Slowed extinction of repetitive threat-neutralization behavior in anxiety-related disorders: Effects from a novel fear-conditioning paradigm

Repetitive threat-neutralization is a common behavior pattern across anxiety disorders and obsessive-compulsive disorder (OCD) that contributes to functional impairment. However, laboratory studies of this behavioral phenomenon are scant. In the present study, we examined effects of anxiety-related disorders and anxiety sensitivity on repetitive threat-neutralization behavior. Adults recruited from the community (n=40) with and without anxiety-related disorders completed clinician-administered and self-reported anxiety assessments and the Tap-to-Safety Task. Task stimuli included a threat cue (CS+) paired with shock, safety cues (CS-) never paired with shock, and safe stimuli varying in similarity to the CS+. The task included choice trials, in which participants could repeatedly tap a button to reduce risk of shock, while also reducing accumulation of reward points. In an extinction phase, shocks were no longer administered. We conducted linear mixed-effects models to examine differences related to anxiety sensitivity and anxiety disorder diagnosis in repetitive threat-neutralization behavior across stimulus types. Participants with greater anxiety sensitivity showed more adaptive neutralization behavior to the true threat-cue as well as more unnecessary neutralization to the former threat-cue. Those with anxiety-related disorders showed more neutralization behavior to the former threat-cue. Anxiety sensitivity and anxiety-related disorder status were both associated with less-steep declines in neutralization behavior across trials of extinction, consistent with the hypothesis that neutralization behaviors would persist in safe situations for anxious individuals. These findings suggest that the TTS task captures anxiety-related individual differences in extinction of repetitive threat-neutralization behavior, and provides an adaptable tool for probing threat-related behaviors.