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Objective: To examine the development and persistence of multiple physical symptoms (MPS) over a decade including the associations with sociodemographics and coping strategies., Method: A longitudinal study of 16,405 individuals aged 20-64 years participating in the Danish Symptom Cohort (DaSC) was conducted in 2012 with follow-up data in 2022 (DaSC II). MPS were assessed according to the unifying diagnostic construct of bodily distress syndrome, and coping was measured with the Brief Approach/Avoidance Coping Questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed., Results: Among individuals not having MPS in 2012, 17 % had developed MPS in 2022. Among individuals having MPS in 2012, 57 % had persistence of MPS in 2022. Individuals who developed or had persistence of MPS at follow-up were more likely to be female, have lower educational level, be immigrant, redeem antidepressants, have lower approach scores as well as higher diversion and resignation scores., Conclusions: Individuals responding to stressful situations with low approach, high diversion, and high resignation may be at higher risk of developing MPS and have persistence of MPS. As coping can be targeted through psychotherapy, it is important to focus on maladaptive strategies, especially in high-risk groups for developing and maintaining MPS., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Interoception, the representation of our bodily state derived from physiological signals, is fundamental to our sense of self. Previous studies using cardiac feedback paradigms demonstrated interoceptive effects on self-perception. However, it remains unclear whether interoceptive information can extend self-attribution to non-bodily objects. This study aimed to elucidate whether cardiac signals can induce self-attribution to non-bodily objects and how interoceptive accuracy modulates this effect. A total of 44 male volunteers participated in an emotion assignment task where they viewed images of palms (bodily targets) and spheres (non-bodily targets) flashing in or out of sync with their heartbeat and assigned emotional images (positive/negative) to these targets. A heartbeat discrimination task was used to measure the interoceptive accuracy. The results showed no significant effect of synchronisation on emotion assignment for either the target type or the valence of the emotional images. However, participants with high interoceptive accuracy attributed both positive and negative images more to synchronised targets than those with low interoceptive accuracy. These findings suggest that although cardiac synchronisation may not uniformly facilitate the self-attribution of external objects, interoceptive accuracy may mediate attention to synchrony. Future studies should explore the conditions under which cardiac signals influence self-attribution., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Shibata, Harada and Ohira.)

In this paper I discuss the main models that have tried to explain brain asymmetries for emotions. The first models, based on clinical observations, proposed either a general right hemisphere dominance for emotions (the'right hemisphere') model or a different specialization of the right hemisphere for negative and of the left hemisphere for positive emotions (the'valence' model). In more recent times new models, based on partly modified versions of the previous ones have been proposed. The revised version of the 'valence' model, labeled the 'approach-avoidance' model maintained that hemispheric asymmetries are not related to the valence of the emotional stimulus but to the motivational (approach vs avoidance) system that is engaged by that stimulus. On the contrary, revised versions of the 'right hemisphere' hypothesis proposed graded versions of this model, maintaining that only some kinds or some levels of emotions are clearly right lateralized. One version of these models (the'emotion type hypothesis') assumed that only elementary basic emotions should be subsumed by the right hemisphere, wheres more complex social emotions should be subtended by the left hemisphere. The other version (the 'schematic level of emotion hypothesis') assumed that the right hemisphere should subsume only the basic 'schematic' level of emotions, characterized by an automatic and unconscious processing, whereas the more propositional and conscious 'conceptual' level could be less lateralized or subsumed by the left hemisphere. This last model is supported by the obsevation that the right hemisphere reveals a modus operandi (i.e. a prevalence of the 'automatic' over the 'intentional' and of the 'unconscious' over the 'conscious' functional processing) that is typical of the 'schematic level of emotions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Understanding emotions in males is crucial given their higher susceptibility to substance use, interpersonal violence, and suicide compared to females. Steroid hormones are assumed to be critical biological factors that affect and modulate emotion-related behaviors, together with psychological and social factors. This review explores whether males' abilities to recognize emotions of others and regulate their own emotions are associated with testosterone, cortisol, and their interaction. Higher levels of testosterone were associated with improved recognition and heightened sensitivity to threatening faces. In contrast, higher cortisol levels positively impacted emotion regulation ability. Indirect evidence from neuroimaging research suggested a link between higher testosterone levels and difficulties in cognitive emotion regulation. However, this notion must be investigated in future studies using different emotion regulation strategies and considering social status. The present review contributes to the understanding of how testosterone and cortisol affect psychological well-being and emotional behavior in males., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Foraging decisions involve assessing potential risks and prioritizing food sources, which can be challenging when confronted with changing and conflicting circumstances. A crucial aspect of this decision-making process is the ability to actively overcome defensive reactions to threats and focus on achieving specific goals. The ventral pallidum (VP) and basolateral amygdala (BLA) are two brain regions that play key roles in regulating behavior motivated by either rewards or threats. However, it is unclear whether these regions are necessary in decision-making processes involving competing motivational drives during conflict. Our aim was to investigate the requirements of the VP and BLA for foraging choices in conflicts involving overcoming defensive responses. Here, we used a novel foraging task and pharmacological techniques to inactivate either the VP or BLA or to disconnect these brain regions before conducting a conflict test in male rats. Our findings showed that BLA is necessary for making risky choices during conflicts, whereas VP is necessary for invigorating the drive to obtain food, regardless of the presence of conflict. Importantly, our research revealed that the connection between VP and BLA is critical in controlling risky food-seeking choices during conflict situations. This study provides a new perspective on the collaborative function of VP and BLA in driving behavior, aimed at achieving goals in the face of dangers., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Recent research shows that sensitivity to interoceptive sensitivity is associated with a more granular experience of emotions. These studies suggest that individuals sensitive to their interoceptive signals can better perceive somatic physiological changes as compared to their counterparts. Therefore, they discriminate among a wide and subtle range of emotions. Further, the perception of others' emotions could be based on our own emotional experiences. However, whether interoceptive sensitivity is related to the perception of others' emotions remains unclear. Therefore, this study examined the relationship between interoceptive sensitivity and emotional perception. Considering the model that emotion perception comprises two processes, categorization of facial expressions and approach-avoidance responses, this study examined both categorizations of facial expressions and approach-avoidance responses. The results showed no relationship between interoceptive sensitivity and the perception of emotion, which suggests that interoceptive sensitivity is related to the experience of emotion but does not affect the granularity of emotional perception. Future studies should diversely and empirically examine the role of the body in emotional perception from the perspective of interoceptive sensitivity., (© 2024. The Author(s), under exclusive licence to Marta Olivetti Belardinelli.)

Background: Clinical anxiety is a generalized state characterized by feelings of apprehensive expectation and is distinct from momentary responses such as fear or stress. In contrast, most laboratory tests of anxiety focus on acute responses to momentary stressors., Methods: Apprehensive expectation was induced by subjecting mice (for 18 days) to manipulations in which a running response (experiment 1) or a conditioned stimulus (experiment 2) were unpredictably paired with reward (food) or punishment (footshock). Before this treatment, the mice were tested in an open field and light/dark box to assess momentary responses that are asserted to reflect state anxiety. After treatment, the mice were assessed for state anxiety in an elevated plus maze, social interaction test, startle response test, intrusive object burying test, and stress-induced corticosterone elevations. In experiment 3, we treated mice similarly to experiment 1, but after mixed-valence training, some mice received either no additional training, additional mixed-valence training, or were shifted to consistent (predictable) reinforcement with food., Results: We consistently observed an increase in anxiety-like behaviors after the experience with mixed-valence unpredictable reinforcement. This generalized anxiety persisted for at least 4 weeks after the mixed-valence training and could be reversed if the mixed-valence training was followed by predictable reinforcement with food., Conclusions: Results indicate that experience with unpredictable reward/punishment can induce a chronic state analogous to generalized anxiety that can be mitigated by exposure to stable, predictable conditions. This learned apprehension protocol provides a conceptually valid model for the study of the etiology and treatment of anxiety in laboratory animals., (© 2024 Published by Elsevier Inc on behalf of Society of Biological Psychiatry.)

Harmful alcohol use is a major public health issue. In-person treatment has been hindered by the restrictions necessary during the Covid-19 pandemic. This study examined the effects of an at-home smartphone-based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20-30-min smartphone-based approach-avoidance training (AAT) on image-induced craving at a 1-day follow-up. Sixty-two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1-week follow-up were compared to an active control group. Experiment 1 showed a significant reduction in image-induced craving for the training group at 1-day follow-up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1-week follow-up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone-based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1-week follow-up., (© 2023 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Recently, approach-avoidance tendencies and visual perception biases have been increasingly studied using bistable point-light walkers (PLWs). Prior studies have found a facing-the-viewer bias when one is primed with general threat stimuli (e.g. angry faces), explained by the "error management theory", as failing to detect a threat as approaching is riskier than the opposite. Importantly, no study has explored how disease threat - linked to the behavioural immune system - might affect this bias. This study aimed to explore whether disease-signalling cues can alter how we perceive the motion direction of ambiguous PLWs. Throughout 3 experiments, participants indicated the motion direction of a bistable PLW previously primed with a control or disease-signalling stimuli - that is, face with a surgical mask (Experiment 1), sickness sound (Experiment 2), or face with a disease cue (Experiment 3). Results showed that sickness cues do not significantly modulate the perception of approach-avoidance behaviours. However, a pattern emerged in Experiments 2 and 3, suggesting that sickness stimuli led to more facing away percepts. Unlike other types of threat, this implies that disease-related threat stimuli might trigger a distinct perceptual bias, indicating a preference to avoid a possible infection source. Nonetheless, this finding warrants future investigations.

A paradox of testosterone effects is seen in adolescents versus adults in social emotional approach-avoidance behavior. During adolescence, high testosterone levels are associated with increased anterior prefrontal (aPFC) involvement in emotion control, whereas during adulthood this neuro-endocrine relation is reversed. Rodent work shows that, during puberty, testosterone transitions from a neuro-developmental to a social-sexual activating hormone. In this study, we explored whether this functional transition is also present in human adolescents and young adults. Using a prospective longitudinal design, we investigated the role of testosterone on neural control of social emotional behavior during the transitions from middle to late adolescence and into young adulthood. Seventy-one individuals (tested at ages 14, 17, and 20 years) performed an fMRI-adapted approach-avoidance (AA) task involving automatic and controlled actions in response to social emotional stimuli. In line with predictions from animal models, the effect of testosterone on aPFC engagement decreased between middle and late adolescence, and shifted into an activational role by young adulthood-impeding neural control of emotions. This change in testosterone function was accompanied by increased testosterone-modulated amygdala reactivity. These findings qualify the testosterone-dependent maturation of the prefrontal-amygdala circuit supporting emotion control during the transition from middle adolescence into young adulthood., (© 2023 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

The three-chamber test, the so-called sociability test, has been widely used to assess social deficits based on impaired socially oriented investigations in rodent models. An innate motivation for investigating conspecifics is theoretically a prerequisite for gaining sociability scores in this paradigm. However, several relevant factors mediating investigatory motives, such as familiarity, attractiveness, and aggression, may affect sociability scores, which must be verified to obtain an adequate evaluation of the psychiatric phenotypes exhibited by disease-relevant rodent models. We assessed the social and non-social factors that mediate proximity preference by the three-chamber test with standard C57BL/6 J (B6) mice and low sociability BTBR+ltpr3tf/J (BTBR) mice. Strains of the opponents had no effect. Sexual cues (i.e., opposite sex) increased proximity preference in both strains of mice; in contrast, novel objects induced an approach in B6 mice but avoidance in BTBR mice. Single-housing before testing, stimulated social motive, affected BTBR mice but not B6 mice. BTBR females showed increased proximity preference across the sessions, and BTBR males showed increased preference toward a male B6 stimulus, but not a male BTBR stimulus. The male preference was restored when the male BTBR stimulus was anesthetized. In addition, self-grooming was facilitated by social and non-social novelty cues in both strains. B6 mice predominantly exhibited an investigatory approach toward social or non-social stimuli, whereas BTBR mice recognized social cues but tended to show avoidance. The three-chamber test could evaluate approach-avoidance strategies in target mouse strains that comprise innate social distance between mice., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2023 The Author. Published by Elsevier Inc. All rights reserved.)

Background: A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs., Objective: We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention., Methods: We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions., Results: The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=-0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition., Conclusions: The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials., Trial Registration: German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007., (©Lydia Helene Rupp, Marie Keinert, Stephanie Böhme, Lena Schindler-Gmelch, Bjoern Eskofier, Björn Schuller, Matthias Berking. Originally published in JMIR Formative Research (https://formative.jmir.org), 30.11.2023.)

Action control theories assume that upon responding to a stimulus response and stimulus features are integrated into a short episodic memory trace; repeating any component spurs on retrieval, affecting subsequent performance. The resulting so-called "binding effects" are reliably observed in discrimination tasks. In contrast, in localization performance, these effects are absent and only inhibition of return (IOR) emerges - a location change benefit. Affective information has been found to modulate binding effects; yet a modulation of IOR has led to mixed results, with many finding no influence at all. In the current study, participants discriminated letters (Experiment 1) or localized dots (Experiment 2) on a touchpad in prime-probe sequences. During the prime display two images - one with fruits and one with a spider - appeared, one of which spatially congruent with the to-be-touched area. In the discrimination task, previously touching a spider compared to a fruit slowed down response repetitions. In contrast, the localization task only showed IOR. This suggests that task-irrelevant valence is integrated with the response and affects subsequent responses due to retrieval. However, this is not ubiquitous but depends on task type. The results shed further light on the impact of affective information on actions., (© 2023. The Author(s).)

In recent years, different studies highlighted the importance of assessing behavioral tendencies toward different food stimuli in healthy and pathological samples. However, heterogeneities in experimental approaches and small sample sizes make this literature rather inconsistent. In this study, we used a mobile approach-avoidance task to investigate the behavioral tendencies toward healthy and unhealthy foods compared to neutral objects in a large community sample. The role of some contextual and stable subjective variables was also explored. The sample included 204 participants. The stimuli comprised 15 pictures of unhealthy foods, 15 pictures of healthy foods, and 15 pictures of neutral objects. Participants were required to approach or avoid stimuli by respectively pull or push the smartphone toward or away from themselves. Accuracy and reaction time of each movement were calculated. The analyses were conducted using a generalized linear mixed-effect model (GLMMs), testing the two-way interaction between the type of movement and the stimulus category and the three-way interactions between type of movement, stimulus, and specific variables (BMI, time passed since the last meal, level of perceived hunger). Our results evidenced faster approaching movement toward food stimuli but not toward neutrals. An effect of BMI was also documented: as the BMI increased, participants became slower in avoiding unhealthy compared to healthy foods, and in approaching healthy compared to unhealthy stimuli. Moreover, as hunger increased, participants became faster in approaching and slower in avoiding healthy compared to unhealthy stimuli. In conclusion, our results show an approach tendency toward food stimuli, independent from caloric content, in the general population. Furthermore, approach tendencies to healthy foods decreased with increasing BMI and increased with perceived hunger, indicating the possible influence of different mechanisms on eating-related behavioral tendencies., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The approach-avoidance task (AAT) is an implicit task that measures people's behavioral tendencies to approach or avoid stimuli in the environment. In recent years, it has been used successfully to help explain a variety of health problems (e.g., addictions and phobias). Unfortunately, more recent AAT studies have failed to replicate earlier promising findings. One explanation for these replication failures could be that the AAT does not reliably measure approach-avoidance tendencies. Here, we first review existing literature on the reliability of various versions of the AAT. Next, we examine the AAT's reliability in a large and diverse sample (N = 1077; 248 of whom completed all sessions). Using a smartphone-based, mobile AAT, we measured participants' approach-avoidance tendencies eight times over a period of seven months (one measurement per month) in two distinct stimulus sets (happy/sad expressions and disgusting/neutral stimuli). The mobile AAT's split-half reliability was adequate for face stimuli (r = .85), but low for disgust stimuli (r = .72). Its test-retest reliability based on a single measurement was poor for either stimulus set (all ICC1s < .3). Its test-retest reliability based on the average of all eight measurements was moderately good for face stimuli (ICCk = .73), but low for disgust stimuli (ICCk = .5). Results suggest that single-measurement AATs could be influenced by unexplained temporal fluctuations of approach-avoidance tendencies. These fluctuations could be examined in future studies. Until then, this work suggests that future research using the AAT should rely on multiple rather than single measurements., (© 2022. The Author(s).)

Depression is linked to dysfunctional appetitive and aversive motivational systems and effort-based decision-making, yet whether such deficits extend to social decisions remains unclear. Participants (23 non-depressed, 48 depressed - 24 with a past history of suicide attempt) completed a social decision-making task consisting in freely choosing whether to approach or avoid individuals displaying happy or angry expressions. Occasionally, participants had to make a further effort (change button press) to obtain the desired outcome. All participants preferentially avoided anger on their first choice. Yet, depressed patients less often chose to approach happy individuals, as a function of anhedonia severity. Depressed patients were also less inclined than controls to change their response when the anticipated outcome of their first choice was undesirable (approach angry and avoid happy). Again, such effect correlated with anhedonia severity. Our results support that both altered valuation and willingness to exert effort impact approach-avoidance decisions in social contexts in depression. On this basis, we propose a new integrating framework for reconciling different hypotheses on the effect of depression and anhedonia on motivational responses to emotional stimuli., Competing Interests: Declaration of competing interest Authors for this manuscript have no conflicts of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Facial expressions are evolutionarily acquired social signals that are processed rapidly by the receiver when deciding to either approach or avoid the person sending the signal. The predominance of the approach or avoidance responses has been examined for various facial expressions. Similar to facial expressions, the approach-avoidance response to affective voice may have been acquired evolutionarily. However, studies examining approach-avoidance to an affective voice are limited. This study used the approach-avoidance task framework developed for facial expressions to determine the dominant behavioural responses to affective voices that indicate either happiness or anger. The results show that the approach response was dominant for the happy voice, while the avoidance response was dominant for the angry voice. This tendency was observed even without the presence of any facial stimuli. These results suggest that an affective voice may be an evolutionarily acquired approach-avoidance-inducing social signal, similar to facial expressions., (© 2022 International Union of Psychological Science.)

Emotional dampening (blunted responses to affective stimuli or experiences) has been reported in individuals with clinical and subclinical levels of elevated blood pressure (BP). Our aim in the present study was to explore how the basic motivational systems of approach and avoidance to positively- and negatively-valenced stimuli are affected in elevated BP. High BP (n = 27) and Low BP (n = 29) participants completed an approach-avoidance task. In this task, participants pulled the joystick towards them when viewing a happy face (approach) and pushing it away when viewing an angry face (avoid) in the congruent condition, and reversed these action-to-emotion pairings in the incongruent condition. A mixed-design ANOVA revealed a significant main effect of condition, such that overall participants were faster across trials in the congruent than trials of the incongruent condition. There was also an emotion x BP interaction. Among the Low BP group, there were no RT differences to happy and angry expressions (across congruent and incongruent conditions) but those with High BP were quicker to respond to actions paired with angry than happy facial expressions (across conditions). Findings suggest that valence-specific motivational reactions are not dampened with an increase in BP, and are rather sensitized for the negative emotion of anger., Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04337-2., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

We put forward a validation of the first instrument to measure the big four health risk behaviours (World Health Organization, Global status report on non-communicable diseases 2014, WHO, 2014) in a single assessment, the Health Risk Behaviour Inventory (HRBI) that assesses physical inactivity, unhealthy diet, smoking and alcohol in Italian- and English-speaking samples. Further, we investigate the instrument's association with self-regulatory dispositions, exploring culture and gender differences in Italian and US subgroup samples. Overall, 304 English- and 939 Italian-speaking participants completed the HRBI and the self-regulatory questionnaire. We explored the factorial structure, convergent validity, invariance and association with self-regulatory dispositions using structural equation modelling.The HRBI has a robust factorial structure; it usefully converges with widely used healthy lifestyle measures, and it is invariant across the categories of age, gender and languages. Regarding self-regulatory dispositions, the promotion focus emerges as the most protective factor over physical inactivity, unhealthy diet, smoking and alcohol, whereas the prevention focus is associated mainly with smoking and alcohol reduction. Results are consistent across genders and US subgroup-Italian samples. The HRBI is a valid instrument for assessing the big four health risk behaviours in clinic and research contexts, and among self-regulatory measures, the promotion and prevention foci have the greatest efficacy in eliciting positive health behaviours., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Individuals with addictions often exhibit approach bias, or the relatively automatic action tendency to approach rather than avoid addiction-related stimuli. The current study used a cannabis-Approach-Avoidance Task (AAT) to assess approach-avoidance tendencies toward cannabis stimuli among 211 undergraduate college students with varying levels of cannabis use. Frequency and severity of cannabis use was assessed using the Cannabis Use Disorder Identification Test - Short Form (CUDIT-R). The sample did not demonstrate a significant approach or avoidance bias toward cannabis stimuli; instead, participants were significantly slower to approach and avoid cannabis stimuli relative to neutral stimuli. Individuals with problematic cannabis use who met criteria for a possible cannabis use disorder (CUD) based on CUDIT-R criteria were significantly slower to avoid but not to approach cannabis stimuli compared to individuals with nonuse and non-problematic use. Moreover, increased frequency and severity of cannabis use was significantly associated with increased reaction times to avoid cannabis stimuli. Findings appear to differ from some previous studies examining approach-avoidance tendencies toward cannabis, suggesting that the role of cognitive biases in cannabis use is complex and should be further investigated.

Health warning labels (HWLs) show promise in reducing motivation towards energy-dense snack foods. Understanding the underlying mechanisms could optimise their effectiveness. In two experimental studies in general population samples (Study 1 n = 90; Study 2 n = 1382), we compared the effects of HWLs and irrelevant aversive labels (IALs) on implicit (approach) motivation towards unhealthy snacks, using an approach-avoidance task (Study 1), and a manikin task (Study 2). We also assessed explicit motivation towards unhealthy snacks using food selection tasks. We examined whether labelling effects on motivation arose from the creation of outcome-dependent associations between the food and its health consequences or from simple, non-specific aversive associations. Both label types reduced motivation towards snack foods but only when the label was physically present. HWLs and IALs showed similar effects on implicit motivation, although HWLs reduced explicit motivation more than IALs. Thus, aversive HWLs appear to act both through low level associative mechanisms affecting implicit motivation, and by additionally emphasizing explicit causal links to health outcomes thereby affecting explicitly motivated choice behaviours., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We have previously proposed that mothers and infants co-regulate one another's autonomic state through an autonomic conditioning mechanism, which starts during gestation and results in the formation of autonomic socioemotional reflexes (ASRs) following birth. Theoretically, autonomic physiology associated with the ASR should correlate concomitantly with behaviors of mother and infant, although the neuronal pathway by which this phenomenon occurs has not been elucidated. In this paper, we consider the neuronal pathway by which sensory stimuli between a mother and her baby/child affect the physiology and emotional behavior of each. We divide our paper into two parts. In the first part , to gain perspective on current theories on the subject, we conduct a 500-year narrative history of scientific investigations into the human nervous system and theories that describe the neuronal pathway between sensory stimulus and emotional behavior. We then review inconsistencies between several currently accepted theories and recent data. In the second part, we lay out a new theory of emotions that describes how sensory stimuli between mother and baby unconsciously control the behavior and physiology of both. We present a theory of mother/infant emotion based on a set of assumptions fundamentally different from current theories. Briefly, we propose that mother/infant sensory stimuli trigger conditional autonomic socioemotional reflexes (ASRs), which drive cardiac function and behavior without the benefit of the thalamus, amygdala or cortex. We hold that the ASR is shaped by an evolutionarily conserved autonomic learning mechanism (i.e., functional Pavlovian conditioning) that forms between mother and fetus during gestation and continues following birth. We highlight our own and others research findings over the past 15 years that support our contention that mother/infant socioemotional behavior is driven by mutual autonomic state plasticity, as opposed to cortical trait plasticity. We review a novel assessment tool designed to measure the behaviors associated with the ASR phenomenon. Finally, we discuss the significance of our theory for the treatment of mothers and infants with socioemotional disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ludwig and Welch.)

Adaptive approach and avoidance in responses to reward and threat are fundamental to prevent harm and to ensure well-being. In contrast, maladaptive approach or avoidance behavior likely contributes to anxiety or substance abuse disorders, respectively. Therefore, there is a need to assess such behavior in humans objectively. Conditioned place preference (CPP) is a well-established animal paradigm investigating approach-avoidance mechanisms, i.e., context-associated appetitive/aversive effects of unconditioned stimuli. Recently, the retranslation of this paradigm for human research started. This meta-analysis provides the first systematic overview of this developing field. A total of 17 studies published before June 2020 fulfil our inclusion criteria: (1) Usage of a rewarding agent, (2) implementation of either virtual or real environments, (3) human subjects, and (4) report of standardized outcome measures. These studies were evaluated and analyzed following the DIAD model and the PRISMA guidelines, respectively, and specific subanalyses were preformed to identify modulating factors of CPP effects (e.g., Virtual Reality applications, biased/unbiased). Overall, a significant medium effect size for the behavioral measure of dwell time (g =.62, p < .001, 95%-CI =.43-.81) and a significant small effect size for verbal self-ratings (g =.33, p < .001, 95%-CI =.04-.63) were observed, although across-study results were characterized by substantial heterogeneity (l 2 > 65%). These results indicate great potential for CPP to study approach-avoidance behavior in humans, directly in analogy to animal studies. We provide guidelines for future CPP research to improve comparability of studies and to facilitate new insights into anxiety disorders and drug abuse., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

This study examined the relationship between worry and health behaviours using an online survey of 69,033 respondents from 32 countries. We hypothesized that past health behaviours predicted worry experienced, which in turn predicted future health behaviours, and included a metric of cultural distance from the US. Past behaviours such as maintaining physical distance predicted higher worry, whereas worry reduced the likelihood of going outside. Being culturally dissimilar to the US was associated with lower worry. However, cultural distance was not associated with future health behaviours. We analyse worry as an approach-avoidance motivator of health behaviours from a cross-cultural perspective, to facilitate effective health communication strategies.

Background: Sexual dysfunctions are commonly associated with depression by which women are particularly affected., Aim: In the following study, we looked at which stage-early attention-related processes or later evaluation-related processes-of the processing of sexual stimuli deviations occur in depressed individuals., Methods: We examined 96 women who either suffered from a major depressive disorder, or had recovered from it, and a healthy control group. The early level of attention processes was represented by reaction time tasks (dot probe, line orientation, picture categorization). In addition, implicit approach and avoidance behavior was tested by the Approach-Avoidance Task. Later evaluation of the visual material was determined with the help of a questionnaire for recording automatic negative thoughts regarding sexuality., Outcomes: Reaction times and explicit ratings as well as the Becks Depression Inventory (BDI II), the Trait Sexual Motivation Questionnaire (TSMQ), the Sexual Modes Questionnaire (SMQ) and a screening for sexual dysfunction were used., Results: Depressed women did not differ significantly from healthy women in their attention processes and approach-avoidance behavior. However, there were clear differences in explicit assessment and automatic thoughts about sexual stimuli. Women who had recovered from depression lay between the 2 groups., Clinical Implications: The results indicated that the therapy of sexual dysfunction in depressed patients should focus more on automatic thoughts than on attention processes., Strengths & Limitations: This study is the first to experimentally research the attention processes of depression towards sexual stimuli. However, participants were only tested on one occasion so that change of attention processes and evaluation of sexual stimuli over the course of a depression could not be assessed., Conclusion: Our novel findings demonstrate the role of attention processes in sexual dysfunctions of depressed women and suggest potential mechanisms that may underlie the observed correlation between depression and sexual dysfunction. Baranowski AM, Noll A-K, Golder S, et al. Effects of Depression on Processing and Evaluation of Sexual Stimuli in Women. J Sex Med 2022;19:441-451., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The emergence of Pavlovian-to-instrumental transfer (PIT) research in the human neurobehavioral domain has been met with increased interest over the past two decades. A variety of PIT tasks were developed during this time; while successful in demonstrating transfer phenomena, existing tasks have limitations that should be addressed. Herein, we introduce two PIT paradigms designed to assess outcome-specific and general PIT within the context of addiction., Materials and Methods: The single-lever PIT task, based on an established paradigm, replaced button presses with joystick motion to better assess avoidance behavior. The full transfer task uses alcohol and nonalcohol rewards associated with Pavlovian cues and instrumental responses, along with other gustatory and monetary rewards. We constructed mixed-effects models with the addition of other statistical analyses as needed to interpret various behavioral measures., Results: Single-lever PIT: both versions were successful in eliciting a PIT effect (joystick: p < 0.001, ηp2 = 0.36, button-box: p < 0.001, ηp2 = 0.30). Full transfer task: it was determined that the alcohol and nonalcoholic reward cues selectively primed their respective reward-associated responses (gustatory version: p < 0.001, r = 0.59, and monetary version: p < 0.001, r = 0.84). The appetitive/aversive cues resulted in a general transfer effect (gustatory: p < 0.001, ηp2 = 0.09, and monetary: p < 0.001, ηp2 = 0.17)., Discussion/conclusion: Single-lever PIT: PIT was observed in both task versions. We posit that the use of a joystick is more advantageous for the analysis of avoidance behavior. It evenly distributes movement between approach and avoid trials, which is relevant to analyzing fMRI data. Full transfer task: While gustatory conditioning has been used in the past to elicit transfer effects, we present the first paradigm that successfully elicits both specific and general transfers in humans with gustatory alcohol rewards., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Objective: Body and food-related information are thought to activate cognitive biases and contribute to the maintenance of eating disorders (ED). Approach-avoidance biases may play an important role in the maintenance of dietary restriction and excessive food intake. Therefore, the present study aimed to examine approach-avoidance biases toward food and body stimuli in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC)., Methods: The study included 42 individuals with AN, 24 individuals with BN, and 38 HCs. We used two implicit Approach-Avoidance Tasks (AAT) to assess approach-avoidance biases: participants completed a Food-AAT (high-calorie vs. low-calorie food) and a Body-AAT (thin vs. normal weight bodies). Additionally, explicit ratings of food and body stimuli were assessed., Results: There were no significant Group × Stimulus × Direction interactions in the implicit Food-AAT or implicit Body-AAT. In explicit ratings, individuals with AN and BN reported less urge to eat and more regret if they ate high-calorie and low-calorie food; individuals with AN and BN rated normal weight bodies as less normal weight, less attractive and less desirable than HCs. There were no group differences in explicit ratings of the thin body., Discussion: We did not find evidence for biased approach-avoidance tendencies toward food or body stimuli in individuals with AN or BN. Future studies are necessary to understand conflicting findings regarding approach-avoidance biases toward food and body stimuli in individuals with ED., (© 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

In everyday life, interactions between humans are generally modulated by the value attributed to the situation, which partly relies on the partner's behavior. A pleasant or cooperating partner may trigger an approach behavior in the observer, while an unpleasant or threatening partner may trigger an avoidance behavior. In this context, the correct interpretation of other's intentions is crucial to achieve satisfying social interactions. Social cues such as gaze direction and facial expression are both fundamental and interrelated. Typically, whenever gaze direction and facial expression of others communicate the same intention, it enhances both the interlocutor's gaze direction and the perception of facial expressions (i.e., shared signal hypothesis). For instance, an angry face with a direct gaze is perceived as more intense since it represents a threat to the observer. In this study, we propose to examine how the combination of others' gaze direction (direct or deviated) and emotional facial expressions (i.e., happiness, fear, anger, sadness, disgust, and neutrality) influence the observer's gaze perception and postural control. Gaze perception was indexed by the cone of direct gaze (CoDG) referring to the width over which an observer feels someone's gaze is directed at them. A wider CoDG indicates that the observer perceived the face as looking at them over a wider range of gaze directions. Conversely, a narrower CoDG indicates a decrease in the range of gaze directions perceived as direct. Postural control was examined through the center of pressure displacements reflecting postural stability and approach-avoidance tendencies. We also investigated how both gaze perception and postural control may vary according to participants' personality traits and emotional states (e.g., openness, anxiety, etc.). Our results confirmed that gaze perception is influenced by emotional faces: a wider CoDGs was observed with angry and disgusted faces while a narrower CoDG was observed for fearful faces. Furthermore, facial expressions combined with gaze direction influence participants' postural stability but not approach-avoidance behaviors. Results are discussed in the light of the approach-avoidance model, by considering how some personality traits modulate the relation between emotion and posture., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lebert, Chaby, Guillin, Chekroun and Vergilino-Perez.)

Background and Objectives: Previous studies have shown that humans, particularly those with high levels of spider fear, show automatic avoidance of spiders. However, most tasks used in these studies employ symbolic approach-avoidance movements instead of naturalistic movements., Methods: The current study employed a touchscreen-based approach-avoidance task in which 86 female participants made hand and arm movements that mimic the real-life touching, grasping, and moving of spiders. Using a large touchscreen, they had to reach for pictures of spiders and neutral objects (leaves), touch them, and drag them either away from themselves or towards themselves. To draw attention to stimulus content, pictures of butterflies were used in additional NoGo trials, they required participants to not move their hand., Results: Avoidance of spiders was observed in both the pre-movement times (time to lift the hand from a starting position) and the grabbing times (time to reach the picture), and this avoidance was larger for more spider-fearful participants. The dragging times (time to swipe the picture), however, revealed a relative spider-approach tendency: Compared to leaves, participants were faster to drag spiders closer than to swipe them away., Limitations: We discuss potential reasons for this mixed pattern of results, including the low reliability of the dragging times., Conclusions: We recommend the use of touchscreens for the assessment of approach-avoidance tendencies, and we suggest avenues for further research., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Facial masks have become and may remain ubiquitous. Though important for preventing infection, they may also serve as a reminder of the risks of disease. Thus, they may either act as cues for threat, priming avoidance-related behavior, or as cues for a safe interaction, priming social approach. To distinguish between these possibilities, we assessed implicit and explicit evaluations of masked individuals as well as avoidance bias toward relatively unsafe interactions with unmasked individuals in an approach-avoidance task in an online study. We further assessed Covid19 anxiety and specific attitudes toward mask-wearing, including mask effectiveness and desirability, hindrance of communication from masks, aesthetic appeal of masks, and mask-related worrying. Across one sample of younger (18-35 years, N = 147) and one of older adults (60+ years, N = 150), we found neither an average approach nor avoidance bias toward mask-wearing compared to unmasked individuals in the indirect behavior measurement task. However, across the combined sample, self-reported mask-related worrying correlated with reduced avoidance tendencies toward unmasked individuals when Covid19 anxiety was low, but not when it was high. This relationship was specific to avoidance tendencies and was not observed in respect to explicit or implicit preference for mask-wearing individuals. We conclude that unsafe interaction styles may be reduced by targeting mask-related worrying with public interventions, in particular for populations that otherwise have low generalized Covid19 anxiety., (© 2021. The Author(s).)

Adverse childhood experiences (ACE) are a major risk factor for major depressive disorder (MDD) in later life. Both conditions are characterized by dysregulations in the noradrenergic system related which again could represent a mediating mechanism for deficits in affective processing and behavioral functioning. In this double-blind, placebo-controlled study we tested the hypothesis that ACE and MDD are characterized by aberrant approach-avoidance (AA) tendencies and that these are mitigated after noradrenergic stimulation with yohimbine. In a mixed-measures, fully crossed design, participants (N = 131, 73 women) with/without MDD and with/without ACE received a single-dose of yohimbine or placebo on different days, followed by an AA task. We found modulation of AA tendencies by the emotional valence of target images, yet there were no effects of group or treatment. From these results, we conclude that AA tendencies are not critically affected by MDD or ACE and that the noradrenergic system is not substantially involved in this behavior., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Strong cravings for unhealthy foods and implicit tendencies to approach them threaten the physical and mental health of vulnerable populations. Yet, implicit measures of food approach tendencies have methodological limitations, as existing approach-avoidance tasks (AAT) are often unreliable and require specialized hardware. We propose a novel method to measure approach biases: on a touchscreen, participants slide their hand either toward a food item (and away from control images) or away from it (and toward control images) in separate blocks. Adequate attention to the stimuli is ensured by the coupling of stimulus category to the required response. We found that this touchscreen-variant of the AAT yielded reliable bias scores when approach and avoidance were defined as movements relative to the stimulus rather than to the body. Compared to control images, we found an approach bias for low-calorie foods but not for high-calorie foods. This bias additionally varied on a food-by-food basis depending on the participant's desire to eat individual food items. Correlations with state and trait cravings were inconclusive. Future research needs to address the order effects that were found, in which participants avoiding foods in the first block showed larger biases than participants approaching food in the first block, likely due to insufficient opportunity to practice the task. Our findings highlight the need for approach bias retraining paradigms to use personalized stimulus sets. The task can enrich the methodological repertoire of research on eating disorders, obesity and cognitive bias modification., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The present study was designed to investigate the representation of calorie levels in space. Previously an association between numerical magnitude and space has been established, namely, the Spatial Numerical Association of Response Codes (SNARC) effect. The spatial-numerical association reveals representation of smaller and larger numbers by the left and right sides, respectively. In addition, previous studies showed that spatial arrangement of foods in space affects the food selection behavior. In three experiments, the presence of an association between calorie magnitude and space was tested to understand how it could potentially affect food selection behavior. Reaction times were recorded to investigate the speed of information processing. In Experiment 1, locations of low and high calorie food stimuli were (in)congruent in terms of the space-calorie association. In Experiment 2, endogenous spatial cues were used to bias attention to investigate if this bias would lead to formation of the space-calorie association. Finally, Experiment 3 investigated whether green and red colors evoke approach or avoidance behavior and prevent formation of the space-calorie association. In all experiments, results revealed lack of an association between space and calorie, that is, presenting low/high calorie items on the left/right hemispace, respectively, did not modulate the processing speed., (Copyright: © 2021 University of Economics and Human Sciences in Warsaw.)

Implicit ('unconscious') approach-avoidance tendencies towards stimuli can be measured using the Approach Avoidance Task (AAT). We recently expanded a toolbox for analyzing the raw data of a novel, mobile version of the AAT (mAAT), that asks participants to move their phone towards their face (pull) or away (push) in response to images presented on the phone. We here tested the mAAT reaction time and the mAAT distance in a study with 71 Dutch participants that were recruited online and performed an experiment without coming to the laboratory. The participants used both the mAAT and (explicit) rating scales to respond to photographic images of food. As hypothesized, the rated wanting, rated valence and mAAT reaction time indicated a preference for palatable over unpalatable food, and for Dutch over Asian food. Additionally, as expected, arousal was rated higher for unpalatable than for palatable food, and higher for Dutch than for Asian food. The mAAT distance indicated that the unpalatable food images were moved across larger distances, regardless of the movement direction (pull or push), compared to the palatable food images; and the Dutch food images were moved across larger distances than the Asian food images. We conclude that the mAAT can be used to implicitly probe approach-avoidance motivation for complex images in the food domain. The new measure of mAAT distance may be used as an implicit measure of arousal. The ratings and the mAAT measures do not reflect the exact same information and may complement each other. Implicit measures, such as mAAT variables, are particularly valuable when response biases that can occur when using explicit ratings are expected.

The objectives of this series of studies were to develop and evaluate a visual self-report measure, the Depicted Action Tendencies (DAT), for the assessment of action tendencies, and to examine relations between action tendencies and emotions. In three independent studies, 938 participants evaluated drawings depicting individuals engaged in actions, reflecting four classes of action tendencies; the tendency to approach reward, approach threat, avoid threat, and avoid reward. The DAT instrument showed specificity in terms of associations with emotions and verbal action-tendency items with minimal overlap between drawings (Study 1). The specificity of the drawings extended to settings in which participants recalled events from their lives (Study 2 and 3). The findings suggest that the drawings can capture different action tendencies in contexts labeled with the same emotion and provide initial support for the DAT instrument as a valid and reliable measure of action tendencies. We believe the DAT instrument offers potential value both in experimental and clinical settings. Given its pictorial format, the DAT is easy to comprehend and may represent a valuable instrument for assessing action tendencies in a quick manner at the momentary level. It may also be useful to individuals with limited linguistic skills or difficulties in verbalizing sensations and feelings., (© 2021 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Survival depends on the ability of animals to avoid threats and approach rewards. Traditionally, these two opposing motivational systems have been studied separately. In nature, however, they regularly compete for the control of behavior. When threat- and reward-eliciting stimuli (learned or unlearned) occur simultaneously, a motivational conflict emerges that challenges individuals to weigh available options and execute a single behavioral response (avoid or approach). Most previous animal models using approach/avoidance conflicts have often focused on the ability to avoid threats by forgoing or delaying the opportunity to obtain rewards. In contrast, behavioral tasks designed to capitalize on the ability to actively choose to execute approach behaviors despite threats are scarce. Thus, we developed a behavioral test battery composed of three conflict tasks to directly study rats confronting threats to obtain rewards guided by innate and conditioned cues. One conflict task involves crossing a potentially electrified grid to obtain food on the opposite end of a straight alley, the second task is based on the step-down threat avoidance paradigm, and the third one is a modified version of the open field test. We used diazepam to pharmacologically validate conflict behaviors in our tasks. We found that, regardless of whether competing stimuli were conditioned or innate, a low diazepam dose decreased risk assessment and facilitated taking action to obtain rewards in the face of threats during conflict, without affecting choice behavior when there was no conflict involved. Using this pharmacologically validated test battery of ethologically designed innate/learned conflict tasks could help understand the fundamental brain mechanisms underlying the ability to confront threats to achieve goals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Illescas-Huerta, Ramirez-Lugo, Sierra, Quillfeldt and Sotres-Bayon.)

Acutely challenging or threatening situations frequently require approach-avoidance decisions. Acute threat triggers fast autonomic changes that prepare the body to freeze, fight or flee. However, such autonomic changes may also influence subsequent instrumental approach-avoidance decisions. Since defensive bodily states are often not considered in value-based decision-making models, it remains unclear how they influence the decision-making process. Here, we aim to bridge this gap by discussing the existing literature on the potential role of threat-induced bodily states on decision making and provide a new neurocomputational framework explaining how these effects can facilitate or bias approach-avoid decisions under threat. Theoretical accounts have stated that threat-induced parasympathetic activity is involved in information gathering and decision making. Parasympathetic dominance over sympathetic activity is particularly seen during threat-anticipatory freezing, an evolutionarily conserved response to threat demonstrated across species and characterized by immobility and bradycardia. Although this state of freezing has been linked to altered information processing and action preparation, a full theoretical treatment of the interactions with value-based decision making has not yet been achieved. Our neural framework, which we term the Threat State/Value Integration (TSI) Model, will illustrate how threat-induced bodily states may impact valuation of competing incentives at three stages of the decision-making process, namely at threat evaluation, integration of rewards and threats, and action initiation. Additionally, because altered parasympathetic activity and decision biases have been shown in anxious populations, we will end with discussing how biases in this system can lead to characteristic patterns of avoidance seen in anxiety-related disorders, motivating future pre-clinical and clinical research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Livermore, Klaassen, Bramson, Hulsman, Meijer, Held, Klumpers, de Voogd and Roelofs.)

In this report, we integrate the principles described in part 1 and describe an operational model for emotional decision making that incorporates brain activation data along with subjective experience correlates. This model takes the form of a state machine that carries out transitions between a finite set of 16 possible states of emotional and decision-making response. By considering a 4 × 4 grid of possible states based on left and right activation, in primary (sensation) and secondary (perception/comprehension) response, the range of responses is completely specified. The transition probabilities within this repertoire of possible response states can be used to characterize an individual (or any system) in terms of its likelihood to respond in a particular fashion. The possible value of this model in psychiatry, psychology, and counseling is introduced and discussed.

In part 1 of this article, we describe an approach and methodology that bridges 2 worlds: the internal, subjective experience of emotions and thoughts, and the external world of brain electrical activity. Using a novel event-related brain activation imaging method, we demonstrate that within single trials, short-term mental processes, on the order of 100 ms, can be clearly related to observed brain activation in controlled experiments. We use an ipsative assessment validation process that combines self-report with real-time EEG recordings to provide a combined picture of both the mental and the brain activity, during short-term reactions, emotions, and decisions regarding controlled information. Part 2 provides a detailed description of the emerging emotional decision-making model.

Background: Given their ubiquity and technological facilities, smartphone-based interventions (SBIs) hold potential to support the cost-effective dissemination of evidence-based treatments for depression. As technologically enriched, blended approach-avoidance modification trainings (AAMTs) have recently been shown effective for symptom reduction in various mental health problems, we developed a blended SBI combining group-based psychoeducation and 14 days of app training utilizing principles from AAMT to reduce depressive symptoms., Methods: In this pilot trial, N = 16 individuals with heightened depression scores were randomized to either an intervention group using the mentalis Phoenix app or a wait list control condition. As outcomes, we descriptively explored usability of the app, engagement with the intervention, and possible reductions of depressive symptoms., Results: Data analyses suggest that the SBI tested in this pilot trial possesses high usability, is frequently engaged with, and reduces depressive symptoms in participants in the intervention group when compared to wait list controls., Conclusions: This pilot study provides preliminary evidence that an SBI utilizing AAMT can reduce depressive symptoms. Future studies should replicate these findings using larger samples and disentangle possible mechanisms of change., Trial Registration: DRKS-ID: DRKS00021613 (retrospectively registered).

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for "mobilization" whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dundon, Shapiro, Babenko, Okafor and Grafton.)

This study investigated the effects of psychobiological characteristics of non-obese women with a high level of weight suppression (H-WS) on explicit-implicit and approach-avoidance response toward food cues, depending on hunger-satiety states. The 634 participants were divided into two groups according to their weight history. If the difference between their highest weight over the last year and their current weight (a difference sustained at least for 1 year) was more than 5%, they were assigned to the "H-WS" group ( N = 25). If the difference in weight was less than 5%, they were assigned to the "low level of weight suppression" (L-WS) group ( N = 29). Explicit approach and avoidance toward food were measured by self-report questionnaires. Implicit approach and avoidance toward food cues were measured using an eye-tracker. Fasting blood samples were obtained to measure fasting serum leptin levels. After this, participants consumed a standard breakfast to control the satiety level. After breakfast, explicit-implicit approach-avoidance responses were repeatedly measured at the satiety states. Self-reported body shape concerns, drive for thinness, ambivalent food craving, and bulimic behavior were also assessed. The results showed that the H-WS group had lower leptin levels, and higher body shape concerns, drive for thinness, ambivalent food craving, and bulimic behaviors compared to the L-WS group. At the explicit level, the H-WS group reported lower approach and higher avoidance to food compared to the L-WS group, regardless of hunger-satiety state. Whereas, at the implicit level, the H-WS group showed higher approach during satiety rather than during hunger states. Regardless of the hunger-satiety state, there were no significant group differences with regard to implicit avoidance between the two groups. Thus, we confirmed that a high level of avoidance toward foods was observed in the H-WS group at the explicit level but not at the implicit level. Moreover, in contrast with a high level of explicit avoidance toward palatable foods, inhibition for implicit approach toward high-calorie foods seemed to be blunted after food consumption in the H-WS group. These inconsistencies may be associated with ambivalent food craving and vulnerability to bulimic behavior among H-WS individuals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lee and Lee.)

Objectives: Borderline personality disorder (BPD) is portrayed by unstable relationships, fears of abandonment and heightened sensitivity to social rejection. Research has shown that these characteristics may lead to inappropriate social behavior including altered approach-avoidance behavior. However, it has remained unclear how social exclusion may affect approach-avoidance behavior in patients with BPD., Design: We assessed social approach-avoidance behavior and the impact of social exclusion in a sample of 38 patients with BPD and 40 healthy control participants., Methods: We used an explicit joystick-based approach-avoidance task (AAT) after playing a virtual ball-tossing game (Cyberball), which simulates the exclusion of the participant by two other players. In the AAT, participants were required to push or pull emotional stimuli, more specifically happy and angry facial expressions, with either direct or averted gaze direction., Results: Patients with BPD approached happy stimuli less and showed overall less differential approach-avoidance behavior toward individuals expressing positive or negative facial emotions compared to healthy participants, who showed more approach behavior for happy compared to angry facial expressions. Moreover, borderline symptom severity correlated inversely with the AAT score for happy facial expressions and positively with subjective unpleasantness during social exclusion as well as rejection sensitivity. However, social exclusion did not influence approach-avoidance tendencies., Conclusion: Patients with BPD showed altered approach-avoidance behavior, which might affect social interactions in the patient's everyday lives and may therefore impede social interaction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Wiesenfeller, Flasbeck, Brown and Brüne.)

The ability to swiftly and accurately respond to others' non-verbal signals, such as their emotional expressions, constitutes one of the building blocks for social adaptation. It is debated whether rapid action tendencies to socio-emotional signals solely depend upon stimulus-evoked pre-decisional motor bias or can also engage goal-directed (decisional) processes that involve the arbitration between action alternatives. Here, we used drift diffusion models (DDMs) of choice and electroencephalography (EEG) to investigate the impact of threat-signaling individuals (angry or fearful) on spontaneous approach-avoidance decisions. Participants choose to avoid angry individuals more often than fearful ones and this effect was stronger for intense expressions. Diffusion models showed that this pattern of choice was accounted for by a process of value-based evidence accumulation, suggesting an active competition between action options. At the brain level, we found that EEG activity preceding movement initiation (200 ms) in a mid-frontal cluster of electrodes - sourced in the orbital and ventromedial frontal cortices - encoded value difference between chosen and unchosen options, thus predicting participant's choices on a trial-by-trial basis. Furthermore, value difference also modulated EEG signal during feedback about the decision. Altogether, the present findings convincingly support the underestimated influence of implicit goal-directed mechanisms in approach-avoidance responses to socio-emotional signals., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier Inc.)

Learning valence-based responses to favorable and unfavorable options requires judgments of the relative value of the options, a process necessary for species survival. We found, using engineered mice, that circuit connectivity and function of the striosome compartment of the striatum are critical for this type of learning. Calcium imaging during valence-based learning exhibited a selective correlation between learning and striosomal but not matrix signals. This striosomal activity encoded discrimination learning and was correlated with task engagement, which, in turn, could be regulated by chemogenetic excitation and inhibition. Striosomal function during discrimination learning was disturbed with aging and severely so in a mouse model of Huntington's disease. Anatomical and functional connectivity of parvalbumin-positive, putative fast-spiking interneurons (FSIs) to striatal projection neurons was enhanced in striosomes compared with matrix in mice that learned. Computational modeling of these findings suggests that FSIs can modulate the striosomal signal-to-noise ratio, crucial for discrimination and learning., Competing Interests: Declaration of Interests The authors declare no competing interests., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The proneness to be sexually aroused, to perform sexual acts, or to be sexually disinhibited during a particular mood varies across individuals. However, the physiological mechanisms underlying this specific and variable relationship between mood and sex-related processes are poorly understood. We propose that cortisol may act as an important moderator in this as it has shown to influence sexual arousal and to play a neuromodulatory role during emotion regulation. Here, we conducted a functional magnetic resonance imaging study in a sample of young males to investigate whether cortisol modulates the neural response during the approach of sexual stimuli in an approach-avoidance task and whether this potential relationship explains the individual differences in sexual inhibition and in mood-related sexual interest and activity. We revealed that cortisol associates with the anteromedial prefrontal cortex activation during the approach towards sexual stimuli. Moreover, this anteromedial prefrontal cortex response was dependent on individual differences in sexual inhibition and the improvements of negative mood as a result of sexual activity. The anteromedial prefrontal cortex is already known to process bottom-up information, reward, and risk estimation. The neuromodulatory role of cortisol within this region during sexual approach may represent a previously unknown yet key element in the regulation of sexual behavior in young males., (Copyright © 2020 Rodríguez-Nieto, Sack, Dewitte, Emmerling and Schuhmann.)

Approach and avoidance tendencies have helped explain phenomena as diverse as addiction (Mogg, Field, & Bradley, 2005), phobia (Rinck & Becker, 2007), and intergroup discrimination (Bianchi, Carnaghi, & Shamloo, 2018; Degner, Essien, & Reichardt, 2016). When the original approach-avoidance task (AAT; Solarz, 1960) that measures these tendencies was redesigned to run on regular desktop computers, it made the task much more flexible but also sacrificed some important behavioral properties of the original task-most notably its reliance on physical distance change (Chen & Bargh, 1999). Here, we present a new, mobile version of the AAT that runs entirely on smartphones and combines the flexibility of modern tasks with the behavioral properties of the original AAT. In addition, it can easily be deployed in the field and, next to traditional reaction time measurements, includes the novel measurement of response force. In two studies, we demonstrate that the mobile AAT can reliably measure known approach-avoidance tendencies toward happy and angry faces both in the laboratory and in the field.

Repeated engagement in addictive behaviors may lead to relatively automatic action tendencies whereby individuals approach rather than avoid addictive stimuli. This study assessed whether an approach bias for erotic stimuli exists among heterosexual college-aged females who report using pornography. We tested 121 female undergraduates using an approach-avoidance task (AAT) employing both erotic and neutral stimuli, during which participants were instructed to push or pull a gaming joystick in response to image orientation. To simulate approach and avoidance movements, pulling the joystick enlarged the image and pushing shrunk the image. Severity of pornography use was assessed using the Brief Pornography Screener (BPS) and the Problematic Pornography Use Scale (PPUS). Participants demonstrated a significant approach bias of 24.81 ms for erotic stimuli as compared to neutral stimuli, and this approach bias significantly positively correlated with PPUS scores. Moreover, approach bias scores were significantly positively correlated with anhedonia (as assessed by the Snaith-Hamilton Pleasure Scale), indicating that the stronger the degree of approach for erotic stimuli, the more anhedonia that was observed. Anhedonia was not significantly associated with pornography use severity, however. Findings implicate both similarities and differences in problematic pornography use among female and male users. A limitation of the current study is that it assessed approach biases among only heterosexual females due to the erotic stimuli employed during the AAT. Future studies should examine approach biases among females of varying sexual orientations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Despite intricate interactions between emotion and decision making, the underlying cognitive mechanisms that govern their relationship remain elusive. Recent theoretical and empirical advances suggest that preferences in risky decision making can arise from the computation of subjective utility (value-dependent) or direct approach-avoidance action tendencies (value-independent). Here, 48 participants performed two gambling tasks (accept/reject and choice selection tasks) under the emotion manipulation (neutral versus disgust) to investigate how decision context and emotion may influence risk preference via the value-dependent and -independent pathways. The results showed that the decision context affected the degree to which both value-dependent and -independent systems were engaged. Crucially, however, the disgust emotion had a selective effect on participants' choices in the accept/reject task. Furthermore, computational analyses revealed that this specific effect resulted from a reduced propensity to gamble for potential gains by engaging only the value-independent system. These results indicate dissociative effects of decision context and emotion and suggest a specific route by which disgust influences choice preference in risky decision making., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)