Costly avoidance in pediatric anxiety and OCD - The impact of emotional reactivity and reward sensitivity
Bibliographic record
Abstract
A central feature of internalizing mental disorders, such as obsessive-compulsive disorder (OCD) and anxiety disorders, is the avoidance of rewarding situations to prevent the risk of experiencing distressing emotions. Previous research has shown that obsessive and anxious individuals avoid situations where rewards come at the cost of aversive experiences, a phenomenon termed costly avoidance. Costly avoidance has not previously been examined in clinical samples of youths with OCD or anxiety disorders, which is an important gap as these disorders typically onset during the first two decades of life. In this study, treatment-seeking youths with OCD (n = 62) and anxiety disorders (n = 43), and a comparison group of youths without mental disorders (n = 47) performed an approach-avoidance conflict task. Participants selected to face either neutral outcomes or to obtain rewards that co-occurred with aversive images and sounds. Results showed more costly avoidance in the OCD and anxiety disorder groups compared to the non-clinical comparison group, but no differences between the two clinical groups emerged. Trait reward sensitivity and subjective negative emotional reactions to aversive sounds and images were the best individual predictors of costly avoidance. The results of our study show that youths with OCD and anxiety disorders display elevated levels of costly avoidance, which is in line with clinical theories and previous findings in adults with anxiety disorders. We also show that these elevated levels of costly avoidance are best explained by individual differences in reward sensitivity and emotional reactivity, suggesting that sensitivity to appetitive and aversive outcomes might underlie differences in maladaptive costly avoidance. • We examined costly avoidance in a clinical youth sample using an approach-avoidance task. • Youths with OCD or anxiety disorders exhibit increased avoidance compared to peers without mental disorders. • This increased avoidance is primarily driven by heightened emotional reactivity to aversive stimuli. • Higher reward sensitivity was associated with reduced avoidance.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".