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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: [email protected])
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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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