Article

Is aversive learning a marker of risk for anxiety disorder in children?

September 2008
Behaviour Research and Therapy 46(8):954-67

September 2008
46(8):954-67

DOI:10.1016/j.brat.2008.04.011

Source
PubMed

Authors:

Allison Maree Waters

Griffith University

Lindsey Bergman

University of California, Los Angeles

Show all 7 authorsHide

Aversive conditioning and extinction were evaluated in children with anxiety disorders (n=23), at-risk for anxiety disorders (n=15), and controls (n=11). Participants underwent 16 trials of discriminative conditioning of two geometric figures, with (CS+) or without (CS-) an aversive tone (US), followed by 8 extinction trials (4 CS+, 4 CS-), and 8 extinction re-test trials averaging 2 weeks later. Skin conductance responses and verbal ratings of valence and arousal to the CS+/CS- stimuli were measured. Anxiety disordered children showed larger anticipatory and unconditional skin conductance responses across conditioning, and larger orienting and anticipatory skin conductance responses across extinction and extinction re-test, all to the CS+ and CS-, relative to controls. At-risk children showed larger unconditional responses during conditioning, larger orienting responses during the first block of extinction, and larger anticipatory responses during extinction re-test, all to the CS+ and CS-, relative to controls. Also, anxiety disordered children rated the CS+ as more unpleasant than the other groups. Elevated skin conductance responses to signals of threat (CS+) and signals of safety (CS-; CS+ during extinction) are discussed as features of manifestation of and risk for anxiety in children, compared to the specificity of valence judgments to the manifestation of anxiety.

The aesthetic valve: how aesthetic appreciation may switch emotional states from anxiety to curiosity

Article

Full-text available

Dec 2023

Pursuing new knowledge in the entropic environment is pivotal for survival. However, dealing with uncertainty is a costly challenge for the agent surrounded by the stochastic sensory world, giving rise to different epistemic emotions, such as curiosity and anxiety. We recently proposed that aesthetic appreciation may have the role of associating pleasant feedback with the update of predictive representations. According to this idea, aesthetic appreciation and its associated rewarding feeling could drive people to seek new knowledge over anxiety. However, the relationship between aesthetic appreciation, curiosity, and anxiety has been still under-examined in the literature. Here, we explore the relationship between these epistemic emotions in a series of three experiments. In study 1, we examined whether music-induced aesthetic appreciation would influence curiosity in a gambling task. In studies 2a and 2b, we explore the relationship between music-induced aesthetic appreciation and anxiety state. Overall, aesthetic appreciation promoted curiosity-driven behaviour while it was negatively associated with anxiety. These results were consistent with the idea that aesthetic appreciation could act as a ‘valve’, prompting the individual to perceive curiosity (i.e. to consider novelty as a valuable opportunity to acquire new knowledge) rather than anxiety (i.e. to consider novelty as a risk to be avoided). This article is part of the theme issue ‘Art, aesthetics and predictive processing: theoretical and empirical perspectives’.

Enhanced late positive potential to conditioned threat cue during delayed extinction in anxious youth

Article

Full-text available

May 2023
J CHILD PSYCHOL PSYC

Background: Deficits in threat learning relate to anxiety symptoms. Since several anxiety disorders arise in adolescence, impaired adolescent threat learning could contribute to adolescent changes in risk for anxiety. This study compared threat learning among anxious and non-anxious youth using self-reports, peripheral psychophysiology measures, and event-related potentials. Because exposure therapy, the first-line treatment for anxiety disorders, is largely based on principles of extinction learning, the study also examined the link between extinction learning and treatment outcomes among anxious youth. Methods: Clinically anxious (n = 28) and non-anxious (n = 33) youth completed differential threat acquisition and immediate extinction. They returned to the lab a week later to complete a threat generalization test and a delayed extinction task. Following these two experimental visits, anxious youth received exposure therapy for 12 weeks. Results: Anxious as compared to non-anxious youth demonstrated elevated cognitive and physiological responses across acquisition and immediate extinction learning, as well as greater threat generalization. In addition, anxious youth showed enhanced late positive potential response to the conditioned threat cue compared to the safety cue during delayed extinction. Finally, aberrant neural response during delayed extinction was associated with poorer treatment outcomes. Conclusions: The study emphasizes differences between anxious and non-anxious youth in threat learning processes and provides preliminary support for a link between neural processing during delayed extinction and exposure-based treatment outcome in pediatric anxiety.

High vagal tone and rapid extinction learning as potential transdiagnostic protective factors following childhood violence exposure

Article

Aug 2021

Childhood exposure to violence is strongly associated with psychopathology. High resting respiratory sinus arrhythmia (RSA) is associated with lower levels of psychopathology in children exposed to violence. High RSA may help to protect against psychopathology by facilitating fear extinction learning, allowing more flexible autonomic responses to learned threat and safety cues. In this study, 165 youth (79 female, aged 9–17; 86 exposed to violence) completed assessments of violence exposure, RSA, and psychopathology, and a fear extinction learning task; 134 participants returned and completed psychopathology assessments 2 years later. Resting RSA moderated the longitudinal association of violence exposure with post-traumatic stress disorder (PTSD) symptoms and externalizing psychopathology, such that the association was weaker among youths with higher RSA. Higher skin conductance responses (SCR) during extinction learning to the threat cue (CS+) was associated with higher internalizing symptoms at follow-up and greater SCR to the safety cue (CS–) was associated with higher PTSD, internalizing, and externalizing symptoms, as well as the p-factor, controlling for baseline symptoms. Findings suggest that higher RSA may protect against emergence of psychopathology among children exposed to violence. Moreover, difficulty extinguishing learned threat responses and elevated autonomic responses to safety cues may be associated with risk for future psychopathology.

Vagal Tone and Extinction Learning as Potential Transdiagnostic Protective Factors Following Childhood Violence Exposure

Preprint

Jan 2021

Childhood exposure to violence is strongly associated with psychopathology. High resting respiratory sinus arrhythmia (RSA) has been found to protect against psychopathology in children who have experienced adversity. High RSA may protect against psychopathology by facilitating fear extinction learning, allowing individuals to more appropriately regulate autonomic responses to learned threat and safety cues. In the present study, 165 youth (79 female, ages 9-17; 86 exposed to violence) completed assessments of violence exposure, RSA, psychopathology, and a fear extinction learning task; 134 participants returned and completed psychopathology assessments two years later. Resting RSA moderated the association of violence exposure with PTSD symptoms and transdiagnostic psychopathology (p-factor) at follow-up, such that the association was weaker among youth with higher RSA. Higher skin conductance responses (SCR) when viewing the stimulus associated with an aversive noise (CS+) as well as when viewing the stimulus that was unassociated with the aversive noise (CS-) during extinction learning predicted higher internalizing symptoms and p-factor at follow-up. These findings suggest that higher RSA may protect against the onset of psychopathology among children exposed to violence. Moreover, our findings suggest that in addition to difficulty extinguishing learned threat responses, elevated autonomic responses to safety cues may contribute to psychopathology.

Developmental Aspects of Fear Learning and Fear Generalization

Thesis

Jan 2019

Julia Reinhard

In situations of real threat, showing a fear reaction makes sense, thus, increasing the chance to survive. The question is, how could anybody differentiate between a real and an apparent threat? Here, the slogan counts “better safe than sorry”, meaning that it is better to shy away once too often from nothing than once too little from a real threat. Furthermore, in a complex environment it is adaptive to generalize from one threatening situation or stimulus to another similar situation/stimulus. But, the danger hereby is to generalize in a maladaptive manner involving as it is to strong and/or fear too often “harmless” (safety) situations/stimuli, as it is known to be a criterion of anxiety disorders (AD). Fear conditioning and fear generalization paradigms are well suited to investigate fear learning processes. It is remarkable that despite increasing interest in this topic there is only little research on fear generalization. Especially, most research on human fear conditioning and its generalization has focused on adults, whereas only little is known about these processes in children, even though AD is typically developing during childhood. To address this knowledge gap, four experiments were conducted, in which a discriminative fear conditioning and generalization paradigm was used. In the first two experiments, developmental aspects of fear learning and generalization were of special interest. Therefore, in the first experiment 267 children and 285 adults were compared in the differential fear conditioning paradigm and generalization test. Skin conductance responses (SCRs) and ratings of valence and arousal were obtained to indicate fear learning. Both groups displayed robust and similar differential conditioning on subjective and physiological levels. However, children showed heightened fear generalization compared to adults as indexed by higher arousal ratings and SCRs to the generalization stimuli. Results indicate overgeneralization of conditioned fear as a developmental correlate of fear learning. The developmental change from a shallow to a steeper generalization gradient is likely related to the maturation of brain structures that modulate efficient discrimination between threatening and (ambiguous) safety cues. The question hereby is, at which developmental stage fear generalization gradients of children adapt to the gradients of adults. Following up on this question, in a second experiment, developmental changes in fear conditioning and fear generalization between children and adolescents were investigated. According to experiment 1 and previous studies in children, which showed changes in fear learning with increasing age, it was assumed that older children were better at discriminating threat and safety stimuli. Therefore, 396 healthy participants (aged 8 to 12 years) were examined with the fear conditioning and generalization paradigm. Again, ratings of valence, arousal, and SCRs were obtained. SCRs indicated differences in fear generalization with best fear discrimination in 12-year-old children suggesting that the age of 12 years seems to play an important role, since generalization gradients were similar to that of adults. These age differences were seen in boys and girls, but best discrimination was found in 12-year-old boys, indicating different development of generalization gradients according to sex. This result fits nicely with the fact that the prevalence of AD is higher in women than in men. In a third study, it was supposed that the developmental trajectory from increased trait anxiety in childhood to manifest AD could be mediated by abnormal fear conditioning and generalization processes. To this end, 394 children aged 8 to 12 years with different scores in trait anxiety were compared with each other. Results provided evidence that children with high trait anxiety showed stronger responses to threat cues and impaired safety signal learning contingent on awareness as indicated by arousal at acquisition. Furthermore, analyses revealed that children with high trait anxiety showed overall higher arousal ratings at generalization. Contrary to what was expected, high trait anxious children did not show significantly more fear generalization than children with low trait anxiety. However, high-trait-anxious (HA) participants showed a trend for a more linear gradient, whereas moderate-trait-anxious (MA) and low-trait-anxious (LA) participants showed more quadratic gradients according to arousal. Additionally, after controlling for age, sex and negative life experience, SCR to the safety stimulus predicted the trait anxiety level of children suggesting that impaired safety signal learning may be a risk factor for the development of AD. Results provide hints that frontal maturation could develop differently according to trait anxiety resulting in different stimuli discrimination. Thus, in a fourth experiment, 40 typically developing volunteers aged 10 to 18 years were screened for trait anxiety and investigated with the differential fear conditioning and generalization paradigm in the scanner. Functional magnetic resonance imaging (fMRI) were used to identify the neural mechanisms of fear learning and fear generalization investigating differences in this neural mechanism according to trait anxiety, developmental aspects and sex. At acquisition, HA participants showed reduced activation in frontal brain regions, but at generalization, HA participants showed an increase in these frontal regions with stronger linear increase in activation with similarity to CS+ in HA when compared to LA participants. This indicates that there is a hyper-regulation in adolescents to compensate the higher difficulties at generalization in form of a compensatory mechanism, which decompensates with adulthood and/or may be collapsed in manifest AD. Additionally, significant developmental effects were found: the older the subjects the stronger the hippocampus and frontal activation with resemblance to CS+, which could explain the overgeneralization of younger children. Furthermore, there were differences according to sex: males showed stronger activation with resemblance to CS+ in the hippocampus and frontal regions when compared to females fitting again nicely with the observation that prevalence rates for AD are higher for females than males. In sum, the studies suggest that investigating developmental aspects of (maladaptive) overgeneralization may lead to better understanding of the mechanisms of manifest anxiety disorders, which could result in development and provision of prevention strategies. Although, there is need for further investigations, the present work gives some first hints for such approaches.

The need for standards in the design of differential fear conditioning and extinction experiments in youth: A systematic review and recommendations for research on anxiety

Article

Nov 2018
BEHAV RES THER

Fear extinction studies in youth have yielded mixed results due to developmental processes and variations in design, methodology and dependent measures. This systematic review focused on studies with healthy youth between 2 and 17 years of age to identify experimental parameters of studies documenting extinction effects. Thirty-five studies met inclusion criteria and the following themes emerged (a) some studies employed parameters and task demands that are complex and require active participant involvement whereas others involved simple stimulus configurations and passive participant involvement, and (b) variation exists among dependent measures in units of measurement, timing and type of measurement. The review identified that studies using geometric shape conditioned stimuli (CS) paired with a tone unconditioned stimulus (US) (e.g., metal scraping on slate), as well as face CSs with a scream US produced the most reliable extinction effects, although the latter combination may be associated with higher drop-out than shape CSs and a tone US. The most commonly used and effective dependent measures for revealing extinction effects were skin conductance responses (SCR) and subjective ratings (SR) of CS valence, fearfulness and arousal. Fear potentiated startle (FPS) blink reflexes were also an effective but less commonly used measure. It is recommended that future studies use shape CSs and the metal scraping on slate US in studies involving children and either shape CSs and the metal scraping on slate US or face CSs paired with a scream US with adolescents. It is also recommended that US expectancy ratings and CS evaluations are assessed trial-by-trial and between-phase, and that startle-eliciting stimuli to measure startle blink reflexes are delivered on every second trial per CS so that SCR and FPS can be examined. However, further research is required to determine whether increased participant involvement due to providing trial-by-trial and between-phase ratings of the CSs and US differentially influences responding, particularly in children relative to adolescents and adults.

Fear conditioning, its generalization and extinction in children and adolescents under consideration of trait anxiety and anxiety sensitivity

Thesis

Jan 2022

Anna Slyschak

The propounded thesis investigated fear learning including fear conditioning, its generalization as well as its extinction in 133 healthy children and adolescents aged 8 to 17 years. The main goal was to analyze these processes also in the course of childhood and adolescence due to far less research in this age span compared to adults. Of note, childhood is the typical period for the onset of anxiety disorders. To achieve this, an aversive discriminative fear conditioning, generalization and extinction paradigm, which based on the “screaming lady paradigm” from Lau et al. (2008) and was adapted by Schiele & Reinhard et al. (2016), was applied. All probands traversed the pre-acquisition (4 x CS-, 4 x CS+, no US), the acquisition (12 x CS-, 12 x CS+, reinforcement rate: 83%), the generalization (12 x CS-, 12 x GS4, 12 x GS3, 12 x GS2, 12 x GS1, 12 x CS+, reinforcement rate: 50%) and the extinction (18 x CS-, 18 x CS+, no US). The generalization stimuli, i.e. GS1-GS4, were built out of CS- and CS+ in different mixtures on a percentage basis in steps of 20% from CS- to CS+. Pictures of faces of two actresses with a neutral expression were used for the discriminative conditioning, whereby the CS+ was paired with a 95-dB loud female scream at the same time together with a fearful facial expression (US). CS- and GS1-GS4 were never followed by the US. Subjective ratings (arousal, valence and US expectancy) were collected and further the psychophysiological measure of the skin conductance response (SCR). The hypotheses were 1) that underage probands show a negative correlation between age and overgeneralization and 2) that anxiety is positively correlated with overgeneralization in the same sample. ANOVAs with repeated measures were conducted for all four dependent variables with phase (pre-acquisition phase, 1. + 2. acquisition phase, 1. + 2. generalization phase, 1. - 3. extinction phase) and stimulus type (CS-, CS+, GS1-GS4) as within-subject factors. For the analyses of the modulatory effects of age and anxiety in additional separate ANCOVAs were conducted including a) age, b) the STAIC score for trait anxiety and c) the CASI score for anxiety sensitivity as covariates. Sex was always included as covariate of no interest. On the one hand, findings indicated that the general extent of the reactions (arousal, valence and US expectancy ratings and the SCR) decreased with growing age, i.e. the older the probands the lower their reactions towards the stimuli regardless of the type of dependent variable. On the other hand, ratings of US expectancy, i.e. the likelihood that a stimulus is followed by a US (here: female scream coupled with a fearful facial expression), showed better discrimination skills the older the probands were, resulting in a smaller overgeneralization within older probands. It must be emphasized very clearly that no causality can be derived. Thus, it was only an association revealed between 15 age and generalization of conditioned fear, which is negative. Furthermore, no obvious impact of trait anxiety could be detected on the different processes of fear learning. Especially, no overgeneralization was expressed by the probands linked to higher trait anxiety. In contrast to trait anxiety, for anxiety sensitivity there was an association between its extent and the level of fear reactions. This could be described best with a kind of parallel shifts: the higher the anxiety sensitivity, the stronger the fear reactions. Likewise, for anxiety sensitivity no overgeneralization due to a stronger extent of anxiety sensitivity could be observed. Longitudinal follow-up examinations and, furthermore, neurobiological investigations are needed for replication purposes and purposes of gaining more supporting or opposing insights, but also for the profound exploration of the impact of hormonal changes during puberty and of the maturation processes of different brain structures. Finally, the question whether enhanced generalization of conditioned fear facilitates the development of anxiety disorders or vice versa remains unsolved yet.

Detecting Subclinical Social Anxiety Using Physiological Data from a Wrist-worn Wearable: A Small-Scale Feasibility Study (Preprint)

Article

Full-text available

Aug 2021

Background Subclinical (ie, threshold) social anxiety can greatly affect young people’s lives, but existing solutions appear inadequate considering its rising prevalence. Wearable sensors may provide a novel way to detect social anxiety and result in new opportunities for monitoring and treatment, which would be greatly beneficial for persons with social anxiety, society, and health care services. Nevertheless, indicators such as skin temperature measured by wrist-worn sensors have not been used in prior work on physiological social anxiety detection. Objective This study aimed to investigate whether subclinical social anxiety in young adults can be detected using physiological data obtained from wearable sensors, including heart rate, skin temperature, and electrodermal activity (EDA). Methods Young adults (N=12) with self-reported subclinical social anxiety (measured using the widely used self-reported version of the Liebowitz Social Anxiety Scale) participated in an impromptu speech task. Physiological data were collected using an E4 Empatica wearable device. Using the preprocessed data and following a supervised machine learning approach, various classification algorithms such as Support Vector Machine, Decision Tree, Random Forest, and K-Nearest Neighbours (KNN) were used to develop models for 3 different contexts. Models were trained to differentiate (1) between baseline and socially anxious states, (2) among baseline, anticipation anxiety, and reactive anxiety states, and (3) social anxiety among individuals with social anxiety of differing severity. The predictive capability of the singular modalities was also explored in each of the 3 supervised learning experiments. The generalizability of the developed models was evaluated using 10-fold cross-validation as a performance index. Results With modalities combined, the developed models yielded accuracies between 97.54% and 99.48% when differentiating between baseline and socially anxious states. Models trained to differentiate among baseline, anticipation anxiety, and reactive anxiety states yielded accuracies between 95.18% and 98.10%. Furthermore, the models developed to differentiate between social anxiety experienced by individuals with anxiety of differing severity scores successfully classified with accuracies between 98.86% and 99.52%. Surprisingly, EDA was identified as the most effective singular modality when differentiating between baseline and social anxiety states, whereas ST was the most effective modality when differentiating anxiety among individuals with social anxiety of differing severity. Conclusions The results indicate that it is possible to accurately detect social anxiety as well as distinguish between levels of severity in young adults by leveraging physiological data collected from wearable sensors.

Pavlovian Learning Processes in Pediatric Anxiety Disorders: A Critical Review

Article

Dec 2020
BIOL PSYCHIAT

Deficits in associative and Pavlovian learning are thought to lie at the center of anxiety-related disorders. However, the majority of studies have been carried out in adult populations. The aim of this review was to critically examine the behavioral and neuroimaging literature on Pavlovian learning in pediatric anxiety disorders. We conclude that although there is evidence for deficits in Pavlovian processes (e.g., heightened reactivity to safety cues in anxious samples), the extant literature suffers from key methodological and theoretical issues. We conclude with theoretical and methodological recommendations for future research in order to further elucidate the role of Pavlovian learning in the etiology, maintenance, and treatment of pediatric anxiety disorders.

Corrigendum to ‘The Suitability of an Inhibitory Learning Approach in Exposure When Habituation Fails: A Clinical Application to Misophonia’ [Cognitive and Behavioral Practice 26(1) (2019) 130-142]

Article

Sep 2019
COGN BEHAV PRACT

Fear Conditioning and Extinction in Anxious Youth, Offspring At-Risk for Anxiety and Healthy Comparisons: an fMRI Study

Article

Aug 2019
BIOL PSYCHOL

Dysfunctions in fronto-amygdala circuitry have been linked to anxiety. Questions remain regarding the impact of familial-risk and ongoing anxiety on such circuitry function, especially in youth. Using fMRI fear conditioning and extinction paradigms, we examined these relationships in 10-17 year-olds: 22 youth with an anxiety disorder, 22 healthy youth born to parents with past or current anxiety disorders (at risk), and 32 healthy comparisons. Skin conductance responses and subjective fear ratings were also assessed. During conditioning, healthy comparisons showed differential activation (CS + >CS-) in regions of the fronto-amygdala circuitry. In comparison, the at-risk group showed greater activation to the safety cue (CS - >CS+) in the amygdala and dorsolateral prefrontal cortex. Failure to show differential fear conditioning in the fronto-amygdala circuitry and impairment in extinction learning was specific to anxious youth. These findings expand our ability to track anxiety-related alterations and potential resilience markers to anxiety.

Fear Extinction Learning as a Predictor of Response to Cognitive Behavioral Therapy for Pediatric Obsessive Compulsive Disorder

Article

Mar 2019
J ANXIETY DISORD

Background: While cognitive behavior therapy (CBT) is an effective treatment for many children and adolescents with Obsessive Compulsive Disorder (OCD), therapeutic response is variable. Fear conditioning and extinction are central constructs underlying exposure-based CBT. Fear extinction learning assessed prior to CBT may be a useful predictor of CBT response for guiding treatment decisions. Methods: Sixty-four youth who participated in a randomized placebo-controlled trial of CBT with and without d-cycloserine (DCS) completed a fear conditioning task. Skin conductance response (SCR) scores were used to measure fear acquisition and extinction to determine whether extinction learning could predict CBT response. Results: CBT responders and non-responders appeared to acquire conditioned fear SCRs in a similar manner. However, differences between treatment responders and non-responders emerged during the extinction phase. A responder (responder, non-responder) by conditioned stimulus type (CS+, CS-) interaction showed that CBT responders differentiated the stimulus paired with (CS+) and without (CS-) the unconditioned stimulus correctly during early and late extinction, whereas the CBT non-responders did not (p = .004). Conclusions: While the small sample size makes conclusions tentative, this study supports an emerging literature that differential fear extinction may be an important factor underlying clinical correlates of pediatric OCD, including CBT response.

Introduction to the Special Series: Clinical Applications of the Inhibitory Learning Model

Article

Dec 2018
COGN BEHAV PRACT

Exposure therapies (ETs) are treatments of choice for a number of mental health disorders, particularly anxiety and associated conditions, and problems due to avoidance. Exposure has received broad empirical support as a primary intervention. Recent efforts have focused on improving the efficacy and acceptability of exposure-based treatments. As proposed by Craske etal. (2014), strategies to improve ETs based on the inhibitory learning model have shown notable promise. However, surveys suggest that clinicians continue to avoid ETs, or implement them in a manner that interrupts their efficacy. In this special series, articles focus on specific inhibitory learning strategies in exposure, and their adaptation to multiple patient populations. The aim of the special series is to critically assess the research support for inhibitory learning approaches to exposure, and provide guidance for clinicians to implement these strategies in everyday practice.

Fear conditioning and fear generalization in children and adolescents with anxiety disorders

Article

Full-text available

Oct 2023
EUR CHILD ADOLES PSY

Overgeneralization of conditioned fear is associated with anxiety disorders (AD). Most results stem from studies done in adult patients, but studies with children are rare, although the median onset of anxiety disorders lies already in childhood. Thus, the goal of the present study was to examine fear learning and generalization in youth participants, aged 10–17 years, with AD (n = 39) compared to healthy controls (HC) (n = 40). A discriminative fear conditioning and generalization paradigm was used. Ratings of arousal, valence, and US expectancy (the probability of an aversive noise following each stimulus) were measured, hypothesizing that children with AD compared to HC would show heightened ratings of arousal and US expectancy, and decreased positive valence ratings, respectively, as well as overgeneralization of fear. The results indicated that children with AD rated all stimuli as more arousing and less pleasant, and demonstrated higher US expectancy ratings to all stimuli when compared to HC. Thus, rather than displaying qualitatively different generalization patterns (e.g., a linear vs. quadratic slope of the gradient), differences between groups were more quantitative (similar, but parallel shifted gradient). Therefore, overgeneralization of conditioned fear does not seem to be a general marker of anxiety disorders in children and adolescents.

Narrative Review of the Complex Interaction between Pain and Trauma in Children: A Focus on Biological Memory, Preclinical Data, and Epigenetic Processes

Article

Full-text available

Jul 2023

The incidence and collective impact of early adverse experiences, trauma, and pain continue to increase. This underscores the urgent need for translational efforts between clinical and preclinical research to better understand the underlying mechanisms and develop effective therapeutic approaches. As our understanding of these issues improves from studies in children and adolescents, we can create more precise preclinical models and ultimately translate our findings back to clinical practice. A multidisciplinary approach is essential for addressing the complex and wide-ranging effects of these experiences on individuals and society. This narrative review aims to (1) define pain and trauma experiences in childhood and adolescents, (2) discuss the relationship between pain and trauma, (3) consider the role of biological memory, (4) decipher the relationship between pain and trauma using preclinical data, and (5) examine the role of the environment by introducing the importance of epigenetic processes. The ultimate scope is to better understand the wide-ranging effects of trauma, abuse, and chronic pain on children and adolescents, how they occur, and how to prevent or mitigate their effects and develop effective treatment strategies that address both the underlying causes and the associated physiological and psychological effects.

Classical Conditioning

Chapter

Jun 2023

Classical conditioning describes the learning process through which an innocuous stimulus (the to-be conditioned stimulus) acquires emotional valence by being paired with an unpleasant (aversive conditioning) or pleasant (appetitive conditioning) event, i.e., the unconditioned stimulus. In this chapter, classical conditioning is delineated as a fundamental mechanism for understanding pathological anxiety, fear, and trauma-related disorders as well as affective disorders and substance abuse. Developmental changes in fear learning will be outlined and how they may account for anxiety and trauma-related disorders in childhood. For example, the magnitude and speed of aversive conditioning increase from childhood to adolescence and adulthood, presumably mediated through changes in neural circuitries involving the amygdala and prefrontal brain areas. Importantly, traits, biological predispositions, and the impact of prior experiences are addressed, in that they make learning through classical conditioning highly flexible and interindividually variable. Moreover, the relative contribution of excitatory and inhibitory learning to exaggerated fear and anxiety is highlighted. Recent advances in our understanding that conditioning does not necessarily require direct experience, but can also occur by making use of imagery, will be summarized. Classical conditioning is not only crucial for understanding the development of psychopathology but has also been pivotal for the development of treatment interventions such as exposure therapy. Extinction learning and memory will be explained, and how the effectiveness of exposure therapy can be bolstered by taking into account what is known about extinction and its underlying mechanisms. Also, the boundaries between classical and operant conditioning are discussed and how a distinction can sometimes be difficult. Finally, an overview of interventions based on classical conditioning beyond exposure therapy is given, which highlights how powerful classical conditioning is in changing behavior, for example as demonstrated by its treatment benefits for various mental health problems during childhood and adolescence, including eating disorders, substance use disorders, nocturnal enuresis, and sleeping difficulties.KeywordsFear conditioningAppetitive conditioningConditioned stimulusUnconditioned stimulusPreparednessOvergeneralizationAnxiety disordersPosttraumatic stress disorderExtinction learningExposure therapy

The perils of acting rashly: Risk-taking propensity impeding emotion-based learning in entrepreneurs

Article

Full-text available

Jan 2023
J Int Enterpren

Errors are common in the entrepreneurial world, but the ability to learn from past mistakes can separate successful entrepreneurs from the rest. On the other hand, it has been demonstrated that the average population can anticipate future problems based on emotional signals elicited from past experience—a capacity known as emotion-based learning. The present research was aimed at examining emotion-based learning while also incorporating risk-taking predisposition (RTP) as an additional measurement among entrepreneurs using Iowa gambling task (IGT). Participants were instructed to pick cards from a deck, and each card either awarded or subtracted points. While performing this task, participants’ skin conductance response (SCR) was recorded to examine subtle emotional signals. The sample of entrepreneurs involved in our study showed worse IGT performances than those in the control group. This was similar to findings in a previous study (Muehlfeld et al., Entrep Theory Pract 41:533–565, 2017) that surmised that the typical behavior was simply due to exploring all opportunities that eventually had significant cost to participants. Here, we extend the explanation that the SCR measurement supported emotion-based learning, indicating that our participants were aware of the potential risks of the IGT. Furthermore, entrepreneurs’ RTP could explain the incompatibility between physiological and behavioral outcomes. Entrepreneurs seemed to ignore the bodily-emotional signals, perhaps tempted by a particular card deck’s gain/loss ratio, which eventually led to significant losses. This study illuminates the interplay between risk-taking propensity, physiological markers of emotion, and performance in a game scenario that simulates decision-making in an ambiguous environment.

Human state anxiety classification framework using EEG signals in response to exposure therapy

Article

Full-text available

Mar 2022
PLOS ONE

Human anxiety is a grave mental health concern that needs to be addressed in the appropriate manner in order to develop a healthy society. In this study, an objective human anxiety assessment framework is developed by using physiological signals of electroencephalography (EEG) and recorded in response to exposure therapy. The EEG signals of twenty-three subjects from an existing database called “A Database for Anxious States which is based on a Psychological Stimulation (DASPS)” are used for anxiety quantification into two and four levels. The EEG signals are pre-processed using appropriate noise filtering techniques to remove unwanted ocular and muscular artifacts. Channel selection is performed to select the significantly different electrodes using statistical analysis techniques for binary and four-level classification of human anxiety, respectively. Features are extracted from the data of selected EEG channels in the frequency domain. Frequency band selection is applied to select the appropriate combination of EEG frequency bands, which in this study are theta and beta bands. Feature selection is applied to the features of the selected EEG frequency bands. Finally, the selected subset of features from the appropriate frequency bands of the statistically significant EEG channels were classified using multiple machine learning algorithms. An accuracy of 94.90% and 92.74% is attained for two and four-level anxiety classification using a random forest classifier with 9 and 10 features, respectively. The proposed state anxiety classification framework outperforms the existing anxiety detection framework in terms of accuracy with a smaller number of features which reduces the computational complexity of the algorithm.

The Transdiagnostic Origins of Anxiety and Depression During the Pediatric Period: Linking NIMH Research Domain Criteria (RDoC) Constructs to Ecological Systems

Article

Full-text available

Dec 2021

In the last decade, an abundance of research has utilized the National Institute of Mental Health (NIMH) research domain criteria (RDoC) framework to examine mechanisms underlying anxiety and depression in youth. However, relatively little work has examined how these mechanistic intrapersonal processes intersect with context during childhood and adolescence. The current paper covers reviews and meta-analyses that have linked RDoC-relevant constructs to ecological systems in internalizing problems in youth. Specifically, cognitive, biological, and affective factors within the RDoC framework were examined. Based on these reviews and some of the original empirical research they cover, we highlight the integral role of ecological factors to the RDoC framework in predicting onset and maintenance of internalizing problems in youth. Specific recommendations are provided for researchers using the RDoC framework to inform future research integrating ecological systems and development. We advocate for future research and research funding to focus on better integration of the environment and development into the RDoC framework.

Paternal expressed emotion influences psychobiological indicators of threat and safety learning in daughters: A preliminary study

Article

Full-text available

Nov 2021

This preliminary study examined the association of children's anxiety, paternal expressed emotion (EE), and their interaction with psychophysiological indices of children's threat and safety learning. Participants included 24 father–daughter dyads. Daughters (ages 8–13 years, 100% Latina) self‐reported their anxiety levels and completed a differential threat conditioning and extinction paradigm, during which psychophysiological responding was collected. Fathers completed a Five‐Minute Speech Sample, from which paternal EE (i.e., criticism, emotional overinvolvement) was assessed. Anxiety‐dependent associations emerged between paternal EE and individual differences in daughters’ psychophysiological responding to safety signals during threat conditioning. Paternal EE was positively associated with psychophysiological responding to safety in daughters with high and mean, but not low, levels of anxiety. Although previous work suggests that chronic harsh maternal parenting is a potential risk factor for children's general threat and safety learning, these preliminary findings implicate milder forms of negative parenting behavior in fathers, particularly for highly anxious children.

Safety learning and the Pavlovian conditioned inhibition of fear in humans: Current state and future directions

Article

May 2021
NEUROSCI BIOBEHAV R

Safety learning occurs when an otherwise neutral stimulus comes to signal the absence of threat, allowing organisms to use safety information to inhibit fear and anxiety in nonthreatening environments. Although it continues to emerge as a topic of relevance in biological and clinical psychology, safety learning remains inconsistently defined and under-researched. Here, we analyse the Pavlovian conditioned inhibition paradigm and its application to the study of safety learning in humans. We discuss existing studies; address outstanding theoretical considerations; and identify prospects for its further application. Though Pavlovian conditioned inhibition presents a theoretically sound model of safety learning, it has been investigated infrequently, with decade-long interims between some studies, and notable methodological variability. Consequently, we argue that the full potential of conditioned inhibition as a model for human safety learning remains untapped, and propose that it could be revisited as a framework for addressing timely questions in the behavioural and clinical sciences.

Aerobic Exercise and Consolidation of Fear Extinction Learning among Women with Posttraumatic Stress Disorder

Article

Apr 2021
BEHAV RES THER

This study tested whether aerobic exercise delivered during the consolidation window following fear extinction learning reduces the return of fear among women with posttraumatic stress disorder (PTSD). Participants (n=35) completed an initial clinical assessment followed by a 3-day fear acquisition, extinction, and recall protocol. On day 1, participants completed a fear acquisition training task in which one geometric shape (conditioning stimulus; CS+) was paired (with 50% probability) with a mild electric shock (unconditioned stimulus; US), while a different shape (CS-) was never paired with the US. On day 2 (24hrs later), participants completed a fear extinction training task in which the CS+ no longer predicted administration of the US. Shortly following extinction, participants were randomly assigned to complete either moderate-intensity aerobic exercise (EX) or a light-intensity exercise control (CON) condition. On day 3 (24hrs later), participants completed fear recall tests assessing the return of fear (spontaneous recovery, renewal, and reinstatement). Fear responding was assessed via threat expectancy ratings and skin conductance responses (SCR). In the threat expectancy ratings, there were no significant differences between groups in spontaneous recovery; however, EX significantly (p=.02) reduced threat expectancy ratings following reinstatement relative to CON. In SCR measures, there were no significant differences between groups in spontaneous recovery, renewal, or reinstatement. These results support a role for moderate-intensity aerobic exercise during the consolidation window in reducing threat expectations following reinstatement in women with PTSD. Research should continue to examine exercise as a potential method for improving the efficacy of exposure-based therapies. Trial Registration ClinicalTrials.gov Identifier: NCT04113798.

Using a novel paradigm to examine observational fear‐learning across development

Article

Full-text available

Mar 2021
DEPRESS ANXIETY

Background Fear‐learning through observing others begins early in life. Yet, most observational fear‐learning research has focused on adults. The current study used a novel developmentally appropriate observational fear conditioning paradigm to examine differences in observational fear‐learning among children, adolescents, and adults. Method Thirty‐six typically developing children, 41 typically developing adolescents, and 40 adults underwent differential observational fear conditioning followed by a direct exposure test. Skin conductance response (SCR) and self‐reported fear were measured. Results Successful differential observational fear‐learning was demonstrated in all three age groups as indexed by SCR, yet developmental differences emerged. Children showed overall higher physiological arousal during acquisition compared to adolescents and adults. Additionally, children reported less differential fear and were less successful at reporting the conditioned stimulus–unconditioned stimulus contingency compared to adolescents and adults. Finally, adolescents tended to overgeneralize their fear compared with adults. Conclusions This is the first study to compare observational fear‐learning among children, adolescents, and adults. The novel task effectively induced observational fear‐learning, particularly among adolescents and adults. Findings revealed developmental differences that have both theoretical and clinical implications.

A legacy of fear: Physiological evidence for intergenerational effects of trauma exposure on fear and safety signal learning among African Americans

Article

Nov 2020
BEHAV BRAIN RES

Objective To determine the influence of maternal trauma and posttraumatic stress disorder (PTSD) symptoms on children’s physiological response to threat and safety signals during a fear conditioning task in trauma-exposed mothers and children. Method Participants were African American mother-child dyads (N = 137; children aged 8-13 years). Mothers’ trauma history and PTSD symptoms were assessed; Latent Class Analysis (LCA) was conducted from these measures to identify distinct classes. Children reported violence exposure and completed a differential fear conditioning task using fear-potentiated startle (FPS) responses to conditioned danger (CS+) and safety (CS-) signals. Results Four classes of maternal trauma history and PTSD symptoms emerged: 1) Lower Trauma, 2) Moderate Trauma, 3) High Sexual Abuse, and 4) High Trauma and PTSD Symptoms. Children’s FPS to CS + and CS- were tested with maternal class as the between-subjects factor. FPS to the danger signal was not significantly different across maternal classes, but FPS to safety (CS-) was significantly higher for the Lower Trauma and High Trauma and PTSD Symptoms classes than either the Moderate Trauma or the High Sexual Abuse classes. Conclusions Results indicate that maternal trauma impacts children’s ability to modulate fear responses in the presence of a safety signal, independent of the children’s own trauma exposure. To our knowledge, this is the first study to demonstrate that children’s fear inhibition is impacted by maternal trauma exposure. Prior studies have linked fear inhibition to mental health outcomes, highlighting the need to understand intergenerational modulation of fear learning and physiology.

Learning About Safety: Conditioned Inhibition as a Novel Approach to Fear Reduction Targeting the Developing Brain

Article

Nov 2020

Adolescence is a peak time for the onset of psychiatric disorders, with anxiety disorders being the most common and affecting as many as 30% of youths. A core feature of anxiety disorders is difficulty regulating fear, with evidence suggesting deficits in extinction learning and corresponding alterations in frontolimbic circuitry. Despite marked changes in this neural circuitry and extinction learning throughout development, interventions for anxious youths are largely based on principles of extinction learning studied in adulthood. Safety signal learning, based on conditioned inhibition of fear in the presence of a cue that indicates safety, has been shown to effectively reduce anxiety-like behavior in animal models and attenuate fear responses in healthy adults. Cross-species evidence suggests that safety signal learning involves connections between the ventral hippocampus and the prelimbic cortex in rodents or the dorsal anterior cingulate cortex in humans. Particularly because this pathway follows a different developmental trajectory than fronto-amygdala circuitry involved in traditional extinction learning, safety cues may provide a novel approach to reducing fear in youths. In this review, the authors leverage a translational framework to bring together findings from studies in animal models and humans and to bridge the gap between research on basic neuroscience and clinical treatment. The authors consider the potential application of safety signal learning for optimizing interventions for anxious youths by targeting the biological state of the developing brain. Based on the existing cross-species literature on safety signal learning, they propose that the judicious use of safety cues may be an effective and neurodevelopmentally optimized approach to enhancing treatment outcomes for youths with anxiety disorders.

Anxiety on Quiet Eye and Performance of Youth Pistol Shooters

Article

Full-text available

Jul 2020

In adults, longer quiet-eye (QE) durations have been associated with more successful sport performances and less deterioration in skill during anxiety-inducing situations. This study aimed to establish if QE patterns in youth are similar to those reported in adults. Ten youth shooters, age 13.13 ± 0.83 years, completed an air-pistol task under a control and an anxiety condition. Mixed design 2 (performance outcome) × 2 (condition) ANOVA tests were conducted with two performance measures—objective and coach rated. No significant main or interaction effects were found. Unlike in adults, performance and anxiety did not differentiate QE duration in youth athletes, although QE duration was longer during good shots than poor shots across both performance measures, and the shortest durations were recorded during poor shots in the anxiety condition. This preliminary exploration encourages more research with youth athletes to determine the efficacy of QE patterns across different learners.

Puberty drives fear learning during adolescence

Article

Jun 2020

Risk for adverse outcomes, including the onset of mental illness, increases during adolescence. This increase may be linked to both new exposures, such as violence at home or in the community, or to physiological changes driven by puberty. There are significant sex differences in adolescent risk, for instance, anxiety disorders are significantly more prevalent in girls than boys. Fear learning is linked to mental health and may develop during adolescence, but the role of puberty in adolescent‐specific change has not yet been systematically evaluated. We conducted a longitudinal study of fear learning that tested fear‐potentiated startle (FPS) in 78 children (40 girls) aged 8‐16 years. Participants completed two to three visits that included a differential fear conditioning task and self‐report of both pubertal status and violence exposure. We tested for effects of sex, pubertal status, and violence exposure on FPS over time with latent growth curve models. We also examined the association between FPS and later anxiety symptoms. We found significant changes in FPS to the threat cue, but not the safety cue, across visits. Higher pubertal status was significantly associated with increased FPS to threat cues at each visit, whereas sex and violence exposure were not. FPS to threat during the baseline visit also predicted later anxiety symptoms. These findings suggest that puberty drives increased fear response to threat cues similarly for girls and boys, and that this effect may not be significantly impacted by individual differences in violence exposure during early adolescence.

Mechanisms linking childhood adversity with psychopathology: Learning as an intervention target

Article

Apr 2019
BEHAV RES THER

Exposure to childhood adversity is common and a powerful risk factor for many forms of psychopathology. In this opinion piece, we argue for greater translation of knowledge about the developmental processes that are influenced by childhood adversity into targeted interventions to prevent the onset of psychopathology. Existing evidence has consistently identified several neurodevelopmental pathways that serve as mechanisms linking adversity with psychopathology. We highlight three domains in which these mechanisms are well-established and point to clear targets for intervention: 1) threat-related social information processing biases; 2) heightened emotional reactivity and difficulties with emotion regulation; and 3) disruptions in reward processing. In contrast to these established pathways, knowledge of how childhood adversity influences emotional learning mechanisms, including fear and reward learning, is remarkably limited. We see the investigation of these mechanisms as a critical next step for the field that will not only advance understanding of developmental pathways linking childhood adversity with psychopathology, but also provide clear targets for behavioral interventions. Knowledge of the mechanisms linking childhood adversity with psychopathology has advanced rapidly, and the time has come to translate that knowledge into clinical interventions to prevent the onset of mental health problems in children who have experienced adversity.

The effects of the angiotensin II receptor antagonist losartan on appetitive versus aversive learning

Preprint

Full-text available

Nov 2018

Exposure therapy is a first-line treatment for anxiety disorders but remains ineffective in a large proportion of patients. A proposed mechanism of exposure involves a form of inhibitory learning where the association between a stimulus and an aversive outcome is suppressed by a new association with an appetitive or neutral outcome. The blood pressure medication losartan augments fear extinction in rodents and might have similar synergistic effects on human exposure therapy, but the exact cognitive mechanisms underlying these effects remain unknown. In this study, we used a reinforcement learning paradigm with compound rewards and punishments to test the prediction that losartan augments learning from appetitive relative to aversive outcomes. Healthy volunteers (N=53) were randomly assigned to single-dose losartan (50mg) versus placebo. Participants then performed a reinforcement learning task which simultaneously probes appetitive and aversive learning. Participant choice behaviour was analysed using both a standard reinforcement learning model and by analysis of choice switching behaviour. Losartan significantly reduced learning rates from aversive events (losses) when participants were first exposed to the novel task environment, while preserving learning from positive outcomes. The same effect was seen in choice switching behaviour. Losartan enhances learning from positive relative to negative events. This effect may represent a computationally defined neurocognitive mechanism by which the drug could enhance the effect of exposure in clinical populations.

Mechanisms, genes and treatment: Experimental fear conditioning, the serotonin transporter gene, and the outcome of a highly standardized exposure-based fear treatment

Article

Jun 2018
BEHAV RES THER

There is considerable interindividual variation in response to psychotherapeutical intervention. In order to realize the long-term goal of personalised treatment approaches, it is important to identify behavioural and biological moderators and mediators of treatment responses. Here, we tested the predictive value of experimental fear extinction efficacy as well as the role of genetic variation of the serotonin transporter gene for the outcome of a fear-exposure treatment. A discriminative fear conditioning paradigm was conducted in 159 adults highly fearful of spiders, dental surgeries or blood, injuries and injections. Participants were genotyped for the long (L) and short (S) allelic variant of the serotonin transporter gene linked polymorphic region (5HTTLPR) and treated with a highly standardized exposure-based one-session treatment. Participants' subjective fear was assessed during experimental fear conditioning and extinction. Furthermore, subjective phobic fear was assessed at pre-, post and at 7 months follow-up treatment assessment. A threat-biased contingency learning pattern characterized by exaggerated fear responses to the CS− was associated with larger initial subjective fear reduction immediately following the large-group treatment, p = .03. There were no learning pattern-associated differences in subjective fear at 7-month follow-up. The odds of homozygous s-allele carriers to display a threat-biased contingency learning pattern were 3.85 times larger compared to l-allele carriers, p = .01. Fear-recovery in homozygous S-allele carriers at follow-up assessment, p = .01, emerged regardless of the experimental fear acquisition pattern. Our results suggest the homozygous S-allele carriers are biologically biased towards ignoring safety signals in threat-related situations. Short-term, this response pattern might be positively related to the outcome of exposure treatments, potentially due to increased responding to safe context conditions or a stronger violation of threat expectancies. However, alterations in inhibiting the response to cues formerly signalling threat evidenced for S-allele carriers can have negative impact on exposure success.

Investigating the Generalizability of Physiological Characteristics of Anxiety

Conference Paper

Dec 2023

Getting Better with Age? A Review of Psychophysiological Studies of Fear Extinction Learning Across Development

Chapter

Sep 2023

A critical developmental task is learning what constitutes reliable threat and safety signals in the environment. In humans, atypical fear learning processes are implicated in many mental health conditions, particularly fear and anxiety disorders, pointing to the potential for laboratory measures of fear learning to facilitate early identification of at-risk individuals. This chapter reviews studies of fear learning and extinction learning that incorporate peripheral measures of psychophysiological response and include a developmental sample. Broadly, these studies indicate substantial consistency in differential learning and extinction across development, as assessed with multiple paradigms, across physiological indices. Importantly, though, response coherence across measures (e.g., physiological, neural, and behavioral) was inconsistent across studies. There was also less consistency in results from studies that probed associations between anxiety and fear learning processes. These mixed findings highlight the need for additional examination of when and why there is variability, both across development and in relation to individual differences factors, including mental health, childhood adversity, and sex. In addition, there remains a need for studies that test for developmental change in extinction recall learning and whether stimulus type impacts learning across development. Longitudinal studies designed to address these questions could provide novel insight into the developmental trajectory of fear learning and extinction.KeywordsFear learningDevelopmentExtinction learningAnxiety

Dopamine release at the time of a predicted aversive outcome causally controls the trajectory and expression of conditioned behavior

Article

Full-text available

Aug 2023

Dopamine release in the nucleus accumbens (NAc) is causally linked to adaptive aversive learning, and its dysregulation is a core phenotype in anxiety and stress disorders. Here, we record NAc core dopamine during a task where mice learn to discriminate between cues signaling two types of outcomes: (1) footshock presentation and (2) footshock omission. We show that dopamine release is evoked by footshock omission. This dopamine response is largest when the omission is unexpected and decreases over learning, and artificially increasing this signal disrupts discrimination learning. Conversely, optogenetic inhibition of dopamine responses to the footshock itself impairs learning. Finally, theory-driven computational modeling suggests that these effects can be explained by dopamine signaling the perceived saliency of predicted aversive events. Together, we elucidate the role of NAc dopamine in aversive learning and offer potential avenues for understanding the neural mechanisms involved in anxiety and stress disorders.

Extinction Learning Across Development: Neurodevelopmental Changes and Implications for Pediatric Anxiety Disorders

Chapter

Aug 2023

Alterations in extinction learning relate to the development and maintenance of anxiety disorders across the lifespan. While exposure therapy, based on principles of extinction, can be highly effective for treating anxiety, many patients do not show sufficient improvement following treatment. In particular, evidence suggests that exposure therapy does not work sufficiently for up to 40% of children who receive this evidence-based treatment.Importantly, fear learning and extinction, as well as the neural circuitry supporting these processes, undergo dynamic changes across development. An improved understanding of developmental changes in extinction learning and the associated neural circuitry may help to identify targets to improve treatment response in clinically anxious children and adolescents. In this chapter, we provide a brief overview of methods used to study fear learning and extinction in developmental populations. We then review what is currently known about the developmental changes that occur in extinction learning and related neural circuitry. We end this chapter with a discussion of the implications of these neurodevelopmental changes for the characterization and treatment of pediatric anxiety disorders.KeywordsExtinction learningAnxietyDevelopmentfMRI

Understanding Human Fear Extinction: Insights from Psychophysiology

Chapter

Aug 2023

The study of fear extinction has been driven largely by Pavlovian fear conditioning methods across the translational spectrum. The primary methods used to study these processes in humans have been recordings of skin conductance (historically termed galvanic skin response) and fear-potentiation of the acoustic startle reflex. As outlined in the following chapter, the combined corpus of this work has demonstrated the value of psychophysiology in better understanding the underlying neurobiology of extinction learning in healthy humans as well as those with psychopathologies. In addition, psychophysiological approaches, which allow for the preservation of methods between species, have shown their applicability to the assessment of wide-ranging treatment effects. The chapter concludes with potential trajectories for future study in this area.KeywordsAcoustic startleFear conditioningPosttraumatic stress disorderPsychophysiologySkin conductance

Anxiety disorders in children and adolescents: A summary and overview of the literature

Article

Jul 2023
BEHAV RES THER

Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.

Relation among, trait anxiety, intolerance to uncertainty and early maltreatment experiences on fear discrimination learning and avoidance generalization online task

Article

Jun 2023
J BEHAV THER EXP PSY

Background and objectives: Early aversive experiences, which have been associated with elevated anxiety and intolerance of uncertainty (IUS), may contribute negatively to fear conditioning learning. The aim of the present study was to analyze the relation among individual differences in childhood maltreatment experiences, trait anxiety, and IUS in adulthood; and to determine how these variables could affect fear learning discrimination and avoidance generalization. Methods: We adapted an avoidance procedure in an online fear learning task. Two pictures of different lamp colors (CS+) were first associated with two aversive images (US), while a third color was not (CS-). Next, clicking a button during one CS + could effectively avoid the US (CS + av), but not during the other (CS + unav). Finally, avoidance generalization was tested to lamp colors that were between CS- and CS + av (safety dimension) and CS + av and CS + unav (avoidability dimension). With a sample of 67 participants, we measured ratings of relief, expectancy, and anxiety, as well as button presses and individual differences (STAI, IUS and MAES). Results: Aversive early experiences were positively related to trait anxiety and intolerance of uncertainty. The results of the task further suggested that maltreatment experience contributes to be more attentive to aversive signals, which could be implicated in leading to difficulties in discrimination learning. Limitations: Online experiments implies some loss of control over subjects and environment that can threaten internal validity. Likewise, the commitment of participants may be low. Conclusions: Results suggest that early aversive experience and anxiety could contribute to the development of IUS, which likely contributes to the development of avoidance behavior.

Fear conditioning is preserved in very preterm-born young adults despite increased anxiety levels

Preprint

Full-text available

Feb 2023

Very preterm birth is associated with an increased risk for anxiety disorders. Abnormal brain development may result in disordered fear learning processes, which may be exacerbated by environmental risk factors and persist in adulthood. We tested the hypotheses that very preterm-born young adults displayed higher levels of fear conditioning, less differentiation between threat, CS+, and safety, CS-, signals and stronger resistance to extinction relative to term-born controls. A group of 37 very preterm-born young adults and 31 age- and sex-matched term-born controls performed a differential fear conditioning paradigm on two consecutive days. Acquisition and extinction training were performed on day 1. Recall and reinstatement were tested on day 2. Preterm-born participants showed significantly higher levels of anxiety in the Depression-Anxiety-Stress-Scale-21 questionnaire. The fear conditioning outcome measures, skin conductance response amplitudes and anxiety ratings, were overall higher in the preterm-born group compared to controls. Acquisition, extinction, recall and reinstatement of differential conditioned fear responses, CS+ > CS-, however, were not significantly different between the groups. There were no significant group by stimulus type interactions. The finding of preserved associative fear learning in very preterm-born young adults was unexpected and needs to be confirmed in future studies.

Pediatric obsessive-compulsive disorder, CBT, and fear extinction learning

Chapter

Jan 2023

From neural circuits to communities: an integrative multidisciplinary roadmap for global mental health

Article

Jan 2023

Suffering due to mental health problems is rising inexorably in all regions of the world. One major reason is that our understanding of the causation, prevention and treatment of mental health problems has been hindered by an over-reliance on diagnostic categories. Yet there is growing evidence for alternative approaches from across multiple disciplines, including neuroscience, which elucidates neural regions and networks underlying specific mental health experiences; cognitive science, which identifies cognitive functions and impairments relevant to mental health; clinical science, which identifies symptom patterns associated with cognitive dysfunctions; developmental science, which identifies environmental influences on brain development in early life; social science, which identifies sociocultural influences on mental health; intervention science, which identifies the ‘active ingredients’ of psychological interventions; and implementation science, which designs scalable interventions to effectively deliver these active ingredients. We propose an integrative model that converges these diverse disciplinary perspectives, from neural circuits to interventions, that can be delivered at scale, with a potential for higher coverage, greater personalization and greater efficacy than traditional diagnostic approaches. This integrative approach can lead to a radical opportunity to shift the needle on mental health-related suffering globally. In this Perspective, the authors propose a new approach to addressing mental health globally that encompasses a breadth of disciplines, from neuroscience to intervention and implementation sciences.

Native and non-native language contexts differently modulate mood-driven electrodermal activity

Article

Full-text available

Dec 2022

Bilingual speakers have been consistently observed to experience reduced emotional sensitivity to their non-native (L2) relative to native (L1) language, particularly to the negatively-valenced L2 content. Yet, little is known about how the L1 and L2 contexts physiologically influence bilinguals’ affective states, such as moods. Here, we show that bilinguals may be less physiologically sensitive to mood changes in the L2 compared to the L1 context. Polish–English bilinguals operating in either the L1 or the L2 mode (elicited via reading L1 and L2 sentences) watched positive and negative mood-inducing films while their electrodermal activity was measured. We observed a greater number of skin conductance responses in the negative compared to positive mood condition in the L1 context only, indexing decreased sensitivity to mood changes in the L2 relative to the L1 mode in bilinguals. Also, skin conductance amplitudes were overall increased in the L2 compared to the L1 context, pointing to increased cognitive load when operating in L2. These findings together suggest that bilinguals experience decreased sensitivity to mood changes in their less dominant language due to L2 processing requiring greater cognitive engagement.

Does fear reduction predict treatment response to exposure for social anxiety disorder?

Article

Dec 2022
J BEHAV THER EXP PSY

Background and objectives: Fear activation and reduction have traditionally been considered important mechanisms of exposure therapy. Evidence to date is mixed and impeded by inadequate methodology. This study examined the extent to which fear activation and reduction within and across exposures predicted treatment outcomes for social anxiety disorder within a paradigm suitable for their measurement. Methods: Sixty-eight adults with social anxiety disorder and fear of public speaking completed seven exposure sessions, each consisting of seven speeches conducted in virtual reality. Exposures were identical in duration, task requirements, and virtual public speaking situation. Fear was measured with skin conductance and subjective distress ratings. At baseline and post-treatment, participants completed a public speaking behavioral approach test with a panel of confederate judges; subjective fear was measured. A standardized questionnaire of anxiety symptoms was administered at baseline, post-treatment, and one-month follow-up. Results: No indices of within- or between-session fear reduction, measured by subjective distress and skin conductance response, predicted treatment outcome. One measure of fear activation was associated with outcomes such that less activation predicted greater symptom reduction; remaining indices did not predict outcomes. Limitations: Data were collected in the context of a randomized controlled trial of scopolamine; drug group was included in analytic models to account for drug influence. VR exposures elicited mild levels of distress that may underestimate levels of distress in clinical settings. Conclusions: Findings failed to support fear activation or reduction within or across exposure sessions as significant predictors of treatment outcome for social anxiety. Treatment implications are discussed.

Unique Associations between Conditioned Cognitive and Physiological Threat Responses and Facets of Anxiety Symptomatology in Youth

Article

Mar 2022
BIOL PSYCHOL

This study examined associations between anxiety symptomatology and cognitive and physiological threat responses during threat learning in a large sample of children and adolescents. Anxiety symptomatology severity along different dimensions (generalized anxiety, separation anxiety, social anxiety, and panic symptoms) was measured using parental and self-reports. Participants completed differential threat acquisition and extinction using an age-appropriate threat conditioning task. They then returned to the lab after 7-10 days to complete an extinction recall task that also assessed threat generalization. Results indicated that more severe overall anxiety was associated with greater cognitive and physiological threat responses during acquisition, extinction, and extinction recall. During acquisition and extinction, all anxiety dimensions manifested greater cognitive threat responses, while panic, separation anxiety, and social anxiety symptoms, but not generalized anxiety, were related to heightened physiological threat responses. In contrast, when we assessed generalization of cognitive threat responses, we found only generalized anxiety symptoms were associated with greater threat response generalization. The study provides preliminary evidence of specificity in threat responses during threat learning across youth with different anxiety symptoms.

Dynamic Alterations in Neural Networks Supporting Aversive Learning in Children Exposed to Trauma: Neural Mechanisms Underlying Psychopathology

Article

Sep 2021
BIOL PSYCHIAT

Background Altered aversive learning represents a potential mechanism through which childhood trauma (CT) might influence risk for psychopathology. This study examines the temporal dynamics of neural activation and patterns of functional connectivity during aversive learning in children with and without exposure to CT involving interpersonal violence, and evaluates whether these neural patterns mediate the association of CT with psychopathology in a longitudinal design. Methods 147 children (aged 8-16 years, 77 with CT) completed a fear conditioning procedure during an fMRI scan. Dynamic patterns of neural activation were examined, and functional connectivity was assessed with generalized psychophysiological interaction analyses. We evaluated whether the associations between CT and psychopathology symptoms at baseline and two-year follow-up were mediated by neural activation and connectivity during aversive learning. Results Children exposed to trauma displayed blunted patterns of neural activation over time to CS+>CS- in right amygdala. Additionally, trauma was associated with reduced functional connectivity of right amygdala with hippocampus, posterior parahippocampal gyrus, and posterior cingulate cortex and elevated connectivity with anterior cingulate cortex (ACC) to CS+>CS-. The longitudinal association between CT and later externalizing symptoms was mediated by blunted activation in right amygdala. Reduced amygdala-hippocampal connectivity mediated the association of CT with transdiagnostic anxiety symptoms, and elevated amygdala-ACC connectivity mediated the association of CT with generalized anxiety symptoms. Conclusions Childhood trauma is associated with poor threat-safety discrimination and altered functional coupling between salience and default mode network regions during aversive learning. These altered dynamics may be key mechanisms linking CT with distinct forms of psychopathology.

Psychotherapieforschung

Chapter

Jan 2021

Safety learning during development: Implications for development of psychopathology

Article

Apr 2021

Fear and safety learning are necessary adaptive behaviors that develop over the course of maturation. While there is a large body of literature regarding the neurobiology of fear and safety learning in adults, less is known regarding safety learning during development. Given developmental changes in the brain, there are corresponding changes in safety learning that are quantifiable; these may serve to predict risk and point to treatment targets for fear and anxiety-related disorders in children and adolescents. For healthy, typically developing youth, the main developmental variation observed is reduced discrimination between threat and safety cues in children compared to adolescents and adults, while lower expression of extinction learning is exhibited in adolescents compared to adults. Such distinctions may be related to faster maturation of the amygdala relative to the prefrontal cortex, as well as incompletely developed functional circuits between the two. Fear and anxiety-related disorders, childhood maltreatment, and behavioral problems are all associated with alterations in safety learning for youth, and this dysfunction may proceed into adulthood with corresponding abnormalities in brain structure and function-including amygdala hypertrophy and hyperreactivity. As impaired inhibition of fear to safety may reflect abnormalities in the developing brain and subsequent psychopathology, impaired safety learning may be considered as both a predictor of risk and a treatment target. Longitudinal neuroimaging studies over the course of development, and studies that query change with interventions are needed in order to improve outcomes for individuals and reduce long-term impact of developmental psychopathology.

Altered functional activations of prefrontal brain areas during emotional processing of fear in Inuit adolescents exposed to environmental contaminants

Article

Mar 2021
NEUROTOXICOL TERATOL

Exposure to mercury, lead and polychlorinated biphenyls (PCBs) have been associated with emotional dysregulation, but their neuronal correlates have yet to be examined. Inuit from Nunavik (Northern Quebec, Canada) face internalizing problems and are among the most exposed individuals to these environmental contaminants in the world. The aim of this study was to examine the link between pre- and postnatal exposure to these contaminants and brain fear-circuitry in Inuit adolescents. Facial expression stimuli were presented to participants (mean age = 18.3 years) in a magnetic resonance imaging (MRI) scanner. Fear conditioning and extinction tasks included neutral faces as the conditioned threat and safety cues and a fearful face paired with a shrieking scream as the unconditioned stimulus. Functional MRI data were gathered at the conditioning phase (n = 71) and at the extinction phase (n = 62). Mercury, lead and PCB 153 concentrations were measured in blood samples at birth (cord blood) and at the time of the adolescent testing to estimate pre- and postnatal exposure, respectively. For each time point, exposures were categorized in tertiles (low, moderate and high exposed groups). Mixed analyses of variance were conducted for each contaminant of interest controlling for sex, age, socioeconomic status, drug/alcohol use, food insecurity and contaminant co-exposure. Results revealed greater differential activation during the conditioning phase in the right orbitofrontal cortex in participants with moderate and high concentrations of cord blood PCB 153 compared to those in the low exposure group. During the extinction phase, the high prenatal mercury exposed group showed a lower differential activation in the right and left anterior cingulate cortex compared to those in the low-exposed group; whereas there was a higher differential activation in right dorsolateral prefrontal cortex in the high postnatal lead exposed group compared to the moderate- and low-exposed groups. Our study is the first to show alterations in the prefrontal brain areas in fear conditioning and extinction tasks in relation to environmental contaminant exposures. The observed brain correlates may advance our understanding of the emotional problems associated with environmental chemical toxicity.

Does Co-Occurring Anxiety Modulate ADHD-Related Cognitive and Neurophysiological Impairments?

Article

Nov 2019

Objective: This study investigates whether anxiety modulates cognitive-performance, electrophysiological and electrodermal processes that we previously found impaired in individuals with ADHD. Method: Self-reported anxiety symptoms, cognitive-electrophysiological measures of response inhibition, working memory, attention, conflict monitoring, error processing, and peripheral arousal during three cognitive tasks were obtained from 87 adolescents and young adults with ADHD and 169 controls. We tested the association of anxiety symptoms with each measure and whether controlling for anxiety symptoms attenuates the ADHD–control difference for each measure. Results: Individuals with ADHD showed significantly elevated anxiety symptoms compared with controls. Only commission errors on a Continuous Performance Test (measuring response inhibition) were significantly associated with anxiety symptoms and only among controls, with the ADHD–control difference in this measure remaining significant. Conclusion: Using a wide range of cognitive, electrophysiological, and electrodermal measures, our investigation suggests, overall, limited malleability of these impairments in individuals with ADHD irrespective of their levels of anxiety.

Chronic harsh parenting and anxiety associations with fear circuitry function in healthy adolescents: A preliminary study

Article

Full-text available

Jul 2019
BIOL PSYCHOL

Previous studies have reported altered fear circuitry function during fear conditioning in highly anxious individuals and in adults with a history of severe childhood adversity; less is known regarding younger populations and more common forms of adversity. We investigated fear circuitry functioning in healthy youths with histories of high (HH) or low (LH) chronic harsh parenting and high (HA) or low (LA) anxiety levels. 84 youths aged 13–16 performed an fMRI fear conditioning task. HH displayed decreased selective medial temporal lobe deactivations to CS+> CS− relative to LH. In addition, we found less amygdala-insula connectivity in HH vs LH. Interestingly, we observed distinct patterns of anxiety differences in amygdala-rostral ACC connectivity and subjective fear ratings depending on harsh parenting levels, suggesting a history of harsh parenting is linked with unique neural and behavioral anxious manifestations, which are different from anxiety manifestations in a context of low adversity. Go to https://authors.elsevier.com/a/1Z65314Stizp10 for free download before July 12 2019

The Effects of the Angiotensin II Receptor Antagonist Losartan on Appetitive Versus Aversive Learning: A Randomized Controlled Trial

Article

Apr 2019
BIOL PSYCHIAT

Background: Exposure therapy is a first-line treatment for anxiety disorders but remains ineffective in a large proportion of patients. A proposed mechanism of exposure involves inhibitory learning whereby the association between a stimulus and an aversive outcome is suppressed by a new association with an appetitive or neutral outcome. The blood pressure medication losartan augments fear extinction in rodents and may have similar synergistic effects on human exposure therapy, but the exact cognitive mechanisms underlying these effects remain unknown. Methods: We used a reinforcement learning paradigm with compound rewards and punishments to test the prediction that losartan augments learning from appetitive relative to aversive outcomes. In a double-blind parallel design, healthy volunteers were randomly assigned to single-dose losartan (50 mg) (n = 28) versus placebo (n = 25). Participants then performed a reinforcement learning task, which simultaneously probes appetitive and aversive learning. Participant choice behavior was analyzed using both a standard reinforcement learning model and analysis of choice switching behavior. Results: Losartan significantly reduced learning rates from aversive events (losses) when participants were first exposed to the novel task environment, while preserving learning from positive outcomes. The same effect was seen in choice switching behavior. Conclusions: This study shows that losartan enhances learning from positive relative to negative events. This effect may represent a computationally defined neurocognitive mechanism by which the drug could enhance the effect of exposure in clinical populations.

Social Skills, Social Outcomes, and Cognitive Features of Childhood Social Phobia

Article

Full-text available

May 1999

Social skills, social outcomes, self-talk, outcome expectancies, and self-evaluation of performance during social-evaluative tasks were examined with 27 clinically diagnosed social phobic children ages 7–14 and a matched nonclinical group. Results showed that, compared with their nonanxious peers, social phobic children demonstrated lower expected performance and a higher level of negative self-talk on social-evaluative tasks. In addition, social phobic children showed social skills deficits as assessed by self- and parent report, an assertiveness questionnaire, and direct behavioral observation. Furthermore, compared with the control group, social phobic children were rated by themselves and others as significantly less socially competent with peers and were found to be less likely to receive positive outcomes from peers during behavioral observation. Implications for the assessment and treatment of childhood social phobia are discussed.

Fears, Phobias, and Preparedness: Toward an Evolved Module of Fear and Fear Learning

Article

Full-text available

Jul 2001

An evolved module for fear elicitation and fear learning with 4 characteristics is proposed. (a) The fear module is preferentially activated in aversive contexts by stimuli that are fear relevant in an evolutionary perspective. (b) Its activation to such stimuli is automatic. (c) It is relatively impenetrable to cognitive control. (d) It originates in a dedicated neural circuitry, centered on the amygdala. Evidence supporting these propositions is reviewed from conditioning studies, both in humans and in monkeys; illusory correlation studies; studies using unreportable stimuli; and studies from animal neuroscience. The fear module is assumed to mediate an emotional level of fear learning that is relatively independent and dissociable from cognitive learning of stimulus relationships.

The psychophysiology of emotion

Article

Full-text available

Jan 2000

Three components of the classically conditioned GSR in human subjects

Article

Full-text available

Feb 1967
J Exp Psychol

3 RESPONSES WERE DEFINED BY A LATENCY CRITERION IN HUMAN GSR CONDITIONING CONDUCTED WITH AN 8-SEC INTERSTIMULUS INTERVAL: 1.35-4.95, 4.95-9.53, AND 9.53-14.55 SEC. AFTER CS ONSET FOR THE 1ST, 2ND, AND 3RD RESPONSES. IT WAS FOUND THAT (1) THE 1ST AND 2ND RESPONSES WERE STATISTICALLY INDEPENDENT; (2) INCREASING THE CS INTENSITY INCREASED 1ST RESPONSE FREQUENCY (BUT NOT AMPLITUDE) AND DID NOT AFFECT THE 2ND RESPONSE AT ALL; (3) OF THE 3 RESPONSES, ONLY THE 2ND DID NOT SHOW A POSTASYMPTOTIC DECREMENT; (4) THE 2ND RESPONSE WAS ESSENTIALLY PROBABILISTIC: NO AMPLITUDE CHANGES WERE OBSERVED; (5) THE 1ST RESPONSE WAS SIMILAR IN MANY RESPECTS TO THE ALPHA RESPONSE IN EYELID CONDITIONING; AND (6) THE 3RD RESPONSE, THOUGH NOT STATISTICALLY INDEPENDENT OF THE 2ND, WAS SUFFICIENTLY DISTINCT TO MERIT FURTHER STUDY. (24 REF.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Human fear learning: Contemporary procedures and measurement

Article

Full-text available

Jan 2006

Ottmar V. Lipp

Major depression and generalized anxiety disorder: Same genes, (partly) different environments?

Article

Full-text available

Oct 1992
ARCH GEN PSYCHIAT

Bivariate twin analysis can determine the extent to which two disorders share common genetic, familial environmental, or individual-specific environmental risk factors. We applied this method to lifetime diagnoses of major depression and generalized anxiety disorder as assessed at personal interview in a population-based sample of 1033 pairs of female same-sex twins. Three definitions of generalized anxiety disorder were used that varied in minimum duration (1 vs 6 months) and in the presence or absence of a diagnostic hierarchy. For all definitions of generalized anxiety disorder, the best-fitting twin model was the same. Familial environment played no role in the etiology of either condition. Genetic factors were important for both major depression and generalized anxiety disorder and were completely shared between the two disorders. A modest proportion of the nonfamilial environmental risk factors were shared between major depression and generalized anxiety disorder. Within the limits of our statistical power, our findings suggest that in women, the liability to major depression and generalized anxiety disorder is influenced by the same genetic factors, so that whether a vulnerable woman develops major depression or generalized anxiety disorder is a result of her environmental experiences.

Habituation: A Dual-Process Theory

Article

Full-text available

Sep 1970

Presented a dual-process theory of response plasticity to repeated stimulation. 2 hypothetical processes, 1 decremental (habituation) and 1 incremental (sensitization), are assumed to develop independently in the CNS and interact to yield the final behavioral outcome. Behavioral experiments are presented, using both the hindlimb flexion reflex of acute spinal cat and the acoustic startle response of intact rat, which are consistent with this theory. Neurophysiological experiments indicate that the 2 processes have separate and distinct neuronal substrates. The dual-process theory and other current theories of response habituation are evaluated in terms of these and other recent findings. (6 p. ref.)

Construct validity of recall and recognition postconditioning measures of awareness

Article

Full-text available

May 1973
J Exp Psychol

Evaluated the construct validity of 4 postconditioning questionnaires using 120 adult Ss within the context of a masked GSR classical conditioning paradigm. A short recognition questionnaire was found to be a more valid and sensitive measure of awareness than short recall, long recall, or long recognition questionnaires. No evidence of unaware differential conditioning was obtained. However, due to inferential limitations associated with all postconditioning questionnaires, it is recommended that future research develop measures of awareness which can be obtained concurrently with the measures of conditioning. (18 ref.)

Sex and anxiety differences in eyelid conditioning

Article

Full-text available

Mar 1966

Data concerning the relationship between eyelid conditioning performance and 2 S variables, Ss' sex, and scores on the MA scale, are examined. In studies employing standard procedures, high-anxiety Ss were superior to low-anxiety Ss in 23 of 27 comparisons, and females superior to males in 18 of 19 comparisons. In contrast, the direction of the differences was split approximately equally between high- and low-anxiety Ss and between males and females in studies in which conditioning was presented within the context of masking probability-learning task. (31 ref.)

Expectancy Bias in Trait Anxiety

Article

Full-text available

Nov 1996

The ability of anxious and control participants to learn about signals for danger and safety was tested within an autonomic conditioned inhibition (A+/AB-) procedure. Only participants who could verbalize the differential contingencies between the stimuli and shock (aware participants) showed discrimination on electrodermal and shock expectancy measures. In Experiment 1, aware high-anxious participants showed similar responding to control participants. However unaware high-anxious participants showed heightened shock expectancy to all stimuli. Experiment 2 replicated this expectancy bias in anxious unaware participants controlling for shock intensity. In both experiments, expectancy bias was associated primarily with anxiety rather than depression. Results support the notion of an interpretive bias in anxious participants under ambiguous threat, consistent with recent findings from information-processing research on linguistic stimuli.

The Multidimensional Anxiety Scale for Children (MASC): Factor Structure, Reliability, and Validity

Article

Full-text available

May 1997
J AM ACAD CHILD PSY

To describe the history, factor structure, reliability, and validity of the Multidimensional Anxiety Scale for Children (MASC). In two separate school-based population studies, principal-components factor analysis was used, first, to test a theory-driven factor structure, and second, to develop an empirically derived factor structure for the MASC. In a separate study using a clinical population, test-retest reliability at 3 weeks and 3 months, interrater concordance, and convergent and divergent validity were examined. The final version of the MASC consists of 39 items distributed across four major factors, three of which can be parsed into two subfactors each. Main and subfactors include (1) physical symptoms (tense/restless and somatic/autonomic), (2) social anxiety (humiliation/rejection and public performance fears), (3) harm avoidance (perfectionism and anxious coping), and (4) separation anxiety. The MASC factor structure, which presumably reflects the in the vivo structure of pediatric anxiety symptoms, is invariant across gender and age and shows excellent internal reliability. As expected, females show greater anxiety on all factors and subfactors than males. Three-week and 3-month test-retest reliability was satisfactory to excellent. Parent-child agreement was poor to fair. Concordance was greatest for easily observable symptom clusters and for mother-child over father-child or father-mother pairs. Shared variance with scales sampling symptom domains of interest was highest for anxiety, intermediate for depression, and lowest for externalizing symptoms, indicating adequate convergent and divergent validity. The MASC is a promising self-report scale for assessing anxiety in children and adolescents.

Individual difference in the acquisition of affectively valenced associations

Article

Full-text available

May 1998

Two studies were conducted to test the predictions derived from the behavioral activation system and behavioral inhibition system theory of personality that trait anxiety is positively related to the speed of acquisition of punishment expectancies and impulsivity is positively related to the speed of acquisition of reward expectancies. Both studies used a standard approach-avoidance discrimination task with self-report measures of expectancies. Both studies found support for the hypothesized relation between trait and acquisition of punishment expectancies but not for the hypothesized relation between impulsivity and acquisition of reward expectancies. Study 2 suggested that the relation between trait anxiety and punishment expectancy is affected by the type of incentive and the type of trait anxiety measure used. The results suggest that highly trait anxious individuals are more susceptible to developing new sources of anxiety than others.

Fear-Potentiated Startle Conditioning to Explicit and Contextual Cues in Gulf War Veterans With Posttraumatic Stress Disorder

Article

Full-text available

Feb 1999

Aversive conditioning to explicit and contextual cues was examined in Gulf War veterans with and without posttraumatic stress disorder (PTSD) by use of the startle reflex methodology. Veterans participated in a differential aversive conditioning experiment consisting of 2 sessions separated by 4 or 5 days. Each session comprised two startle habituation periods, a preconditioning phase, a conditioning phase, and a postconditioning extinction test. In contrast to the non-PTSD group, the PTSD group showed a lack of differential startle response in the presence of a conditioned stimulus with or without an unconditioned stimulus in Session 1 and an increase in the baseline startle response during Session 2. The PTSD group also exhibited normal differential conditioning following reconditioning in Session 2. These data suggest that individuals with PTSD tend to generalize fear across stimuli and are sensitized by stress.

Social skills, social outcomes, and cognitive features of childhood social phobia

Article

Full-text available

Jun 1999

Social skills, social outcomes, self-talk, outcome expectancies, and self-evaluation of performance during social-evaluative tasks were examined with 27 clinically diagnosed social phobic children ages 7-14 and a matched nonclinical group. Results showed that, compared with their nonanxious peers, social phobic children demonstrated lower expected performance and a higher level of negative self-talk on social-evaluative tasks. In addition, social phobic children showed social skills deficits as assessed by self- and parent report, an assertiveness questionnaire, and direct behavioral observation. Furthermore, compared with the control group, social phobic children were rated by themselves and others as significantly less socially competent with peers and were found to be less likely to receive positive outcomes from peers during behavioral observation. Implications for the assessment and treatment of childhood social phobia are discussed.

Vulnerability factors among children at risk for anxiety disorders

Article

Full-text available

Jan 2000
BIOL PSYCHIAT

The high-risk strategy is one of the most powerful approaches for identifying premorbid risk factors and reducing etiologic and phenotypic heterogeneity characteristic of the major psychiatric disorders. This paper reviews the methods of high-risk research and findings from previous high-risk studies of anxiety. The preliminary results of the 6-8 year follow-up of a high-risk study of 192 offspring of probands with anxiety disorders, substance abuse, and unaffected controls are presented. The key study measures include comprehensive diagnostic interviews, symptom ratings, indirect measures of brain functioning (neuropsychologic, neurologic and psychophysiologic function), developmental measures, and family functioning measures. The major findings reveal that there is specificity of familial aggregation of anxiety disorders among parents and children; children at high risk for anxiety have increased startle reflex, autonomic reactivity, and stress reactivity, higher verbal IQ, and deficits in paired associative learning as compared to other children. The finding that family environment and parenting do not differ between children at risk for anxiety disorders and other children, when taken together with the strong degree of specificity of transmission of anxiety disorders, suggests that there may be temperamental vulnerability factors for anxiety disorders in general that may already manifest in children prior to puberty.

De Novo Conditioning in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder

Article

Full-text available

May 2000

Differential conditioning was assessed in 15 medication-free individuals meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for chronic posttraumatic stress disorder (PTSD) and 18 trauma-exposed individuals who never developed PTSD (non-PTSD). Conditioned stimuli (CSs) were colored circles, and the unconditioned stimulus was a "highly annoying" electrical stimulus. Individuals with PTSD had higher resting heart rate (HR) and skin conductance (SC) levels and produced larger SC orienting responses. During conditioning, the PTSD group showed larger differential SC, HR, and electromyogram responses to the reinforced vs. nonreinforced stimuli (CS+ vs. CS-) compared with the non-PTSD group. Only PTSD participants continued to show differential SC responses to CS+ vs. CS- during extinction trials. Results suggest that individuals with PTSD have higher sympathetic nervous system arousal at the time of conditioning and are more conditionable than trauma-exposed individuals without PTSD.

The Association Between Psychopathology in Fathers Versus Mothers and Children's Internalizing and Externalizing Behavior Problems: A Meta-Analysis

Article

Full-text available

Sep 2002

In light of the selective focus on maternal (vs. paternal) psychopathology as a risk factor for child development, this meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children. Associations were stronger between maternal than paternal psychopathology and the presence of internalizing (but not externalizing) problems in children, with all average effect sizes being small in magnitude. Relations were moderated by variables that highlight theoretically relevant differences between psychopathology in mothers versus fathers (e.g., age of children studied, type of parental psychopathology) and by variables related to methodological differences across studies (e.g., method of assessing psychopathology in parents and children, type of sample recruited, familial composition).

Neuroticism: A non-informative marker of vulnerability to psychopathology

Article

Full-text available

Dec 2004

Neuroticism measures are very popular in psychopathological research, but it is unclear how useful neuroticism is in studies of the aetiology of psychopathology. A conceptual examination was made of the literature on the association of neuroticism and psychopathology, the ontological status of neuroticism, the purport of neuroticism questionnaires, and causal issues. The research on which neuroticism is built has historically been based solely on the factor analyses of the common adjectives used to describe usual behaviours. An abundance of studies have shown that neuroticism scores predict life stress, psychological distress, emotional disorders, psychotic symptoms, substance abuse, physical tension-related symptoms, medically unexplained physical symptoms, and health care utilisation. This evidence suggests that neuroticism scales index vulnerability to many forms of negative affect and psychiatric disorder. However, the associations do not clarify the nature of this vulnerability nor the underlying psychobiological mechanisms. We present evidence that neuroticism scores reflect a person's characteristic (or mean) level of distress over a protracted period of time. In this perspective, even prospective associations of neuroticism with mental health outcomes are basically futile, and largely tautological since scores on any characteristic with substantial within-subject stability will predict, by definition, that characteristic and related variables at later points in time. Neuroticism is not an explanatory concept in the aetiology of psychopathology, since it measures a person's characteristic level of distress over a protracted period of time. This situation will not change until knowledge becomes available about: (i) the mechanisms that produce high neuroticism scores (and, therefore, also psychopathology) and (ii) its neurobiological substrate. Only then will we understand why neuroticism appears to "predict" the outcomes it predicts.

Anxiety Disorders Interview for DSM-IV: Client Interview Schedule

Article

Jan 1999
J Cognit Psychother

Classical fear-conditioning in the anxiety disorders: A meta-analysis

Conference Paper

Apr 2004
BIOL PSYCHIAT

Classical Conditioning

Chapter

Dec 1973

Neural Systems Involved in Fear Inhibition: Extinction and Conditioned Inhibition

Chapter

Jan 2000

“I can’t get the memories out of my mind! The images come flooding back in vivid detail, triggered by the most inconsequential things, like a door slamming or the smell of stir-fried pork. Last night, I went to bed, was having a good sleep for a change. Then in the early morning a storm-front passed through and there was a bolt of crackling thunder. I awoke instantly, frozen in fear. I am right back in Viet Nam, in the middle of the monsoon season at my guard post. I am sure I’ll get hit in the next volley and convinced I will die. My hands are freezing, yet sweat pours from my entire body. I feel each hair on the back of my neck standing on end. I can’t catch my breath and my heart is pounding. I smell a damp sulfur smell. Suddenly I see what’s left of my buddy Troy, his head on a bamboo platter, sent back to our camp by the Viet Cong. Propaganda messages are stuffed between his clenched teeth. The next bolt of lightning and clap of thunder makes me jump so much that I fall to the floor..... ” (Paraphrased from a war veteran’s conversations with Dr. R. L. Gelman, Dept. of Psychiatry, Yale University School of Medicine).

Techniques in psychophysiology

Article

Jan 1980

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arc Gen Psychiatry 62: 593-602

Article

Jul 2005
ARCH GEN PSYCHIAT

Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:593-602), an author’s name was inadvertently omitted from the byline and author affiliations footnote on page 592, and another author’s affiliation was listed incorrectly. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” The author affiliations footnote should have appeared as follows: “Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler; Mss Demler and Walters; and Mr Jin); Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); and Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Rockville, Md (Dr Merikangas).” On page 601, the first sentence of the acknowledgment should have appeared as follows: “The authors appreciate the helpful comments of William Eaton, PhD, and Michael Von Korff, ScD.” Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.

The Neuropsychology of Anxiety: An enquiry into the function of the septo-hippocampal system

Article

Jan 1982

J. A. G. Gray

This book provides an updated theory of the nature of anxiety and the brain systems controlling anxiety, combined with a theory of hippocampal function, which was first proposed thirty years ago. While remaining controversial, the core of this theory, of a 'Behavioural Inhibition System', has stood the test of time, with its main predictions repeatedly confirmed. Novel anti-anxiety drugs share none of the side effects or primary pharmacological actions of the classical anti-anxiety drugs on the actions of which the theory was based; but they have both the behavioural and hippocampal actions predicted by the theory. This text is the second edition of the book and it departs significantly from the first. It provides, for the first time, a single construct - goal conflict - that underlies all the known inputs to the system; and it includes current data on the amygdala. Its reviews include the ethology of defence, learning theory, the psychopharmacology of anti-anxiety drugs, anxiety disorders, and the clinical and laboratory analysis of amnesia. The cognitive and behavioural functions in anxiety of the septo-hippocampal system and the amygdala are also analysed, as are their separate roles in memory and fear. Their functions are related to a hierarchy of additional structures - from the prefrontal cortex to the periaqueductal gray - that control the various forms of defensive behaviour and to detailed analysis of the monoamine systems that modulate this control. The resultant neurology is linked to the typology, symptoms, pre-disposing personality and therapy of anxiety and phobic disorders, and to the symptoms of amnesia. © Jeffrey A. Gray and Neil McNaughton 2000 , 2003. All rights reserved.

Part VI. Evaluating evaluative conditioning: Some comments on “cognitions, evaluations, and conditioning: Rules of sequence and rules of consequence” by Levey and Martin

Article

Dec 1983
Adv Behav Res Ther

Arne Öhman

Contends that A. B. Levey and I. Martin (see record 1984-21205-001) have not made the case that evaluative responses are the necessary and sufficient components of conditioning. It is suggested that they are silent on current research that shows the UCS must be surprising in classical conditioning. It is further contended that "preattentive processes" are involved in what Levey and Martin call evaluative conditioning. (33 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Magnitude and habituation of the orienting reaction as predictors of discriminative electrodermal conditioning

Article

Apr 1973

Separated the effect of magnitude and rate of habituation of the orienting response (OR) on electrodermal conditioning simultaneously grouping college students (N = 55) according to the magnitude of response to the 1st CS during an initial habituation phase of a discriminative conditioning experiment, and according to whether Ss habituated or not during 12 CS-alone presentations. Thus, 4 groups, habituators and nonhabituators high or low in OR, were formed. It was found that OR magnitude had no predictive power with regard to subsequent conditioning. However, compared to habituators, Ss who did not habituate showed (a) larger overall CS, pre-UCS, and post-UCS responses during both conditioning and extinction; (b) superior CS response discrimination during extinction; and (c) better pre-UCS response conditioning both during conditioning and extinction. (27 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Fear and learning: From basic processes to clinical implications

Article

Jan 2006

The goal of this volume is to bring together the most recent empirical and theoretical developments in the basic science of fear learning and to translate these developments to the clinical understanding and treatment of fears and phobias. A major impetus for the volume was the recognition that basic science in fear learning is advancing far more rapidly than the clinical application of this knowledge. The book is structured to cover three main areas. The first presents the history of fear learning theory and fear measurement. The second area examines the acquisition and maintenance of fear, including neural circuitry, associative pathways, and cognitive mechanisms; the role of avoidance; and individual differences in fear learning. The third area covers the extinction, renewal, and reinstatement of fear, including neural circuitry and context dependency. The volume developed out of the Special Interest Meeting on Fear and Learning in Lignely, Belgium (May 2003), sponsored by the Fund for Scientific Research in Flanders, Belgium, and inspired by Paul Eelen. This volume is intended for both basic scientists and clinical scientists at undergraduate, graduate, and more advanced levels, as well as practicing clinicians who are interested in gaining an in-depth understanding of learning theory as it applies to fear and anxiety. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-hippocampal System

Article

Sep 1982
BEHAV BRAIN SCI

Jeffrey A. Gray

A model of the neuropsychology of anxiety is proposed. The model is based in the first instance upon an analysis of the behavioural effects of the antianxiety drugs (benzodiazepines, barbiturates, and alcohol) in animals. From such psychopharmacologi-cal experiments the concept of a “behavioural inhibition system” (BIS) has been developed. This system responds to novel stimuli or to those associated with punishment or nonreward by inhibiting ongoing behaviour and increasing arousal and attention to the environment. It is activity in the BIS that constitutes anxiety and that is reduced by antianxiety drugs. The effects of the antianxiety drugs in the brain also suggest hypotheses concerning the neural substrate of anxiety. Although the benzodiazepines and barbiturates facilitate the effects of γ-aminobutyrate, this is insufficient to explain their highly specific behavioural effects. Because of similarities between the behavioural effects of certain lesions and those of the antianxiety drugs, it is proposed that these drugs reduce anxiety by impairing the functioning of a widespread neural system including the septo-hippocampal system (SHS), the Papez circuit, the prefrontal cortex, and ascending monoaminergic and cholinergic pathways which innervate these forebrain structures. Analysis of the functions of this system (based on anatomical, physiological, and behavioural data) suggests that it acts as a comparator: it compares predicted to actual sensory events and activates the outputs of the BIS when there is a mismatch or when the predicted event is aversive. Suggestions are made as to the functions of particular pathways within this overall brain system. The resulting theory is applied to the symptoms and treatment of anxiety in man, its relations to depression, and the personality of individuals who are susceptible to anxiety or depression.

Preparedness” and “Arousability” as determinants of electrodermal conditioning

Article

Feb 1977
BEHAV RES THER

‘Arousability’, as defined through spontaneous electrodermal responses, has been empirically linked to anxiety, phobic symptoms and outcome of systematic desensitization. Previous data from our laboratory indicate that ‘preparedness’, as defined through potentially phobic vs. fear-irrelevant or ‘neutral’ conditioned stimuh, is an important determinant of electrodermal conditioning. The present experiment compared groups selected to be high or low in spontaneous responding during differential conditioning to potentially phobic or neutral stimuh. It was found that the effects of these two factors were essentially additive, i.e. conditioning and resistance to extinction were better for phobic stimuli and for high-arousal groups. The high-aroused group with phobic stimuh showed diffuse responding during acquisition, not differentiating between reinforced and unreinforced cues. However, it was the only group that failed to extinguish during 20 trials, which indicates that high arousal gives superior resistance to extinction particularly for phobic stimuli.

Characterization of a psychophysiological model of classical fear conditioning in healthy volunteers

Article

Feb 1991

Two experiments are described which evaluate the role of associative mechanisms and placebo effects on aversively conditioned skin conductance responses in groups of healthy volunteers. In both experiments, skin conductance level (SCL), variability (spontaneous fluctuations, SF) and amplitude (SCR) were recorded during a sequence of tone stimuli (80 dB, 1 s, 360 Hz). All the variables habituated during the first ten presentations of the tones. Tone 11 was immediately followed by a loud (100 dB) aversive brief (1 s) white noise UCS. The conditioning trial significantly enhanced SCRs to a further ten presentations of the tones and increased SCL and variability (SF). No enhancement of SCRs occurred when tone 11 was omitted and the UCS occurred in temporal isolation (experiment 1). Thus enhanced SCRs to tones following paired tone-noise presentation involves an associative mechanism. Increased "spontaneous" variability was shown to involve both conditioning and sensitization following the UCS. In both experiments females showed greater conditioned SCRs than males. In experiment 2 no effect of "anxiolytic" placebo could be discerned and there were no general relationships between questionnaires scores of extraversion or neuroticism with skin conductance measures in a group of 40 volunteers. The results question the role of conditionability and autonomic lability as major determinants of extraversion and neuroticism. These studies validate the use of the psychophysiological model of aversive conditioning in pharmacological studies of the mechanisms of habituation, conditioning and sensitization.

The Anxiety Disorders Interview Schedule for Children (ADIS-C)

Article

Dec 1988
J AM ACAD CHILD PSY

The reliability of DSM-III/DSM-III-R childhood anxiety disorder diagnoses was determined using a new semistructured interview, the Anxiety Disorders Interview Schedule for Children child and parent versions (ADIS-C and ADIS-P). The interviewer-observer paradigm was used. Pairs of independent clinicians examined 51 outpatients and their mothers and assigned independent primary and secondary diagnoses. Product-moment correlations were calculated between pairs of raters and by computing kappa coefficients, based upon perfect matches on primary diagnoses. Both overlap and differences were evident in the anxiety disorders diagnosed. Agreement between clinicians was moderate to high, with the exception of overanxious disorder. The latter resulted in a low kappa coefficient based upon the child interview data only. Reasons for diagnostic disagreements between the parent and child interviews are discussed.

The Children's Depression inventory (CDI)

Article

Feb 1985
Psychopharmacol Bull

Maria Kovacs

Rating Scales to Assess Depression in School-Aged Children

Article

Mar 1981

Maria Kovacs

To assess the severity of depression in school-aged children, self-report, clinician-rated and peer-rated instruments have been developed. Since these rating scales attempt to quantify an alleged clinical phenomenon, they represent a needed step toward more systematic scientific research into childhood depression. On the other hand, they are not diagnostic tools. The available instruments are promising but are still experimental. Additional data are needed to support their usefulness and accuracy as measurement devices.

Social Consequences of Psychiatric Disorders, I: Educational Attainment

Article

Aug 1995

This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented. The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population. Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts. Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.

Classical conditioning in children with Attention Deficit Hyperactivity Disorder (ADHD) and anxiety disorders: A test of Quay's model

Article

Sep 1993

Quay (1988) put forward a model of childhood mental disorders based on Gray's (1982) theory that there exists within the brain a behavioral inhibition system (BIS), which processes signals related to aversive or punishing stimuli. According to this model, children with attention deficit hyperactivity disorder (ADHD) show lower than optimal levels of activity in this system, which leads to less responsiveness at a physiological level to signals related to punishment. Children with ADHD and controls were compared on a classical conditioning paradigm. Skin conductance and cardiac responses were measured in response to a conditioned stimulus that had been paired with an aversive unconditioned stimulus. There were no differences between the groups, suggesting that, in terms of classical conditioning, ADHD children are equally responsive to signals related to punishment as controls.

The Risk for Early-Adulthood Anxiety and Depressive Disorders in Adolescents With Anxiety and Depressive Disorders

Article

Feb 1998
ARCH GEN PSYCHIAT

Various studies find relationships among anxiety and depressive disorders of adolescence and adulthood. This study prospectively examines the magnitude of longitudinal associations between adolescent and adult anxiety or depressive disorders. An epidemiologically selected sample of 776 young people living in upstate New York received DSM-based psychiatric assessments in 1983, 1985, and 1992 using structured interviews. The magnitude of the association between adolescent and adult anxiety or depressive disorders was quantified using odds ratios generated from logistic regression analyses and from a set of latent Markov analyses. We focus on longitudinal associations among narrowly defined DSM anxiety or depressive disorders. In simple logistic models, adolescent anxiety or depressive disorders predicted an approximate 2- to 3-fold increased risk for adulthood anxiety or depressive disorders. There was evidence of specificity in the course of simple and social phobia but less specificity in the course of other disorders. Results from the analyses using latent variables suggested that while most adolescent disorders were no longer present in young adulthood, most adult disorders were preceded by adolescent disorders. An anxiety or depressive disorder during adolescence confers a strong risk for recurrent anxiety or depressive disorders during early adulthood. Most anxiety and depressive disorders in young adults may be preceded by anxiety or depression in adolescence.

Linking Self-Reported Childhood Behavioral Inhibition to Adolescent Social Phobia

Article

Jan 1999
J AM ACAD CHILD PSY

Behavioral inhibition in children has been hypothesized to be a risk factor for the later development of social phobia. However, this hypothesis has yet to be demonstrated in a prospective study. The purpose of the study presented here is to test whether behavioral inhibition in childhood constitutes a risk factor for social phobia during adolescence. The sample consisted of 2,242 high school students assessed over a 4-year period. Assessments included self-report questionnaires, structured clinical interviews, and measurements of heart rate. Cox proportional hazards models were used to evaluate risk. Social avoidance, a component of behavioral inhibition, predicted onset of social phobia during high school. However, social avoidance was not related to depression in adolescence. Another component of behavioral inhibition, fearfulness, increased the risk for both social phobia and depression. Among subjects who were both socially avoidant and fearful, 22.3% developed social phobia--a risk more than four times greater than that for subjects with neither feature of behavioral inhibition. This prospective study demonstrates that behavioral inhibition in childhood increases the risk of social phobia in adolescence.

Adolescent Social Anxiety as an Outcome of Inhibited Temperament in Childhood

Article

Sep 1999
J AM ACAD CHILD PSY

Chess and Thomas suggested that temperament might make a contribution to social phobia and other forms of extreme social anxiety. This study provides the first investigation of the outcomes in adolescents who had been inhibited (subdued to and avoidant of novelty) or uninhibited (approaching novelty) in the second year of life, utilizing both direct interview and direct observation. Seventy-nine subjects, aged 13 years, who had been classified as inhibited or uninhibited in the second year were assessed with both standardized interview and direct observation. There was a significant association between earlier classification of a child as inhibited and generalized social anxiety at adolescence, but no association with specific fears, separation anxiety, or performance anxiety. The adolescents who were classified as socially anxious made fewer spontaneous comments than those without social anxiety; no relation was seen between any other type of fear and the number of spontaneous comments. Adolescent girls who had been inhibited as toddlers were more likely to be impaired by generalized social anxiety than boys. The interview and observational data indicate that important aspects of an inhibited temperament are preserved from the second year of life to early adolescence, which predispose an adolescent to social anxiety.

How serious are common childhood fears?

Article

Apr 2000
BEHAV RES THER

The present study examined the clinical status of common childhood fears. Fears of the 290 children aged 8 to 13 years were assessed and then their severity was explored by means of a structured diagnostic interview measuring anxiety disorders according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Childhood fears reflect significant anxiety disorders in a substantial minority (i.e. 22.8%) of the children. In most children, childhood fears are part of the normal development. However, in some children, these fears reflect serious anxiety problems which interfere with daily routine.

Peri T, Ben-Shankhar G, Orr SP, Shalev AY. Psychophysiologic assessment of aversive conditioning in posttraumatic stress disorder. Biol Psychiat 47: 512-519

Article

Apr 2000
BIOL PSYCHIAT

The objective of this study was to evaluate the acquisition, generalization, and extinction of conditioned physiologic responses to aversive stimuli in posttraumatic stress disorder (PTSD). Thirty-six PTSD patients, 20 individuals with past trauma and no current PTSD, and 30 mentally healthy individuals without exposure to major trauma underwent a differential aversive conditioning experiment. Bursts of 105 dB white noise were used as unconditioned stimuli (UCSs), and 35x24 mm slides of different colors served as either CS+ (paired) or CS- (unpaired) stimuli. Heart rate (HR) and nondominant palm skin conductance (SC) were measured at rest and between 1 and 4 sec following each CS presentation. The PTSD group showed higher levels of resting SC and resting HR, larger SC responses to the initial presentation of unpaired CSs, larger HR responses following paired CS+ stimuli, larger SC responses to unpaired CS- during acquisition and extinction, and larger SC and HR responses to CS+ during extinction. The group differences in responses to CS+ during extinction remained statistically significant after controlling for age, resting physiologic levels, and initial responsivity. PTSD is associated with elevated autonomic responses to both innocuous and aversive stimuli, with larger responses to unpaired cues and with reduced extinction of conditioned responses.

Patterns of Psychopathology and Dysfunction in High-Risk Children of Parents With Panic Disorder and Major Depression

Article

Feb 2001

The purpose of the study was to evaluate 1) whether an underlying familial predisposition is shared by all anxiety disorders or whether specific risks are associated with specific disorders, and 2) whether panic disorder and major depression have a familial link. The study compared four groups of children: 1) offspring of parents with panic disorder and comorbid major depression (N=179), 2) offspring of parents with panic disorder without comorbid major depression (N=29), 3) offspring of parents with major depression without comorbid panic disorder (N=59), and 4) offspring of parents with neither panic disorder nor major depression (N=113). Parental panic disorder, regardless of comorbidity with major depression, was associated with an increased risk for panic disorder and agoraphobia in offspring. Parental major depression, regardless of comorbidity with panic disorder, was associated with increased risks for social phobia, major depression, disruptive behavior disorders, and poorer social functioning in offspring. Both parental panic disorder and parental major depression, individually or comorbidly, were associated with increased risk for separation anxiety disorder and multiple (two or more) anxiety disorders in offspring. These findings confirm and extend previous results documenting significant associations between the presence of panic disorder and major depression in parents and patterns of psychopathology and dysfunction in their offspring.

Fears, Phobias, and Preparedness: Toward an Evolved Module of Fear and Fear Learning

Article

Aug 2001

Test-Retest Reliability of Anxiety Symptoms and Diagnoses With the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions

Article

Sep 2001
J AM ACAD CHILD PSY

To examine the test-retest reliability of the DSM-IV anxiety symptoms and disorders in children with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions (ADIS for DSM-IV:C/P). Sixty-two children (aged 7-16 years) and their parents underwent two administrations of the ADIS for DSM-IV:C/P with a test-retest interval of 7 to 14 days. Results revealed that the ADIS for DSM-IV:C/P is a reliable instrument for deriving DSM-IV anxiety disorder symptoms and diagnoses in children. The ADIS for DSM-IV:C/P was found to have excellent reliability in symptom scale scores for separation anxiety disorder, social phobia, specific phobia, and generalized anxiety disorder and good to excellent reliability for deriving combined diagnoses of these disorders, as well as using child-only and parent-only interview information. Reliability coefficients were generally similar and, in most instances, superior to those found in previous ADIS-C/P reliability studies. Limitations and directions for future research are discussed.

Brain circuits involved in emotional learning in antisocial behavior and fear

Article

Sep 2002
NEUROSCI LETT

While psychopaths (PP) lack anticipatory fear, social phobics (SP) are characterized by excessive fear. Criminal PP, SP and healthy controls (HC) participated in differential aversive delay conditioning with neutral faces as conditioned (CS) and painful pressure as unconditioned stimuli. Functional magnetic resonance imaging revealed differential activation in the limbic-prefrontal circuit (orbitofrontal cortex, insula, anterior cingulate, amygdala) in the HC. By contrast, the PP displayed brief amygdala, but no further brain activation. The SP showed increased activity to the faces in the amygdala and orbitofrontal cortex already during habituation. Thus, a hypoactive frontolimbic circuit may represent the neural correlate of psychopathic behavior, whereas an overactive frontolimbic system may underly social fear.

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions

Article

Sep 2002

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.

Impairment in Childhood Anxiety Disorders: Preliminary Examination of the Child Anxiety Impact Scale-Parent Version

Article

Feb 2004

Although anxiety disorders are prevalent among children and adolescents, with a chronic and often disabling course, there is a paucity of research examining the specific ways in which anxiety interferes with various domains of functioning in childhood. The purpose of the current investigation was to examine the initial reliability and construct validity of the Child Anxiety Impact Scale-Parent version (CAIS-P). The CAIS-P is a parent-report measure consisting of School, Social, and Home/Family subscales. In a clinical sample (N = 92), the internal reliability and the convergent and divergent validity were evaluated. Internal consistency was good for the total score as well as each subscale (Cronbach's alpha ranged from 0.73-0.87). The CAIS-P total score demonstrated good construct validity, showing predicted significant correlations with the Child Behavior Checklist Internalizing Scale and the Child Depression Inventory but not the Externalizing Scale of the Child Behavior Checklist. The Social subscale of the CAIS-P was also significantly correlated with measures of social anxiety. The results provide initial support that the CAIS-P is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning.

Classical fear conditioning in the anxiety disorders: A meta-analysis

Article

Dec 2005
BEHAV RES THER

Fear conditioning represents the process by which a neutral stimulus comes to evoke fear following its repeated pairing with an aversive stimulus. Although fear conditioning has long been considered a central pathogenic mechanism in anxiety disorders, studies employing lab-based conditioning paradigms provide inconsistent support for this idea. A quantitative review of 20 such studies, representing fear-learning scores for 453 anxiety patients and 455 healthy controls, was conducted to verify the aggregated result of this literature and to assess the moderating influences of study characteristics. Results point to modest increases in both acquisition of fear learning and conditioned responding during extinction among anxiety patients. Importantly, these patient-control differences are not apparent when looking at discrimination studies alone and primarily emerge from studies employing simple, single-cue paradigms where only danger cues are presented and no inhibition of fear to safety cues is required.

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

Article

Jul 2005
ARCH GEN PSYCHIAT

Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

Evidence for retarded extinction of aversive learning in anxious children

Article

Nov 2006
BEHAV RES THER

The habituation to intense acoustic stimuli and the acquisition of differentially conditioned fear were assessed in 53 clinically anxious and 30 non-anxious control children and young adolescents. Anxious children tended to show larger electrodermal responses during habituation, but did not differ in blink startle latency or magnitude. After acquisition training, non-anxious children rated the CS+ as more fear provoking and arousing than the CS- whereas the ratings of anxious children did not differ. However, anxious children rated the CS+ as more fear provoking after extinction, a difference that was absent in non-anxious children. During extinction training, anxious children displayed larger blink magnitude facilitation during CS+ and a trend towards larger electrodermal responses, a tendency not seen in non-anxious children. These data suggest that extinction of fear learning is retarded in anxious children.

Is aversive learning a marker of risk for anxiety disorder in children?

Abstract

No full-text available

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