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LIT-1490: Impaired action-safety learning and excessive relief during avoidance in patients with anxiety disorders

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StatusActive — read in full 2026-10-24 (NOTE-1123) from the CC BY version of record; worth reading as, by its own count, the third experimental study of avoidance learning in anxiety patients, and the first to track what they learn from avoiding as well as how often they avoid. Against 47 controls, OCD and PTSD patients avoided a safety cue more and, after effective avoidance, still expected the aversive picture more; PDA and PTSD patients reported more relief at omissions; nobody differed on the danger cues. Cross-sectional, with no cost to avoiding; relief was already higher before avoidance was possible, and patients rated the pictures as more aversive. That the excess relief reinforces avoidance is the authors' interpretation, not a finding.
Version3
Tagspsychopathology-and-treatment, learning-and-conditioning
Cited as “paper” byNOTE-1123 — De Kleine et al. — Impaired action-safety learning and excessive relief during avoidance
Cited as “source” byTHEORY-912 — In a picture-based avoidance task, treatment-seeking patients with OCD or PTSD avoided a safety cue more than healthy controls and, after effective avoidance, still expected the aversive picture more; patients with panic disorder with agoraphobia or PTSD reported more relief when it was omitted; the groups did not differ in avoiding the danger cues

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De Kleine, R. A., Hutschemaekers, M. H. M., Hendriks, G. J., Kampman, M., Papalini, S., Van Minnen, A. & Vervliet, B. (2023). Impaired action-safety learning and excessive relief during avoidance in patients with anxiety disorders. Journal of Anxiety Disorders 96: 102698. doi:10.1016/j.janxdis.2023.102698.

Key takeaways

From the reading, NOTE-1123. Page numbers are the journal’s.

  • Avoidance of the safety cue, not of danger cues. OCD (p = .004) and PTSD (p = .028) patients pressed the avoidance button more than controls to the safety cue; “No significant differences between groups were found in reaction to the CS+ ’s” (p. 5).
  • Avoiding without trusting it. After effective avoidance, OCD and PTSD patients still expected the aversive picture more than controls (p. 6).
  • More relief, but not only from avoiding. PDA and PTSD patients reported more relief at omissions, controlling for rated aversiveness (p. 7). Relief to the safety cue was already higher before avoidance was available (p. 5).
  • The mechanism is proposed. Relief “reinforces the avoidance action further, thereby leading to higher levels of avoidance, but apparently not by strengthening the action → safety association (which is weakened in the patients)” (p. 7). A habit route is called “untested”.
  • Limits the authors state. Cross-sectional, so not causal; no cost to avoiding; aversiveness a rival explanation (pp. 7–8).

Why this is here

The exchange cited it at turn U15 for patients avoiding even during safety cues, with higher threat expectancy and more relief. The abstract matches, and its groups sum to the exchange’s 139 patients (33 + 40 + 66).

Corrected 2026-10-24, from the reading. The description is right in outline, with two corrections. The safety-cue avoidance and the higher expectancy were found in the OCD and PTSD groups, and the higher relief in the PDA and PTSD groups, not in all patients. And the relief difference was present before avoidance was possible, so it is not shown to come from avoiding. For CLAIM-446 the study weakly supports the clause that relief reinforces the defence without being evidence of danger, through the authors’ interpretation. It complicates the identifiability clause: patients avoided without confidence that avoiding works, which is a different gap from learning that avoidance works and nothing about the world without it. Filed from it: THEORY-912.

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