Elsevier

Clinical Psychology Review

Volume 31, Issue 7, November 2011, Pages 1156-1168
Clinical Psychology Review

Exploring the roles of approach and avoidance in depression: An integrative model

https://doi.org/10.1016/j.cpr.2011.07.007Get rights and content

Abstract

Human behavior can be organized around two fundamental motivational principles: the desire to approach positive outcomes and the desire to avoid negative outcomes. Both approach and avoidance motivation are relevant to a range of psychopathology, including depression. However, with some notable exceptions, avoidance processes have been underemphasized in the literature on motivational processes in depression. This review will examine the roles that approach and avoidance play in depression and will present an integrative model of approach and avoidance processes in depression. Both approach deficits and avoidance motivation are argued to play a role in limiting positive experiences and reinforcement for non-depressed behavior, contributing to the onset and maintenance of depression. In addition, avoidance processes are argued to play a role in negative information processing biases that may increase vulnerability to the onset and recurrence of depression. Lastly, avoidance processes and dysregulation in the connections between the approach and avoidance systems may contribute to depression by promoting inappropriate perseveration in the pursuit of unattainable approach goals. Theoretical rationales and empirical evidence for each of these roles are presented. Understanding the roles that both approach and avoidance play in depression may help to inform current conceptualizations of depression and improve treatment outcomes.

Highlights

► Approach deficits may contribute to decreased positive experiences in depression. ► Avoidance may further decrease positive reinforcement and exacerbate problems. ► Avoidance processes may also contribute to negative information processing biases. ► Approach perseveration may result from dysregulated links between the two systems. ► Addressing both approach and avoidance may improve outcomes in depression.

Section snippets

Approach and avoidance motivation

Before examining the roles of approach and avoidance in depression, it is important to consider current theoretical models of approach and avoidance and how these constructs relate to affect and emotions. Several research groups have suggested that desires to approach positive outcomes and avoid negative outcomes are fundamental human motives embodied in separate motivational systems. The approach system is variously referred to as the behavioral activation system, behavioral approach system,

Approach deficits in depression

Researchers have long suggested that depression is associated with a disruption in appetitive motivation (e.g., Eastman, 1976). Consistent with this, BAS sensitivity negatively predicts depressive symptoms (Jones & Day, 2008), episode duration, general functioning (Kasch, Rottenberg, Arnow, & Gotlib, 2002), average weekly depression, and time to recovery and positively predicts clinical improvement at six (McFarland, Shankman, Tenke, Bruder, & Klein, 2006) and eight month follow up (Kasch et

Avoidance, low positive reinforcement, and negative outcomes in depression

Avoidance processes may also contribute to onset and maintenance of depression. Early on, Ferster (1973) noted that depression is characterized by an increase in avoidance and escape activity, with complaints, requests for help, crying, and irritability reflecting efforts to remove or ameliorate aversive conditions that, while effective in the past, may have little chance of influencing the aversive environment. More recently, Martell et al. (2001) argued that NA from low levels of positive

Avoidance and negative information processing biases in depression

In addition to limiting positive experiences and increasing the likelihood of negative outcomes, avoidance processes may promote negative information processing biases that are commonly observed in depression. This role has not been explored at any length in the literature. Depression, approach motivation, and avoidance motivation are characterized by distinct patterns of information processing that facilitate attention toward and memory for certain types of information. These patterns of

Approach perseveration and depression

This literature supports the idea that both approach deficits and heightened (or dominant) avoidance play a role in depression. However, while many researchers have promoted the approach deficit model of depression, others have argued for a role of approach perseveration in depression. Self-Regulatory Perseveration Theory (Pyszczynski and Greenberg, 1987a, Pyszczynski and Greenberg, 1987b) argues that individuals may have difficulty disengaging from goals that are important to the self concept,

Neurobiological substrates for approach and avoidance in depression

Biological substrates can be posited for several of the processes outlined in Fig. 1. Several neurobiological features of depression are relevant to approach deficits. Depression is associated with hypometabolism and focal hyperintensities indicating white matter lesions in the basal ganglia (Dougherty & Rauch, 1997). Basal ganglia activation has been linked to both the approach system (Davidson, 1994) and the experience of PA (Feldman Barrett & Wager, 2006). In addition, abnormal cerebral

Davidson's model of cortical asymmetry

Davidson, 1992, Davidson, 1993 has developed a model focusing on EEG asymmetries in the PFC that is relevant to approach, avoidance, and depression and offers an additional biological substrate for approach and avoidance processes in depression. This model argues that individual differences in anterior activation asymmetry may predict important features of affective style and change the probability of experiencing particular emotions. State independent hypoactivation in the left frontal region

Approach, avoidance, and depression

This research suggests that approach deficits may be relevant to onset, experience, and maintenance of depression by limiting exposure to success experiences, rewards, and positive events. It also suggests that avoidance processes may contribute to depression by limiting exposure to positive experiences and sources of positive reinforcement and increasing the likelihood of negative outcomes and experiences, exacerbating the impact of approach deficits. Avoidance may also contribute to negative

Summary and conclusion

The goal of this paper was to present an integrative model outlining several roles that approach and avoidance processes may play in depression. This model argues that both approach and avoidance processes are relevant to depression, with decreased approach motivation and increased (or dominant) avoidance motivation combining to limit access to positive reinforcing experiences, increase negative experiences, and contribute to and maintain depression. In addition, it has been argued that

Acknowledgments

Funding for this paper was provided by the Social Sciences and Humanities Research Council of Canada, the Alberta Heritage Foundation for Medical Research, and the University of British Columbia Affiliated Fellowships Program.

I would like to thank Lynn Alden, Sheila Woody, Colleen Brenner, and two anonymous reviewers for their valuable feedback and comments on earlier versions of this paper.

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