Autonomic Balance for Adaptive Decision Making

forthcoming

Why do some people make highly flexible approach-avoid decisions under threat, while others can only follow fight-flight impulses? Computational psychiatry has advanced formalizations on how utility functions shape optimal decisions. But decisions are made by embodied agents, equipped with potent and competing autonomic arousal systems: Approach-avoidance conflicts elicit stress and are marked by concurrent sympathetic and parasympathetic arousal. The impact of para- and sympathetic dominance on decisions is very different, but decision science has largely ignored autonomic balance, failing to explain altered decisions in real-life threats and anxiety. Leveraging theoretical innovations that bridge the decision and affective neurosciences, HEART2ADAPT develops a new framework to explain how our brains adapt value-based approach-avoidance decisions under the influence of our autonomic state. It will—for the first time—document the direct impact of autonomic balance on decisions in health and anxiety. HEART2ADAPT tests the hypotheses that: (1) sympathetic overdrive and failure to reach parasympathetic dominance makes anxious individuals misinterpret random environmental changes (noise) as actual threats, causing avoidance biases, while (2) parasympathetic dominance promotes integration of phasic amygdala-signaled changes with longer-term fronto-striatal updating, facilitating flexible decision making. To do so, HEART2ADAPT will (1) leverage groundbreaking innovations in the concurrent, real-time tracking of body-brain states (cardio- & posturography; high resolution MEG; fMRI/MRS); (2) pioneer focused ultrasound stimulation and cholinergic modulation to directly explore causal contributions of deep neural regions on decisions under threat, and (3) test these interventions in clinical proof-of-concept studies. HEART2ADAPT articulates a novel integrated neurocomputational framework that will radically change our understanding of fearful avoidance and its management.