# Neural markers of avoidant decision-making in anxiety disorders

> **NIH NIH R01** · GEORGIA STATE UNIVERSITY · 2020 · $356,328

## Abstract

ABSTRACT
Anxiety disorders are the most common mental illness in the United States and affect more
women than men. Chronic avoidance of external threats and negative thoughts/feelings is a
prominent diagnostic feature. Yet, we lack psychiatric or biological assays to measure or predict
functional outcomes and guide treatments for reducing avoidance. We thus need etiological
models grounded in theory and human research to clarify neural markers of vulnerability to
avoidance in men and women and aid development of tailored, sex-specific interventions. This
application draws on affective and decision neuroscience to address how activation associated
with avoidant decision-making differs between anxious individuals and those with low anxiety. We
couple a behavioral model of real-world social approach-avoidance (AP-AV) decision-making with
fMRI to measure signaling of social reward-threat value differences and outcomes. Our model
suggests the dorsal anterior cingulate (dACC) and dorsal medial prefrontal cortex (dmPFC) signal
value differences between approach and avoidance actions, while the ventromedial prefrontal
cortex (vmPFC) signals value of reward and threat outcomes. Anterior insula (AI) signals of threat
and ventral striatum (VS) signals of reward also interplay. Preliminary data show that individuals
with high experiential avoidance base choices to approach/avoid on distinctively altered signaling
of reward-threat value differences and outcomes. Such biased signaling could explain excessive
avoidance or suggest potential mechanisms. We propose two neuroimaging experiments
designed to determine whether altered signaling reflects a stable neuropathology in anxiety
disorders or whether threat/reward manipulations common to behavioral treatments can
normalize signaling and increase approach behavior. For each we will recruit healthy (25M/25F)
and clinically anxious (25M/25F) 18-35 yr-old adults matched on age, sex, ethnicity, SES, and IQ
(total N=200). We aim to determine the extent to which anxiety modulates signaling and (1)
decreased threat increases approach behavior and normalizes signaling and connectivity; (2)
increased reward increases approach behavior and normalizes signaling and connectivity; and
(3) sex modulates signaling of reward-threat value differences and outcomes. Completion of our
aims will yield a detailed understanding of neural mechanisms of avoidant decision-making in
anxiety, responsiveness to reward-threat value differences, and sex differences.

## Key facts

- **NIH application ID:** 10016374
- **Project number:** 5R01MH120448-02
- **Recipient organization:** GEORGIA STATE UNIVERSITY
- **Principal Investigator:** MICHAEL W. SCHLUND
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $356,328
- **Award type:** 5
- **Project period:** 2019-09-11 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10016374

## Citation

> US National Institutes of Health, RePORTER application 10016374, Neural markers of avoidant decision-making in anxiety disorders (5R01MH120448-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10016374. Licensed CC0.

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