Behavioral approach and avoidance in schizophrenia: An evaluation of motivational profiles

Abstract

Schizophrenia is associated with motivational deficits that interfere with a wide range of goal directed activities. Despite their clinical importance, our current understanding of these motivational impairments is limited. Furthermore, different types of motivational problems are commonly seen among individuals within the broad diagnosis of schizophrenia. The goal of the current study was to examine whether clinically meaningful subgroups could be identified based on approach and avoidance motivational tendencies. We measured these tendencies in 151 individuals with schizophrenia. Although prior studies demonstrate elevated BIS sensitivity in schizophrenia at the overall group level, none have explored various combinations of BIS/BAS sensitivities within this disorder. Cluster analyses yielded five subgroups with different combinations of low, moderate, or high BIS and BAS. The subgroups had interpretable differences in clinically rated negative symptoms and self-reported anhedonia/socio-emotional attitudes, which were not detectable with the more commonly used linear BIS/BAS scores. Two of the subgroups had significantly elevated negative symptoms but different approach/avoidance profiles: one was characterized by markedly low BIS, low BAS and an overall lack of social approach motivation; the other had markedly high BIS but moderate BAS and elevated social avoidance motivation. The two subgroups with relatively good clinical functioning showed patterns of BAS greater than BIS. Our findings indicate there are distinct motivational pathways that can lead to asociality in schizophrenia and highlight the value of considering profiles based on combined patterns of BIS and BAS in schizophrenia.

Validation of the Korean Version of the Clinical Assessment Interview for Negative Symptoms

“…One study found high BAS score was related to low negative symptoms measured by PANSS, 26 whereas the other study reported only BIS but not BAS score was positively correlated with expression deficits dimension of the CAINS. 27 The discrepancy may be partly attributed to differences in sample characteristics such as a shorter illness duration in the current study compared to the previous one. 27 Additionally, it is recently suggested that negative symptoms of schizophrenia may involve at least two distinct motivational profiles including high BIS and moderate BAS, and low BIS and BAS, rather than a single motivational dimension solely implicated in these symptoms.…”

“… 27 The discrepancy may be partly attributed to differences in sample characteristics such as a shorter illness duration in the current study compared to the previous one. 27 Additionally, it is recently suggested that negative symptoms of schizophrenia may involve at least two distinct motivational profiles including high BIS and moderate BAS, and low BIS and BAS, rather than a single motivational dimension solely implicated in these symptoms. 27 According to this account, a categorical approach rather than considering BIS and BAS as continuous and orthogonal variables may better elucidate motivation systems involved in manifestations of negative symptoms.…”

“… 27 Additionally, it is recently suggested that negative symptoms of schizophrenia may involve at least two distinct motivational profiles including high BIS and moderate BAS, and low BIS and BAS, rather than a single motivational dimension solely implicated in these symptoms. 27 According to this account, a categorical approach rather than considering BIS and BAS as continuous and orthogonal variables may better elucidate motivation systems involved in manifestations of negative symptoms. Therefore, it is possible that understanding of the relationship between the CAINS-K and latent motivation systems may be better aided by considering different combinations of BIS and BAS, which should be investigated in future studies.…”

The interactive effects of negative symptoms and social role functioning on suicide ideation in individuals with schizophrenia

“…We utilized data from 162 participants diagnosed with schizophrenia or schizoaffective disorder (based on the Structured Clinical Interview for DSM-IV ; First et al, 2001) collected as part of a larger study validating a new instrument for the assessment of negative symptoms (Kring et al, 2013); a complete description of the methods has been reported elsewhere (Kring et al, 2013; Reddy et al, 2014). The sample was 57.4% male, with a mean age of 46.84 ( SD = 9.48, Range = 23-65).…”

The current conceptualization of negative symptoms in schizophrenia

“…Felice Reddy et al investigated asociality in schizophrenia using Gray's model of behavioural approach (i.e., behavioural activation system, BAS, relying on a reward system sensitive to appetitive stimuli and termination of punishment) and behavioural avoidance (i.e., behavioural inhibition system, BIS, sensitive to aversive stimuli, activated by anxiety, novelty, and fear stimuli, and responsible for inhibiting behaviour), and classified subjects according to the presence of negative symptoms and different levels of BIS and BAS scores. Among subjects with elevated negative symptoms, the authors identified two subgroups with different approach/avoidance profiles leading to asociality: one characterized by avoidance tendencies (high inhibition/moderate activation) and another characterized by lack of approach motivation (low inhibition/low activation).…”