Background & Aims

While our instinctive responses involve avoiding threats and approaching rewards, real-world situations often present a complex interplay of potential outcomes. Threat and reward values tend to vary, and deciding to approach the reward or avoid the threat will depend on an evaluation of potential costs and benefits. As the perceived threat intensifies, a behavioural shift typically occurs, transitioning from a reward-based approach to threat-based avoidance. This so-called tipping point likely varies across individuals and contextual factors.1-4 It may be worthwhile to face a threat to pursue a competing reward, especially if it aligns with valued goals. Stress has also been shown to affect approach-avoidance tendencies,5-7 and value-based decision-making more generally, but it remains to be tested how stress interacts with threats and rewards to jointly impact behavioural choices. We therefore aim to examine approach-avoidance behaviour and its modulation by rewards and acute stress.

Methods

Sixty pain-free volunteers (49f; age M = 20.7±2.3) were randomized into a group receiving an acute stress induction (MAST;8 n=30) or a no-stress control group (n=30). Then, in the classical fear conditioning phase, participants received instructions regarding the conditioned stimuli (CSs; 1 CS-, 5 CS+) and the corresponding probability of receiving the unconditioned stimulus (US; ranging from 0 to 1 in steps of .2). The US was an electrical stimulus at the left wrist, which was calibrated to be painful, but tolerable (8 on VAS 0-10). 15 min post-MAST (when cortisol typically starts to peak), the approach-avoidance choice phase started, in which 1 of 6 CSs and a reward (low, medium or high) were presented and participants were free to choose to avoid (reduce US probability to zero, no reward) or approach (face probability of US, receive reward). Approach-avoidance behaviour and its modulation by Group, CS and reward were analyzed using a Binomial Generalized Linear Mixed Model (GLMM).

Results

The acute stress manipulation check revealed a Group-by-Time interaction for mean arterial blood pressure (BP), indicating that the Stress Group showed a significant increase in BP after the MAST, while the Controls did not show any changes over time. In addition, the Stress Group perceived the MAST as more stressful compared to the Controls.

The GLMM revealed a significant 3-way interaction between Group, CS and reward for avoidance behaviour. Simple effects per group revealed a CS-by-reward interaction in both groups, indicating that avoidance increased with increasing CS but that this slope was less steep for higher rewards. Simple effects per reward level furthermore revealed i) a Group-by-CS interaction for high rewards, indicating that the Stress Group avoided less than the Controls, especially for higher CSs; ii) a main effect of Group for medium rewards, indicating that the Stress Group avoided less overall, and iii) no group differences for low rewards.

Conclusions

Our study examined how threat, reward, and acute stress jointly impact approach-avoidance choices. First, we showed that our stress manipulation was successful as the stress group reported more stress and showed higher BP compared to the no-stress control group. Then, our findings indicated that people avoided more as the threat of receiving pain increased, but that this transition to threat-based avoidance is pushed back by competing rewards. We also observed that an acute stress induction impacted this cost-benefit decision-making, as the stress group avoided less (and hence approached more) than the controls, but only for higher rewards and especially at higher threat levels. Whether and how the hypothalamic-pituitary-adrenal (HPA) axis underlies this effect will be tested in further analyses. Taken together, our findings suggest that acute stress intricately modulates approach-avoidance behaviour by increasing people’s tendency to face higher threats to obtain valued rewards.

References

1Schlund, M. W. et al. The tipping point: Value differences and parallel dorsal-ventral frontal circuits gating human approach-avoidance behavior. Neuroimage 136, 94-105 (2016). https://doi.org:10.1016/j.neuroimage.2016.04.070

2Pittig, A. & Scherbaum, S. Costly avoidance in anxious individuals: Elevated threat avoidance in anxious individuals under high, but not low competing rewards. J Behav Ther Exp Psychiatry 66, 101524 (2020). https://doi.org:10.1016/j.jbtep.2019.101524

3Hulsman, A. M. et al. Individual differences in costly fearful avoidance and the relation to psychophysiology. Behav Res Ther 137, 103788 (2021). https://doi.org:10.1016/j.brat.2020.103788

4Claes, N., Karos, K., Meulders, A., Crombez, G. & Vlaeyen, J. W. S. Competing goals attenuate avoidance behavior in the context of pain. J Pain 15, 1120-1129 (2014). https://doi.org:10.1016/j.jpain.2014.08.003

5Livermore, J. J. A. et al. Approach-Avoidance Decisions Under Threat: The Role of Autonomic Psychophysiological States. Front Neurosci 15, 621517 (2021). https://doi.org:10.3389/fnins.2021.621517

6Roelofs, K., Elzinga, B. M. & Rotteveel, M. The effects of stress-induced cortisol responses on approach-avoidance behavior. Psychoneuroendocrinology 30, 665-677 (2005). https://doi.org:10.1016/j.psyneuen.2005.02.008

7Lemmens, A., Quaedflieg, C., Dibbets, P., Rijkeboer, M. & Smeets, T. Examining the effect of stress on the flexible updating of avoidance responses. The European journal of neuroscience 55, 2542-2557 (2022). https://doi.org:10.1111/ejn.15155

8Smeets, T. et al. Introducing the Maastricht Acute Stress Test (MAST): A quick and non-invasive approach to elicit robust autonomic and glucocorticoid stress responses. Psychoneuroendocrinology 37, 1998-2008 (2012). https://doi.org:10.1016/j.psyneuen.2012.04.012

9Meulders, A. Fear in the context of pain: Lessons learned from 100 years of fear conditioning research. Behav Res Ther 131, 103635 (2020). https://doi.org:10.1016/j.brat.2020.103635

10Vlaeyen, J. W. & Linton, S. J. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 153, 1144-1147 (2012). https://doi.org:10.1016/j.pain.2011.12.009

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Presenting Author

Inge Timmers

Poster Authors

Inge Timmers

MSc

Tilburg University

Lead Author

Conny Quaedflieg

PhD

Lead Author

Simone Roelands

MSc

Lead Author

Flora Liesenfelder

BSc

Lead Author

Emma Biggs

PhD

Lead Author

Tom Smeets

PhD

Lead Author

Inge Timmers

Phd

Tilburg University

Lead Author

Topics

  • Mechanisms: Psychosocial and Biopsychosocial