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Depression risk genes in combination with childhood events have been associated with biased processing as an intermediate phenotype for depression. The aim of the present conceptual replication study was to investigate the role of biased automatic approach-avoidance tendencies as a candidate intermediate phenotype for depression, in the context of genes (5-HTTLPR polymorphism) and childhood trauma. A naturalistic remitted depressed patients sample (N = 209) performed an Approach-Avoidance Task (AAT) with facial expressions (angry, sad, happy and neutral). Childhood trauma was assessed with a questionnaire. Genotype groups were created based on allele frequency: LaLa versus S/Lg-carriers. The latter is associated with depression risk. We found that remitted S/Lg-carriers who experienced childhood trauma automatically avoided sad facial expressions relatively more than LaLa homozygotes with childhood trauma. Remitted LaLa-carriers who had not experienced childhood trauma, avoided sad faces relatively more than LaLa homozygotes with childhood trauma. We did not find a main effect of childhood trauma, nor differential avoidance of any of the other facial expressions. Although tentative, the results suggest that automatic approach-avoidance tendencies for disorder-congruent materials may be a fitting intermediate phenotype for depression. The specific pattern of tendencies, and the relation to depression, may depend on the genetic risk profile and childhood trauma, but replication is needed before firm conclusions can be drawn.

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BACKGROUND: Avoidance of stimuli that are associated with the traumatic event is a key feature of posttraumatic stress disorder (PTSD). Thus far, studies on the role of avoidance in the development and maintenance of PTSD focused primarily on strategic or explicit avoidance. However, patients may also show implicit avoidance behavior, which may remain even when explicit avoidance is reduced. OBJECTIVES: The present pilot study was designed to test the hypothesis that PTSD patients show implicit avoidance of threatening, trauma-related stimuli. In addition, it was tested whether this avoidance behavior also occurs for other stimuli. METHODS: The Approach-Avoidance Task was used as an indirect measure of avoidance. Participants were 16 women suffering from PTSD who had experienced a sexual trauma, and 23 healthy non-traumatized women. Using a joystick, they pulled pictures closer to themselves or pushed them away. The pictures varied in content, being either high-threat sexual, non-threat sexual, high-threat accident, or positive. RESULTS: Compared to control participants, PTSD patients avoided high-threat sexual pictures, and the degree of avoidance was predicted by self-reported arousal level. Moreover, PTSD patients with high levels of self-reported explicit avoidance, depressive symptoms, and PTSD symptom severity also avoided high-threat accident pictures. CONCLUSIONS: These findings point to the possible importance of threat value instead of trauma-relatedness in explaining implicit avoidance. The results are discussed in light of cognitive-behavioral models of PTSD, and clinical implications are suggested.

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The present study investigated specificity of attentional biases for trauma-related stimuli using an Emotional Stroop Task. Participants were 14 women suffering from posttraumatic stress disorder (PTSD) who had experienced a sexual trauma and 24 healthy non-traumatized women. They were asked to name print colors of 4 different word types: threatening sexual violence words and non-threatening sexual words, threatening accident trauma words, and positive words. Compared to control participants, PTSD patients displayed increased interference by threatening trauma-related, but not by accident trauma and positive words. Interference by non-threatening sexual words occurred as well, but only in those patients who suffered from more severe PTSD arousal symptoms. These findings suggest graded generalization of the attentional bias across stimuli of varying emotional valence, but specificity regarding the trauma topic. Results are discussed in light of current cognitive models of PTSD, and clinical implications are suggested.

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We investigated if an attentional bias for spiders in spider fearful individuals (SFs) can also be found for moving spiders, rather than static images. In Study 1, 28 SFs and 33 non-anxious controls (NACs) participated in a modified version of the dot probe paradigm: they had to react to a probe that appeared either in the next, previous, or side position of a spider's or a wheel's path. 24 SFs and 29 NACs participated in Study 2, in which a fourth, highly predictable, probe position was added. We expected that moving spiders would capture the attention of SFs. In addition, we tested whether SFs try to predict the movement of the spider to make it less threatening. As expected, SFs showed an attentional bias towards moving spiders. However, both groups reacted fastest to unpredictable movements, indicating that SFs and NACs alike anticipate unpredictable spider movements.

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