Working hard to stay safe: Effects of anxiety sensitivity on repetitive threat-neutralization behavior

Individuals with anxiety-related disorders (AD) often sacrifice positive outcomes in order to avoid or neutralize threats. Mixed findings to date suggest that individual differences in threat-related behavior patterns may vary based on specific parameters of the behavior being measured. Repetitive threat-neutralization behaviors, such as repeated checking or reassurance-seeking, are a prominent feature of many AD but remain sparsely studied. In this preliminary study, we employed a novel fear conditioning paradigm to assess repetitive threat-neutralization behavior in adults (n=35) with and without AD. The paradigm included a threat cue (CS+) paired with shock, safety cues (CS-) never paired with shock, and safe stimuli varying in similarity to the CS+, followed by an extinction phase with no shocks. Participants were instructed that they could repeatedly tap a button to reduce risk of shock, while also reducing accumulation of reward points. Those with greater self-reported anxiety sensitivity showed greater threat expectancy and more threat-neutralization behavior to the CS+ while under true threat, and during extinction in the absence of threat. Those with versus without AD showed more threat expectancy and threat-neutralization during extinction only. We discuss clinical implications and future directions for assessment of threat-neutralization behaviors.