Striatal reactivity during emotion and reward relates to approach-avoidance conflict behaviour and is altered in adults with anxiety or depression.

Background: We have previously reported activation in reward, salience and executive control regions during functional MRI (fMRI) using an approach-avoidance conflict (AAC) decision-making task with healthy adults. Further investigations into how anxiety and depressive disorders relate to differences in neural responses during AAC can inform their understanding and treatment. We tested the hypothesis that people with anxiety or depression have altered neural activation during AAC.
Methods: We compared 118 treatment-seeking adults with anxiety or depression and 58 healthy adults using linear mixed-effects models to examine group-level differences in neural activation (fMRI) during AAC decision-making. Correlational analyses examined relationships between behavioural and neural measures.
Results: Adults with anxiety or depression had greater striatal engagement when reacting to affective stimuli ( p = 0.008, d = 0.31) regardless of valence, and weaker striatal engagement during reward feedback ( p = 0.046, d = -0.27) regardless of the presence of monetary reward. They also had blunted amygdala activity during decision-making ( p = 0.023, d = -0.32) regardless of the presence of conflict. Across groups, approach behaviour during conflict decision-making was inversely correlated with striatal activation during affective stimuli ( p < 0.001, r = -0.28) and positively related to striatal activation during reward feedback ( p < 0.001, r = 0.27).
Limitations: Our transdiagnostic approach did not allow for comparisons between specific anxiety disorders, and our cross-sectional approach did not allow for causal inference.
Conclusion: Anxiety and depression were associated with altered neural responses to AAC. Findings were consistent with the role of the striatum in action selection and reward responsivity, and they point toward striatal reactivity as a future treatment target. Blunting of amygdala activity in anxiety or depression may indicate a compensatory response to inhibit affective salience and maintain approach.
Competing Interests: Competing interests: M. Paulus is an advisor to Spring Care, Inc., a behavioural health startup; has received royalties for an article about methamphetamine in UpToDate; and serves on the board of directors of the Anxiety and Depression Association of America. R. Aupperle has received payment for invited lectures at Harvard Medical School and the University of Michigan, and has participated in a data safety monitoring board at New York University Langone Health. No other competing interests declared.
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