'Avoidance in depression: the AAT-training in depression'

“Desire urges me on, while fear bridals me” Giordano Bruno

Human behavior knows two fundamental motivational principles: the desire to approach positive outcomes and the desire to avoid negative outcomes. Both play a major role in many psychopathologies, including depression: Avoidance motivation and approach deficits seem to play an important role in maintaining depression by limiting positive experiences. However, avoidance and approach processes have been understudied in depression and their correction is often not an explicit part of treatment. I will present a serias of studies that target the approach deficit in depressed patietns with a computerized training program. In a randomized controlled trial, 256 patients who suffered from different psychological disorders completed four sessions of either an active training in which positive emotional pictures were pulled closer and neutral pictures were pushed away with a joystick movement, or a placebo-training, additional to their treatment as usual. We were able to induce a positive bias. But more importantly depressed patients in the active training condition had a significant lower BDI score at the end of their treatment. This was only true in depressed patients. In the second study, again a randomized-controlled design, 122 depressed inpatients received either four sessions of the CBM Attention Dot-Probe Training (DPT) or the CBM Approach-Avoidance Training (AAT), next to treatment as usual. Both trainings had an active and a control condition. Clinician-rated depressive symptom severity decreased more in patients who received the active condition of either the DPT or the AAT compared to patients in the control conditions. Both active training conditions reduced the depressive symptoms. The studies indicate that an approach-positive training can be an option as add on treatments for patients with depression.

_{Becker, E. S., Barth, A., Smits, J. A., Beisel, S., Lindenmeyer, J., & Rinck, M. (2019). Positivity-approach training for depressive symptoms: A randomized controlled trial. Journal of affective disorders, 245, 297-304.}

_{Vrijsen, J. N., Fischer, V. S., Müller, B. W., Scherbaum, N., Becker, E. S., Rinck, M., & Tendolkar, I. (2018). Cognitive bias modification as an add-on treatment in clinical depression: results from a placebo-controlled, single-blinded randomized control trial. Journal of affective disorders, 238, 342-350.}

Kort CV:
Eni S. Becker is the chair of Clinical Psychology and the director of the research program "Experimental psychopathology and treatment" of the Behavioural Science Institute at the Radboud University Nijmegen. Her research interest are cognitive processes and their role in psychopathology, mostly in anxiety and affective disorders. Recently she has concentrated on how we can influence those processes to benefit patients with the help of CBM (Cognitive bias modification). She also is a trained Psychotherapist specialized in the treatment of anxiety disorders.