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Updated: May 8, 2026

Elevated Plus Maze for Mice
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Measuring approach-avoidance behavior in patients with panic disorder using the human elevated plus maze in mixed

Till Dobner1, Jana Christina Müller1, Daniel Biedermann1

  • 1Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Journal of Psychiatric Research
|May 6, 2026
PubMed
Summary

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Panic disorder patients show heightened anxiety but not avoidance in a virtual reality maze. Trait factors like sensation seeking, not diagnosis, predict avoidance, suggesting personalized interventions for panic disorder.

Area of Science:

  • Psychology
  • Neuroscience
  • Clinical Psychology

Background:

  • Avoidance behavior is key in panic disorder (PD), but hard to study without specific threats.
  • The human Elevated Plus Maze (EPM) in mixed reality offers a way to assess approach-avoidance.
  • This paradigm allows ecologically valid measurement under controlled conditions.

Purpose of the Study:

  • To investigate approach-avoidance behavior in PD patients versus healthy controls (HC).
  • To assess subjective anxiety, physiological responses, and hormonal markers in relation to avoidance.
  • To explore the role of trait factors like sensation seeking in avoidance behavior.

Main Methods:

  • Twenty PD patients and 20 HC were tested on the human EPM.
  • Approach-avoidance behavior, anxiety, tension, and cardiovascular responses were measured.
Keywords:
Avoidance behaviorElevated plus mazePanic disorderSensation seekingVirtual reality

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  • Hormonal markers (copeptin, ACTH, cortisol) were analyzed in a subgroup.

    • Main Results:

    • PD patients exhibited higher anticipatory anxiety, tension, and heart rate than HC.
    • No significant differences in approach-avoidance behavior were found between PD patients and HC.
    • Sensation seeking was the strongest inverse predictor of avoidance and anxiety; higher center anxiety predicted avoidance.

    Conclusions:

    • The human EPM effectively elicits anxiety responses, proving its translational value.
    • Avoidance behavior is more influenced by trait factors (e.g., sensation seeking) than by PD diagnosis.
    • Sensation seeking may be a protective trait; antidepressant use might reduce avoidance in PD, suggesting personalized treatment targets.