Approach-avoidance behaviours play a major role in the development and maintenance of anxiety disorders as repeated avoidance behaviours are assumed to prevent fear extinction. Approach-avoidance decisions (Conditioned Stimulus (CS)-avoidance and Unconditioned Stimulus (US)-avoidance) and their effect on fear extinction and renewal were investigated using a novel Virtual Reality fear conditioning procedure that included avoidance costs that are relevant in real-life settings (i.e., temporal delay and physical effort). Participants had to choose between a safe (low approach incentive, no US) and risky stimulus (high approach incentive, US in 75 %). After differential fear acquisition and avoidance learning, participants were randomized to an Avoidance condition or No Avoidance condition during fear extinction. Fear extinction took place in either the original contingency learning context or in a new context and was followed by a renewal test. Furthermore, the influence of trait anxiety, distress tolerance, and intolerance of uncertainty on approach-avoidance decisions was investigated. Exploratively, a second experiment with varying avoidance costs was conducted. Results showed that high (Study 1), but not low (Study 2), avoidance costs resulted in less avoidance behaviour. Even though there were no between-group differences, exploratory comparisons of avoiders and non-avoiders in both studies demonstrated that avoidance behaviours protected from extinction learning, resulting in the maintenance of retrospective US expectancies and a sustained preference for the safe stimulus. Finally, no renewal effect and no robust associations with the individual difference measures were found. Collectively, these findings provide insight in how avoidance behaviours maintain fear and how treatment might be improved by focusing on avoidance costs.

避免进近行为在焦虑症的发生和维持中起着重要作用，因为人们假定反复回避行为可以防止恐惧的消失。使用一种新颖的虚拟现实恐惧调节程序，研究了避免规避决策（避免条件刺激（CS）和无条件刺激（US））及其对恐惧消灭和更新的影响，其中包括与现实生活相关的避免成本设置（即时间延迟和体力劳动）。参与者必须在安全（低进场奖励，无US）和高风险刺激（高进场奖励，75％的美国）之间进行选择。在获得不同的恐惧感和回避学习能力后，参与者在恐惧消灭期间被随机分为回避条件或无回避条件。恐惧的消亡发生在原始的偶然性学习环境或新的环境中，随后进行了更新测试。此外，研究了特质焦虑，遇险容忍度和不确定性的不容忍度对避免进近决策的影响。探索性地进行了具有不同规避成本的第二项实验。结果表明，回避成本高（研究1）但不低（研究2），导致回避行为减少。尽管两组之间没有差异，但在两项研究中对回避者和非回避者的探索性比较表明，回避行为可以避免灭绝学习，从而保持了美国的回顾性预期并持续偏爱安全刺激措施。最后，没有发现更新效果，也没有发现与个体差异测度有很强的联系。总的来说，这些发现提供了关于避免行为如何保持恐惧以及如何通过关注避免成本来改善治疗的见识。