & Dolan, R. J. (2009) · Journal of Neuroscience · doi:10.1523/jneurosci.2026-09.2009 · Cited by 239
Amygdala Response in Patients With Acute PTSD to Masked and Unmasked Emotional Facial Expressions
Armony, J. L., Corbo, V., Clément, M.-H., & Brunet, A. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.10.1961 · Cited by 239
The Neural Basis of Loss Aversion in Decision-Making Under Risk
Tom, S. M., Fox, C. R., Trepel, C., & Poldrack, R. A. (2008) · ACR North American Advances · Cited by 239
Dissociable roles for the hippocampus and the amygdala in human cued versus context fear conditioning
Marschner, A., Kalisch, R., Vervliet, B., Vansteenwegen, D., & Büchel, C. (2008) · The Journal of Neuroscience · doi:10.1523/jneurosci.1651-08.2008 · Cited by 235
Cerebral blood flow during anticipation of public speaking in social phobia: a PET study
Tillfors, M., Furmark, T., Marteinsdóttir, Í., & Fredrikson, M. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01396-3 · Cited by 230
Increased activation of the anterior cingulate cortex during processing of disgust faces in individuals with social phobia
Amir, N., Klumpp, H., Elias, J., Bedwell, J. S., Yanasak, N., & Miller, L. S. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.01.044 · Cited by 229
Decreased experimental anxiety and voluntary ethanol consumption in rats following central but not basolateral amygdala lesions
Möller, C., Wiklund, L., Sommer, W., Thorsell, A., & Heilig, M. (1997) · Brain Research · doi:10.1016/s0006-8993(97)00308-9 · Cited by 229
Exploring the roles of emotional numbing, depression, and dissociation in PTSD
Feeny, N. C., Zoellner, L. A., Fitzgibbons, L. A., & Foa, E. B. (2000) · Journal of Traumatic Stress · doi:10.1023/a:1007789409330 · Cited by 229
Pleasure Rather Than Salience Activates Human Nucleus Accumbens and Medial Prefrontal Cortex
Sabatinelli, D., Bradley, M. M., Lang, P. J., Costa, V. D., & Versace, F. (2007) · Journal of Neurophysiology · doi:10.1152/jn.00230.2007 · Cited by 225
The role of the human amygdala in the production of conditioned fear responses
Knight, D. C., Nguyen, H. T., & Bandettini, P. A. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2005.03.020 · Cited by 223
Subcortical correlates of differential classical conditioning of aversive emotional reactions in social phobia
Schneider, F. W., Weiss, U., Kessler, C., Müller-Gärtner, H.-W., Posse, S., Salloum, J. B., Grodd, W., Himmelmann, F. M., Gäebel, W., & Birbaumer, N. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00269-8 · Cited by 222
The Neurobiology of Conditioned and Unconditioned Fear: A Neurobehavioral System Analysis of the Amygdala
Rosen, J. B. (2004) · Behavioral and Cognitive Neuroscience Reviews · doi:10.1177/1534582304265945 · Cited by 219
Should OCD be classified as an anxiety disorder in DSM-V?
Stein, D. J., Fineberg, N. A., Bienvenu, O. J., Denys, D., Lochner, C., Nestadt, G., Leckman, J. F., Rauch, S. L., & Phillips, K. A. (2010) · Depression and Anxiety · doi:10.1002/da.20699 · Cited by 212 · cited 1×
“We exclude obsessive-compulsive disorder because significant distinctions between obsessive-compulsive spectrum disorders and other anxiety disorders have been noted with respect to both symptom presentation and underlying neural substrates.(22)”
A functional MRI study of amygdala responses to angry schematic faces in social anxiety disorder
Evans, K. C., Wright, C. I., Wedig, M. M., Gold, A. L., Pollack, M. H., & Rauch, S. L. (2008) · Depression and Anxiety · doi:10.1002/da.20347 · Cited by 211
Activation of the medial prefrontal cortex and extended amygdala by individual ratings of emotional arousal: a fMRI study
Phan, K. L., Taylor, S. F., Welsh, R. C., Decker, L. R., Noll, D. C., Nichols, T. E., Britton, J. C., & Liberzon, I. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01485-3 · Cited by 207
Lights, Camembert, Action! The Role of Human Orbitofrontal Cortex in Encoding Stimuli, Rewards, and Choices
O’Doherty, J. P. (2007) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1401.036 · Cited by 206
Emotional imagery: Assessing pleasure and arousal in the brain's reward circuitry
Costa, V. D., Lang, P. J., Sabatinelli, D., Versace, F., & Bradley, M. M. (2010) · Human Brain Mapping · doi:10.1002/hbm.20948 · Cited by 202
Altered reward processing in the nucleus accumbens and mesial prefrontal cortex of patients with posttraumatic stress disorder
Sailer, U., Robinson, S., Fischmeister, F. P. S., König, D., Oppenauer, C., Lueger-Schuster, B., Moser, E., Kryspin-Exner, I., & Bauer, H. (2008) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2008.05.022 · Cited by 201 · cited 4×
“PTSD has been associated with attenuated mPFC activation during risk-related decision making.(36) Self-reported intolerance of uncertainty in adolescents with GAD or SAD was associated with greater OFC (rostral/subgenual ACC) activation during uncertain, or risky, conditions of a decision-making task.”
Influential
Excitotoxic lesions of the medial prefrontal cortex attenuate fear responses in the elevated-plus maze, social interaction and shock probe burying tests
Shah, A. A., & Treit, D. (2003) · Brain Research · doi:10.1016/s0006-8993(03)02299-6 · Cited by 196
Nucleus accumbens dopamine release increases during instrumental lever pressing for food but not free food consumption
Salamone, J. D., Cousins, M. S., McCullough, L. D., Carriero, D. L., & Berkowitz, R. J. (1994) · Pharmacology Biochemistry and Behavior · doi:10.1016/0091-3057(94)90452-9 · Cited by 196
Anticipation of emotionally aversive visual stimuli activates right insula
Simmons, A., Matthews, S. C., Stein, M. B., & Paulus, M. P. (2004) · NeuroReport · doi:10.1097/00001756-200410050-00024 · Cited by 195
Self-citation
Role of the amygdala in decisions under ambiguity and decisions under risk: Evidence from patients with Urbach-Wiethe disease
Brand, M., Fabian Grabenhorst, B., Starcke, K., Vandekerckhove, M. M. P., & Markowitsch, H. J. (2006) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2006.09.021 · Cited by 192
Functional Activation and Neural Networks in Women with Posttraumatic Stress Disorder Related to Intimate Partner Violence
Simmons, A. N., Paulus, M. P., Thorp, S. R., Matthews, S. C., Norman, S. B., & Stein, M. B. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.05.027 · Cited by 191
Brain activation to phobia-related pictures in spider phobic humans: an event-related functional magnetic resonance imaging study
Dilger, S., Straube, T., Mentzel, H., Fitzek, C., Reichenbach, J. R., Hecht, H., Krieschel, S., Gutberlet, I., & Miltner, W. H. R. (2003) · Neuroscience Letters · doi:10.1016/s0304-3940(03)00647-5 · Cited by 190
Extended Amygdala and Emotional Salience: A PET Activation Study of Positive and Negative Affect
Liberzon, I., Phan, K. L., Decker, L. R., & Taylor, S. F. (2002) · Neuropsychopharmacology · doi:10.1038/sj.npp.1300113 · Cited by 189
Anhedonia and emotional numbing in combat veterans with PTSD
Kashdan, T. B., Elhai, J. D., & Frueh, B. C. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.03.001 · Cited by 186
Differential role of the medial and lateral prefrontal cortices in fear and anxiety.
Lacroix, L. P., Spinelli, S., Heidbreder, C. A., & Feldon, J. (2000) · Behavioral Neuroscience · doi:10.1037//0735-7044.114.6.1119 · Cited by 185
Separate brain regions code for salience vs. valence during reward prediction in humans
Jensen, J., Smith, A. J., Willeit, M., Crawley, A. P., Mikulis, D. J., Vitcu, I., & Kapur, S. (2006) · Human Brain Mapping · doi:10.1002/hbm.20274 · Cited by 184
Neural Mechanisms of Automatic and Direct Processing of Phobogenic Stimuli in Specific Phobia
Straube, T., Mentzel, H., & Miltner, W. H. R. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.06.013 · Cited by 184
Nucleus accumbens dopamine depletions in rats affect relative response allocation in a novel cost/benefit procedure
Cousins, M. S., & Salamone, J. D. (1994) · Pharmacology Biochemistry and Behavior · doi:10.1016/0091-3057(94)90460-x · Cited by 174
A functional magnetic resonance imaging study of deliberate emotion regulation in resilience and posttraumatic stress disorder
New, A. S., Fan, J., Murrough, J. W., Liu, X., Liebman, R. E., & Guise, K. G. (2009) · PsycEXTRA Dataset · doi:10.1037/e717692011-018 · Cited by 172
Modulation of Emotional Appraisal by False Physiological Feedback during fMRI
Gray, M. A., Harrison, N. A., Wiens, S., & Critchley, H. D. (2007) · PLoS ONE · doi:10.1371/journal.pone.0000546 · Cited by 170
Decoding different roles for vmPFC and dlPFC in multi-attribute decision making
Kahnt, T., Heinzle, J., Park, S. Q., & Haynes, J. (2010) · NeuroImage · doi:10.1016/j.neuroimage.2010.05.058 · Cited by 168
Corticolimbic Blood Flow During Nontraumatic Emotional Processing in Posttraumatic Stress Disorder
Phan, K. L., Britton, J. C., Taylor, S. F., Fig, L. M., & Liberzon, I. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.2.184 · Cited by 168
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Authors: Robin L., A., & Martin, P. P.
Affiliations: Department of Psychiatry, University of California, San Diego (UCSD), California, USA
Psychiatry Service, Veterans Affairs San Diego Health Care System, San Diego, California, USA
Venue: Dialogues in Clinical Neuroscience
Publisher: Informa UK Limited
Published: 2010-12-31
Volume: 12
Issue: 4
Pages: 517-531
ISSN: 1294-8322 (ISSN-L)
1958-5969
DOI: 10.31887/dcns.2010.12.4/raupperle
PMC: PMC3181993
OpenAlex: W1574357942
Cited by: 227
References: 251
Citations by year: 2026: 17 · 2025: 18 · 2024: 18 · 2023: 22 · 2022: 25 · 2021: 18 · 2020: 21 · 2019: 8 · 2018: 7 · 2017: 11 · 2016: 15 · 2015: 12 · 2014: 14 · 2013: 8 · 2012: 7
FWCI: 8.66
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/3.0/ (vor)
Locations: Dialogues in Clinical Neuroscience (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
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 › Cognitive Neuroscience › Memory and Neural Mechanisms
Keywords: approach-avoidance conflict, anxiety disorders, decision-making, amygdala, insula, ventral striatum, orbitofrontal cortex
MeSH terms: Anxiety Disorders, Avoidance Learning, Brain, Decision Making, Emotions, Humans, Models, Biological, Social Behavior

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Neural systems underlying approach and avoidance in anxiety disorders

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