Article Figures & Tables
Figures
- Figure 1
Approach–avoidance conflict task. The 3 phases of the approach–avoidance conflict task are displayed in order from left to right. Left: During the decision-making phase, participants had 4 seconds to move the avatar (by moving a joystick) to a position that accurately reflected their preference of 2 potential outcomes. The position to which they moved the avatar determined the relative probability that each of the outcomes would occur (e.g., 90%:10% or 50%:50%). For approach–reward (APP) trials, participants were presented with a choice of 2 positive outcomes; 1 of the outcomes was paired with a 2-cent reward, as indicated by the filling of the red bar. For avoid–threat (AV) trials, participants were presented with a choice of a positive or negative outcome, and neither was paired with a reward. For conflict (CONF) trials, participants were presented with a choice of a positive outcome not paired with a reward and a negative outcome paired with a reward. The reward level was indicated by the level of filling of the red bar (2, 4 or 6 cents). Middle: During the affective outcome phase, participants were presented with a positive or negative affective stimulus picture and sound pairing. The pictures and sounds were drawn from the IAPS,45 IADS46 and other public-domain audio files. (The pictures displayed in this figure are from the public domain and not from IAPS to maintain stimulus novelty). Right: During the reward feedback phase, participants were presented with text indicating their level of reward for the trial (i.e., 0, 2, 4 or 6 cents), their total accumulated award and a trumpet sound when they received a reward (indicated by an asterisk). IADS = International Affective Digitized Sounds; IAPS = International Affective Picture System.
- Figure 2
Brainnetome composite regions of interest. We used 6 composite regions of interest for primary analyses, constructed using the Brainnetome atlas.49 We overlaid these regions of interest on the MNI152_T1_2009c T1-weighted anatomic template brain (https://afni.nimh.nih.gov/MNI_Atlas) in neurologic orientation (i.e., left is left). dACC = dorsal anterior cingulate cortex; dlPFC = dorsolateral prefrontal cortex.
- Figure 3
Decision-making group effect for the bilateral amygdala region of interest. Bar graphs depict percent signal change estimated marginal means (error bars depict ± 1 standard error) for a significant group effect for the bilateral amygdala in the decisionmaking phase (p = 0.023; d = −0.32); *p < 0.05. Compared to healthy participants, participants with anxiety or depression showed blunted activation of the amygdala during decision-making, regardless of the presence of conflict. We observed no significant group × trial type interaction. This amygdala blunting effect in participants with anxiety or depression was consistent across each decision-making trial type. APP = approach–reward trial; AV = avoid–threat trial; CONF2 = conflict trial with a 2-cent reward; CONF4 = conflict trial with a 4-cent reward; CONF6 = conflict trial with a 6-cent reward.
- Figure 4
Affective outcomes and reward feedback group effects for the striatum region of interest. Bar graphs depict percent signal change estimated marginal means (error bars depict ± 1 standard error) for significant group effects for the striatum during affective outcomes and reward feedback; *p < 0.05, **p < 0.01. Compared to healthy participants, participants with anxiety or depression showed increased activation of the striatum during affective outcomes, regardless of valence (p = 0.008, d = 0.31), and decreased activation of the striatum during reward feedback, regardless of reward presence (p = 0.046, d = −0.27).
- Figure 5
Group differences for negative associations between activation and approach behaviour. Scatterplots depict the linear relationships between approach behaviour during conflict decision-making trials (i.e., CONF2, CONF4 and CONF6) and percent signal change in the dACC or striatum; the line of best fit for each group is plotted with ± 1 standard error. Approach behaviour during conflict decision-making trials was inversely associated with neural activation in the dACC and striatum during affective outcomes. The magnitude of the association was significantly stronger for healthy participants than for participants with anxiety or depression in the dACC (p = 0.018) and the striatum (p = 0.049). CONF2 = conflict trial with a 2-cent reward; CONF4 = conflict trial with a 4-cent reward; CONF6 = conflict trial with a 6-cent reward; dACC = dorsal anterior cingulate cortex.
Tables
Characteristic Adults with anxiety or depression*
n = 118Healthy participants*
n = 58p value† Age, yr 34.08 ± 10.79 24.21 ± 8.59 < 0.001 Female 77.97% 62.07% 0.031 Race or ethnicity other than white 35.59% 37.93% 0.87 Education, yr 14.92 ± 2.24 13.60 ± 2.20 < 0.001 Anxiety only‡ 27.12% 0.00% — Depression only 22.03% 0.00% — Comorbid anxiety and depression 50.85% 0.00% — PROMIS score Anxiety 63.54 ± 5.94 46.76 ± 6.74 < 0.001 Depression 59.34 ± 6.83 43.89 ± 6.23 < 0.001 Psychotropic medications§ None 69.50% 0.00% — 1 25.42% 0.00% — 2–3 5.08% 0.00% — Substance use (past 30 days) Cannabis 15.25% 11.54% 0.48 Alcohol 60.17% 62.07% 0.87 Tobacco 9.26% 5.17% 0.55 PROMIS = Patient-Reported Outcomes Measurement Information System.
↵* Values are mean ± standard deviation or %.
↵† We used independent-samples t tests for comparisons of continuous variables between groups, and Fisher’s exact tests for frequency comparisons of categorical variables between groups.
↵‡ Anxiety disorder and related diagnoses included generalized anxiety disorder (n = 89), social anxiety disorder (n = 30), panic disorder (n = 10), posttraumatic stress disorder (n = 6) and obsessive–compulsive disorder (n = 1).
↵§ Psychotropic medications included escitalopram (n = 10), bupropion (n = 9), sertraline (n = 8), citalopram (n = 3), fluoxetine (n = 2), paroxetine (n = 2), desvenlafaxine (n = 1), mirtazapine (n = 1), trazodone (n = 1) and lamotrigine (n = 1).
- Table 2
Demographic and clinical characteristics, anxiety and depression subgroups (n = 118)
Characteristic Anxiety only*
n = 32Depression only*
n = 25Comorbid anxiety and depression*
n = 61p value Significant pair-wise differences (p value) Age, yr 34.72 ± 11.32 34.36 ± 11.18 33.62 ± 10.50 0.89 — Female 90.63% 52.00% 85.61% — Depression < anxiety = anxiety and depression (p < 0.001) Race or ethnicity other than white 28.13% 32.00% 40.98% — Depression = anxiety = anxiety and depression (p > 0.22) Education, yr 15.69 ± 2.24 14.00 ± 1.76 14.89 ± 2.30 0.017 Depression < anxiety (p = 0.003) PROMIS score Anxiety 63.37 ± 4.95 57.16 ± 7.48 65.87 ± 3.89 < 0.001 Depression < anxiety = anxiety and depression (p < 0.001) Depression 54.04 ± 5.81 61.32 ± 7.13 61.45 ± 5.68 < 0.001 Anxiety < depression = anxiety and depression (p < 0.001) PROMIS = Patient-Reported Outcomes Measurement Information System.
* Values are mean ± standard deviation or %.
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