Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial
Abstract Treatments for generalized anxiety disorder (GAD) often aim to address maladaptive approach-avoidance behavior patterns. Approach-avoidance conflict (AAC) offers a potential framework for identifying treatment outcome predictors and informing optimization of GAD treatment. The current study...
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| Format: | Article |
| Language: | English |
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Nature Publishing Group
2025-07-01
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| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-025-03460-x |
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| author | Hannah Berg Timothy J. McDermott Rayus Kuplicki Hung-Wen Yeh Wesley K. Thompson Ryan Smith Elisabeth Akeman Namik Kirlic Ashley Clausen Mallory Cannon Evan White Christopher R. Martell Kate B. Wolitzky-Taylor Michelle G. Craske James L. Abelson Martin P. Paulus Robin L. Aupperle |
| author_facet | Hannah Berg Timothy J. McDermott Rayus Kuplicki Hung-Wen Yeh Wesley K. Thompson Ryan Smith Elisabeth Akeman Namik Kirlic Ashley Clausen Mallory Cannon Evan White Christopher R. Martell Kate B. Wolitzky-Taylor Michelle G. Craske James L. Abelson Martin P. Paulus Robin L. Aupperle |
| author_sort | Hannah Berg |
| collection | DOAJ |
| description | Abstract Treatments for generalized anxiety disorder (GAD) often aim to address maladaptive approach-avoidance behavior patterns. Approach-avoidance conflict (AAC) offers a potential framework for identifying treatment outcome predictors and informing optimization of GAD treatment. The current study examined whether pre-treatment neurobehavioral AAC indices predict symptom improvement in behavioral activation (BA) and exposure therapy (EXP) for GAD. Treatment-seeking adults meeting criteria for GAD completed a randomized clinical trial with pre-treatment blinding, conducted from 2016–2021. Participants were randomized to complete 10 manualized sessions of BA or EXP. Participants completed an AAC task during functional magnetic resonance imaging pre-treatment. Computational parameters of task behavior were derived, and neural activity was assessed during decision-making and positive and negative outcomes of decisions. Outcome measures were GAD symptoms and depressive symptoms. Of 121 participants recruited, 56 (29 BA, 27 EXP; mean age 33.0 years; 12.5% male) treatment completers were included in analyses. Greater AAC task avoidance (d = −0.28) and greater left dorsolateral prefrontal cortex activation during negative outcomes (d = −0.32), predicted greater symptom reduction across treatments. Blunted left amygdala activation to positive outcomes was associated at a trend level with favorable symptom reduction for BA but not EXP (d = −0.20). The dorsolateral prefrontal cortex may be a target for enhancing behavior therapy outcomes generally, while left amygdala activation to positive affect may be a target for enhancing outcomes for BA. These findings may inform the optimization of behavioral therapies for GAD and hold potential for transdiagnostic applications, warranting larger, longitudinal studies in clinical settings. Clinical Trials Registration: ClinicalTrials.gov NCT02807480. |
| format | Article |
| id | doaj-art-7dbb2851d7a841758aadbcf70708ccaf |
| institution | Kabale University |
| issn | 2158-3188 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj-art-7dbb2851d7a841758aadbcf70708ccaf2025-08-20T04:01:40ZengNature Publishing GroupTranslational Psychiatry2158-31882025-07-0115111110.1038/s41398-025-03460-xPrediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trialHannah Berg0Timothy J. McDermott1Rayus Kuplicki2Hung-Wen Yeh3Wesley K. Thompson4Ryan Smith5Elisabeth Akeman6Namik Kirlic7Ashley Clausen8Mallory Cannon9Evan White10Christopher R. Martell11Kate B. Wolitzky-Taylor12Michelle G. Craske13James L. Abelson14Martin P. Paulus15Robin L. Aupperle16Laureate Institute for Brain ResearchLaureate Institute for Brain ResearchLaureate Institute for Brain ResearchHealth Services & Outcomes Research, Children’s Mercy HospitalLaureate Institute for Brain ResearchLaureate Institute for Brain ResearchLaureate Institute for Brain ResearchLaureate Institute for Brain ResearchSaint Luke’s Marion Bloch Neuroscience InstituteLaureate Institute for Brain ResearchLaureate Institute for Brain ResearchDepartment of Psychological and Brain Sciences, University of Massachusetts–AmherstPsychology, Psychiatry and Biobehavioral Sciences, University of CaliforniaPsychology, Psychiatry and Biobehavioral Sciences, University of CaliforniaDepartment of Psychiatry, University of MichiganLaureate Institute for Brain ResearchLaureate Institute for Brain ResearchAbstract Treatments for generalized anxiety disorder (GAD) often aim to address maladaptive approach-avoidance behavior patterns. Approach-avoidance conflict (AAC) offers a potential framework for identifying treatment outcome predictors and informing optimization of GAD treatment. The current study examined whether pre-treatment neurobehavioral AAC indices predict symptom improvement in behavioral activation (BA) and exposure therapy (EXP) for GAD. Treatment-seeking adults meeting criteria for GAD completed a randomized clinical trial with pre-treatment blinding, conducted from 2016–2021. Participants were randomized to complete 10 manualized sessions of BA or EXP. Participants completed an AAC task during functional magnetic resonance imaging pre-treatment. Computational parameters of task behavior were derived, and neural activity was assessed during decision-making and positive and negative outcomes of decisions. Outcome measures were GAD symptoms and depressive symptoms. Of 121 participants recruited, 56 (29 BA, 27 EXP; mean age 33.0 years; 12.5% male) treatment completers were included in analyses. Greater AAC task avoidance (d = −0.28) and greater left dorsolateral prefrontal cortex activation during negative outcomes (d = −0.32), predicted greater symptom reduction across treatments. Blunted left amygdala activation to positive outcomes was associated at a trend level with favorable symptom reduction for BA but not EXP (d = −0.20). The dorsolateral prefrontal cortex may be a target for enhancing behavior therapy outcomes generally, while left amygdala activation to positive affect may be a target for enhancing outcomes for BA. These findings may inform the optimization of behavioral therapies for GAD and hold potential for transdiagnostic applications, warranting larger, longitudinal studies in clinical settings. Clinical Trials Registration: ClinicalTrials.gov NCT02807480.https://doi.org/10.1038/s41398-025-03460-x |
| spellingShingle | Hannah Berg Timothy J. McDermott Rayus Kuplicki Hung-Wen Yeh Wesley K. Thompson Ryan Smith Elisabeth Akeman Namik Kirlic Ashley Clausen Mallory Cannon Evan White Christopher R. Martell Kate B. Wolitzky-Taylor Michelle G. Craske James L. Abelson Martin P. Paulus Robin L. Aupperle Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial Translational Psychiatry |
| title | Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial |
| title_full | Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial |
| title_fullStr | Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial |
| title_full_unstemmed | Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial |
| title_short | Prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach-avoidance conflict: a randomized clinical trial |
| title_sort | prediction of generalized anxiety disorder treatment outcomes with neurobehavioral responses to approach avoidance conflict a randomized clinical trial |
| url | https://doi.org/10.1038/s41398-025-03460-x |
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