Background Pathological avoidance is a transdiagnostic characteristic of anxiety disorders. Avoidance conditioning re‐emerged as a translational model to examine mechanisms and treatment of avoidance. However, its validity for anxiety disorders remains unclear. Methods This study tested for altered avoidance in patients with anxiety disorders compared to matched controls (n = 40/group) using instrumental conditioning assessing low‐cost avoidance (avoiding a single aversive outcome) and costly avoidance (avoidance conflicted with gaining rewards). Autonomic arousal and threat expectancy were assessed as indicators of conditioned fear. Associations with dimensional symptom severity were examined. Results Patients and controls showed frequent low‐cost avoidance without group differences. Controls subsequently inhibited avoidance to gain rewards, which was amplified when aversive outcomes discontinued. In contrast, patients failed to reduce avoidance when aversive and positive outcomes competed (elevated costly avoidance) and showed limited reduction when aversive outcomes discontinued (persistent costly avoidance). Interestingly, elevated costly avoidance was not linked to higher conditioned fear in patients. Moreover, individual data revealed a bimodal distribution of costly avoidance: Some patients showed persistent avoidance, others showed little to no avoidance. Persistent versus low avoiders did not differ in other task‐related variables, response to gains and losses in absence of threat, sociodemographic data, or clinical characteristics. Conclusions Findings suggest that anxious psychopathology is associated with a deficit to inhibit avoidance in presence of competing positive outcomes. This offers novel perspectives for research on mechanisms and treatment of anxiety disorders.

Anxiety patients over-generalize fear, possibly because of an incapacity to discriminate threat and safety signals. Discrimination trainings are promising approaches for reducing such fear over-generalization. Here we investigated the efficacy of a fear-relevant vs. a fear-irrelevant discrimination training on fear generalization and whether the effects are increased with feedback during training. Eighty participants underwent two fear acquisition blocks, during which one face (conditioned stimulus, CS+), but not another face (CS−), was associated with a female scream (unconditioned stimulus, US). During two generalization blocks, both CSs plus four morphs (generalization stimuli, GS1–GS4) were presented. Between these generalization blocks, half of the participants underwent a fear-relevant discrimination training (discrimination between CS+ and the other faces) with or without feedback and the other half a fear-irrelevant discrimination training (discrimination between the width of lines) with or without feedback. US expectancy, arousal, valence ratings, and skin conductance responses (SCR) indicated successful fear acquisition. Importantly, fear-relevant vs. fear-irrelevant discrimination trainings and feedback vs. no feedback reduced generalization as reflected in US expectancy ratings independently from one another. No effects of training condition were found for arousal and valence ratings or SCR. In summary, this is a first indication that fear-relevant discrimination training and feedback can improve the discrimination between threat and safety signals in healthy individuals, at least for learning-related evaluations, but not evaluations of valence or (physiological) arousal.

ZusammenfassungDer Veterans RAND 12-Item Health Survey (VR-12) wurde als Selbstbeurteilungsverfahren zur Erfassung gesundheitsbezogener Lebensqualität 2016 in den Deutschen Schmerzfragebogen (DSF) aufgenommen und ersetzt den bis dahin verwendeten lizenzpflichtigen SF-12. Beide Verfahren haben 12 Items und führen zu einer körperlichen und einer psychischen Summenskala. Auswertungen der deutschen Version mit größerer Stichprobe zu Kennwerten und zur teststatistischen Güte des VR-12 bei Patienten mit chronischem Schmerz fehlen bislang.Daten zum VR-12 und weiterer Verfahren des DSF wurden von 11.644 Patienten aus 31 an KEDOQ-Schmerz beteiligten Zentren ausgewertet. Die Patienten hatten den DSF vor Beginn einer angestrebten schmerztherapeutischen Behandlung ausgefüllt. Die Bestimmung der Änderungssensitivität erfolgte für 565 Patienten, für die der VR-12 aus einem Verlaufsfragebogen des DSF mehrere Monate nach der Ersterhebung vorlag.Die Reliabilität (Cronbachs Alpha) der körperlichen Summenskala war rtt = 0,78 und für die psychische Summenskala rtt = 0,84. Die psychische Summenskala wies deutliche Beziehungen zu den Depression-Angst-Stress-Skalen (DASS) auf (r = −0,51 bis r = −0,72), die körperliche Summenskala korrelierte höher mit Bereichen schmerzbedingter Beeinträchtigungen (r = −0,48 bis r = −0,52). Patienten mit höherer Schmerzchronifizierung, solche mit höherem Schmerz-Schweregrad und solche mit Hinweis auf hohe psychische Belastung beschrieben in beiden Summenskalen signifikant geringere gesundheitsbezogene Lebensqualität. Die Effektstärke (ES) der Veränderung im Sinne einer Verbesserung der gesundheitsbezogenen Lebensqualität war in der psychischen Summenskala ES = 0,33 und in der körperlichen Summenskala ES = 0,51.Die Ergebnisse sind in Übereinstimmung zu Befunden zum SF-36 bzw. SF-12 bei anderen Patientenkollektiven mit chronischem Schmerz. Sie zeigen zusammengefasst, dass mit dem VR-12 ein angemessener Ersatz zum SF-12 im Deutschen Schmerzfragebogen integriert wurde.

Growth hormone (GH) release was measured in 17 patients with active acromegaly following the administration of insulin, LH-RH and TRH given intravenously either combined or each separately. The simultaneous application of insulin and the hypothalamic releasing hormones resulted in a striking increase of plasma GH in 15 out of 17 patients. Inappropriate stimulation of GH release was found in 9 out of the 17 patients with acromegaly, when TRH was given as the only hormone; conversely this phenomenon due to LH-RH application was observed in 4 cases. In insulin-induced hypoglycemia GH release could be stimulated in 5 patients. After selective, transsphenoidal hypophysectomy, 4 of 13 patients still showed a definite stimulation of GH release after the combined use of test substances. Two of these also exhibited a comparable stimulation of GH after TRH, indicating adenoma cells remaining active after operation. The combined insulin-induced hypoglycemia/LH-RH/TRH-test is therefore advisable for patients with acromegaly, since GH release as well as other hypophyseal partial functions can be tested. The performance of individual tests is essential for evaluating selective stimulation of GH release.

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