Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n?=?30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

     

Anxiety sensitivity moderates the painful effects of feeling burdensome to others

Perceived burdensomeness (PB), the perception of being a burden to others, is associated with pain and physical symptoms. Anxiety sensitivity (AS), the fear of arousal-related sensations, arising from beliefs that the sensations may have adverse personal consequences (physical, cognitive, and social), may increase risk for pain responding, particularly in anxiety-provoking (e.g. socially threatening) contexts. Accordingly, individuals high in AS may have a stronger pain response when experiencing PB than those low in AS. Undergraduate participants (n = 262) completed the Anxiety Sensitivity Index (ASI-3), and then were randomly assigned to re-live an experience when they were either burdensome to others (burdensome condition) or contributed equally to a group (control condition). Both social and physical self-reported pain were assessed post-manipulation. Those high in AS reported significantly higher pain ratings in the burdensome condition than the control condition; for those low in AS, pain did not change across conditions. In particular, being fearful of the physical repercussions of anxiety (AS physical concerns) while also feeling burdensome to others was associated with greater physical pain. AS may exacerbate the already painful effects of feeling burdensome to others, and may have important implications for the development of future suicide- and pain-related interventions.     

Latent growth curve analysis of fear during a speech task before and after treatment for social phobia

Models of social phobia highlight the importance of anticipatory anxiety in the experience of fear during a social situation. Anticipatory anxiety has been shown to be highly correlated with performance anxiety for a variety of social situations. A few studies show that average ratings of anxiety during the anticipation and performance phases of a social situation decline following treatment. Evidence also suggests that the point of confrontation with the feared stimulus is the peak level of fear. No study to date has evaluated the pattern of anxious responding across the anticipation, confrontation, and performance phases before and after treatment, which is the focus of the current study. Socially phobic individuals (N = 51) completed a behavioral avoidance task before and after two types of manualized cognitive behavioral therapy, and gave ratings of fear during the anticipation and performance phases.Results from latent growth curve analysis were the same for the two treatments and suggested that before treatment, anxiety sharply increased during the anticipation phase, was highly elevated at the confrontation, and gradually increased during the performance phase. After treatment, anxiety increased during the anticipation phase, although at a much slower rate than at pretreatment, peaked at confrontation, and declined during the performance phase. The findings suggest that anticipatory experiences are critical to the experience of fear for public speaking and should be incorporated into exposures.     

The cortisol awakening response: Associations with trait anxiety and stress reactivity

This study investigated the extent to which trait anxiety and state anxiety in response to stress are associated with the cortisol awakening response (CAR).Fifty-one healthy participants were recruited. State anxiety measures were taken in anticipation of and during a laboratory stressor. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) on two consecutive mornings. Cortisol awakening response was assessed by the area under the curve with respect to zero (AUC_G).The magnitude of the CAR was found to be negatively associated with both trait anxiety and anticipatory anxiety. Moreover, regression analysis showed that the effects of trait anxiety on the AUC_G were mediated by anticipatory anxiety.These results suggest that the CAR is influenced by trait anxiety. Moreover, the effect of trait anxiety on the CAR seems to operate by impacting on psychological stress reactivity (i.e., anticipatory anxiety).     

Timing is everything: Anticipatory stress dynamics among cortisol and blood pressure reactivity and recovery in healthy adults

Psychological states of anticipation modulate biological stress responsivity. While researchers generally investigate how subjective distress corresponds to the magnitude of stress reactivity, physiological recovery after acute stressors must also be considered when investigating disease vulnerabilities. This study assessed whether anticipatory stress would correspond to stress reactivity and recovery of salivary cortisol and blood pressure levels in response to a well-validated psychosocial stressor. Thirty participants (63% female; mean?±?SEM age 45.4?±?2.12 years) were exposed to the Trier Social Stress Test (TSST) consisting of a public speech and mental arithmetic. Ten salivary cortisol samples and systolic and diastolic blood pressure recordings were collected at time points spanning 50?min before and up to 50?min after stress exposure. These data were transformed into parameters representing stress reactivity (area under the curve) and stress recovery (percent change). The Primary Appraisal Secondary Appraisal scale assessed anticipatory stress before exposure to the TSST. Our results revealed that increased anticipatory stress predicted increased stress reactivity for cortisol (p?=?0.009) but not blood pressure. For stress recovery, increased anticipatory stress predicted greater decrements of cortisol concentration (p?=?0.015) and blood pressure (p?=?0.039), even when controlling for total systemic "output" by incorporating baseline activity. This efficient shutdown of stress responses would have otherwise been ignored by solely investigating reactive increases. These findings underscore the importance of measuring multiple dynamic parameters such as recovery when investigating physiological stress response patterns as a function of psychosocial factors.     

Objective and perceived physiological arousal in trait social anxiety and post-event processing of a prepared speaking task

This study investigated the influence of trait social anxiety on subjective and physiological responses to an anticipated stressor. Seventy normotensive female students characterized as either high or low in social anxiety engaged in a demanding speech task after an anticipation period of one week that provided opportunity to prepare for the task. Trait social anxiety substantially influenced objective and perceived physiological arousal. High socially anxious individuals displayed greater heart rate reactivity and greater increases in perceived arousal that were in excess of objective HR reactivity. Perceived, but not objective arousal, partially mediated the relationship between social anxiety and negative post-task reappraisals of perceived coping resources. Furthermore, self-evaluations were found to be an essential determinant of post-task rumination. The results provide support for central predictions of cognitive models on social phobia.     

On the distinction between physical and psychological stressors

The distinction between physical and psychological stressors is reviewed, including some implications for anxiety research. The relationships among anxiety states, anxiety traits, and type of stressor are complex and can be influenced by such factors as the preciseness by which the stressor is identified, how it is measured, and the coping mechanisms available to deal with the stress. The choice of appropriate state and trait anxiety measures is crucial when assessing the differential impact of physical and psychological stressors.     

Social Anxiety–Linked Attention Bias to Threat Is Indirectly Related to Post-Event Processing Via Subjective Emotional Reactivity to Social Stress

Attention bias to threat (e.g., disgust faces) is a cognitive vulnerability factor for social anxiety occurring in early stages of information processing. Few studies have investigated the relationship between social anxiety and attention biases, in conjunction with emotional and cognitive responses to a social stressor. Elucidating these links would shed light on maintenance factors of social anxiety and could help identify malleable treatment targets. This study examined the associations between social anxiety level, attention bias to disgust (AB-disgust), subjective emotional and physiological reactivity to a social stressor, and subsequent post-event processing (PEP). We tested a mediational model where social anxiety level indirectly predicted subsequent PEP via its association with AB-disgust and immediate subjective emotional reactivity to social stress. Fifty-five undergraduates (45% female) completed a passive viewing task. Eye movements were tracked during the presentation of social stimuli (e.g., disgust faces) and used to calculate AB-disgust. Next, participants gave an impromptu speech in front of a video camera and watched a neutral video, followed by the completion of a PEP measure. Although there was no association between AB-disgust and physiological reactivity to the stressor, AB-disgust was significantly associated with greater subjective emotional reactivity from baseline to the speech. Analyses supported a partial mediation model where AB-disgust and subjective emotional reactivity to a social stressor partially accounted for the link between social anxiety levels and PEP.     

Preparing for racial microaggressions: The role of cognition and emotion in the proactive coping process of African American college students

Traditionally, conceptual models of racial stressors (including racial microaggressions) have characterized the reactive experiences of African Americans, particularly identifying how African Americans cognitively, emotionally, and behaviorally respond to racial stress. The current study extends beyond the reactive coping experience and identifies nuances in the anticipatory and preparatory coping processes associated with racial microaggressions. Methods: 58 African American college students participated in a stress induction condition that exposed them to racial microinsults and prompted anticipatory concerns of further exposure to racial stress while completing a task with a racially insensitive peer. Following exposure to the stress induction condition, participants completed self-report questionnaires about their anticipatory thoughts, current affect, and proactive coping behaviors. Results: Threat-oriented thinking and negative affect were experienced in anticipation of racial discrimination; however, the endorsement of challenge-oriented thinking and positive affect were better predictors of how the current sample planned to use proactive coping behaviors to manage the anticipated racial stress. Implications: The current findings expand the racial stress coping narrative by capturing how the expression of optimism, perceived control, self-confidence, goal attainability, and positive emotion in anticipation of racial stress increases one's intention to implement coping strategies to minimize the impact of racial stress on task completion. Such findings provide cognitive and emotional targets for assessment when attempting to understand how African Americans are preparing themselves to manage anticipated racial stressors.     

The effects of exposure to an acute naturalistic stressor on working memory, state anxiety and salivary cortisol concentrations

Exposure to an acute naturalistic stressor induces both psychological and physiological changes in humans. The two studies reported here explored the impact of exposure to an acute naturalistic stressor on state anxiety, working memory and HPA axis activation (salivary cortisol). In both experiments, ten healthy male participants were exposed to an acute naturalistic stressor, helicopter underwater evacuation training (HUET), and their physiological and behavioural responses before (first study) and after (second study) the stressor were compared to ten non-stressed controls. The results of both experiments showed that working memory performance was preserved during anticipation of an acute stressor, but impairments were observed immediately after stress exposure. Participants reported significantly higher state anxiety levels during anticipation and following stress exposure, whereas significant elevations in cortisol levels were only observed 25 min post exposure to stress, but not before or immediately after stress exposure. The results of both experiments demonstrated a dissociation between behavioural and biochemical measures and provided evidence for a dissociation of the effects of stress on cognitive and physiological measures depending on the time of testing, with cognitive impairments most evident following stress exposure.     

Relationships among anxious symptomatology, anxiety sensitivity and laboratory pain responsivity in children

Existing laboratory-based research in adult samples has suggested that anxiety sensitivity (AS) increases an individual's propensity to experience pain-related anxiety, which in turn enhances pain responsivity. Such relationships have not been examined in younger populations. Thus, the present study used structural equation modeling (SEM) to test a conceptual model in which AS would evidence an indirect relationship with pain intensity via its contribution to state-specific anticipatory anxiety in relation to a variety of laboratory pain tasks (cold pressor, thermal heat, and pressure pain) in 234 healthy children (116 girls; mean age = 12.6 years, range = 8-18 years). The model further hypothesized that existing anxious symptomatology would demonstrate a direct relationship with pain intensity. Results of the SEM supported the proposed conceptual model with the total indirect effect of AS accounting for 29% of the variance in laboratory pain intensity via its effects on pain-related anticipatory anxiety. AS did not however, evidence a direct relationship with pain intensity. Anxious symptomatology on the other hand, demonstrated a significant direct effect on pain intensity, accounting for 15% of variance. The combined effects of AS, anxiety symptoms, and anticipatory anxiety together explained 62% of the variance in pain intensity. These relationships did not differ for boys and girls, indicating no moderating effect of sex in the proposed model. The present results support the potential benefit of assessing both AS and anxiety symptoms in children prior to undergoing painful stimulation.     

Sleep deprivation and stressors: Evidence for elevated negative affect in response to mild stressors when sleep deprived

Stress often co-occurs with inadequate sleep duration, and both are believed to impact mood and emotion. It is not yet known whether inadequate sleep simply increases the intensity of subsequent stress responses or interacts with stressors in more complicated ways. To address this issue, we investigated the effects of one night of total sleep deprivation on subjective stress and mood in response to low-stress and high-stress cognitive testing conditions in healthy adult volunteers in two separate experiments (total N = 53). Sleep was manipulated in a controlled, laboratory setting and stressor intensity was manipulated by changing difficulty of cognitive tasks, time pressure, and feedback about performance. Sleep-deprived participants reported greater subjective stress, anxiety, and anger than rested controls following exposure to the low-stressor condition, but not in response to the high-stressor condition, which elevated negative mood and stress about equally for both sleep conditions. These results suggest that sleep deprivation lowers the psychological threshold for the perception of stress from cognitive demands but does not selectively increase the magnitude of negative affect in response to high-stress performance demands. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Talking facilitates cognitive-emotional processes of adaptation to an acute stressor

The authors examined the influence of talking and the social context of talking on cognitive-emotional processes of adjustment to stressors. Two hundred fifty-six undergraduates viewed a stressful stimulus and were then assigned to a no-talk control condition or 1 of 3 talk conditions: talk alone, talk to a validating confederate, or talk to an invalidating confederate. Two days later, they were reexposed to the stressor. Compared with individuals in the no-talk condition, those in the talk alone and validate conditions had a lower level of intrusive thoughts in the 2-day interim, and they had lower perceived stress when reexposed to the stressor. The effects of talking and validation on perceived stress appeared to be mediated by lowered intrusions. The benefits of talking were diluted when disclosures were invalidated. These findings suggest that talking about acute stressors can facilitate adjustment to stressors through cognitive resolution.     

Anxiety and heart rate under psychological stress: The effects of exercise-training

Abstract The effects of a 12-week exercise-training program on cognitive, somatic, and behavioral anxiety and on heart rate responses to evaluative stress were scrutinized in 89 subjects randomly assigned to an experimental (exercise) or a control group. The training program consisted of exercises that were aimed to the improvement of the general physical fitness (i.e., strength, flexibility, and endurance). Following the 12-week training period, exercising subjects showed improved motor skill capacity as well as higher VO(2) max. In an anxiety inciting test situation, that consisted of the video-taped delivery of a 5-min speech, a mental arithmetic and a fine motor task, exercising subjects showed more favourable responses than control subjects in three ways: (a) they exhibited lower behavioral anxiety during the anticipation phase of the three stressors, (b) they reported lower cognitive and somatic anxiety during the anxiety provoking situation, and (c) their heart rate recovered faster, in contrast to both their baseline heart rate and the control subjects' heart rate, from the stress episode. These results demonstrate that a fitness-oriented exercise program has anxiolytic properties. They also provide a primary evidence that overt behavioral anxiety, as opposed to the usually measured self-reported anxiety, may be affected by exercise.     

Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes

Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12–17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.     

Emotion regulation in social anxiety: a systematic investigation and meta-analysis using self-report,subjective, and event-related potentials measures

Recent models of social anxiety disorder emphasise the role of emotion dysregulation; however, the nature of the proposed impairment needs clarification. In a replication and extension framework, four studies (N?=?193) examined whether individuals with social anxiety (HSAs) are impaired in using cognitive reappraisal and expressive suppression. Self-reports and lab-based tasks of suppression and reappraisal were utilised among individuals with high and low levels of social anxiety. A meta-analysis of these studies indicated that, compared to controls, HSAs reported less frequent and effective use of reappraisal and more frequent and effective use of suppression. Counter to most models and our hypotheses, HSAs were more successful than controls in lab-based reappraisal of shame-arousing pictures as measured by subjective ratings, but not by event-related potentials. HSAs were less successful than controls in lab-based suppression of shame-arousing pictures as measured by subjective ratings, but not by event-related potentials. The results held even when participants were under social stress (impromptu speech anticipation). Overall, subjective reports of HSAs reveal strong deficits in emotion regulation whereas lab-based measures provided less conclusive evidence of such deficits. These results suggest that individuals with social anxiety experience difficulties implementing their reappraisal abilities in daily life.     

状态焦虑对条件恐惧习得和消退的影响

采用44名正常女性大学生作为被试, 通过心理社会压力暴露的方法诱发焦虑组被试的状态焦虑, 采用主观预期值作为指标, 考察焦虑对条件恐惧习得和消退的直接影响, 并探讨这种影响是否也表现在评价性条件作用上。结果表明：心理社会压力暴露显著提高了焦虑组被试的状态焦虑。在习得阶段, 状态焦虑降低了被试对条件刺激的辨别条件恐惧反应, 具体而言, 状态焦虑降低了被试对CS+的主观预期值, 但是却提高了对CS?的主观预期值; 在消退阶段, 状态焦虑抑制了被试对条件刺激的消退。状态焦虑的影响也表现在评价性条件作用上, 和控制组相比, 焦虑组在习惯化和消退阶段对条件刺激表现出了更为负性的效价评定。     

Prospective evaluation of the etiology of anxiety sensitivity: test of a scar model

A large body of research has suggested that anxiety sensitivity (AS) acts as a specific vulnerability factor in the development of anxiety pathology. More recently, attention has turned to the etiology of AS per se. The present study represents a specific test of a Scar model of AS. A Scar model posits that the experience of distress will affect the vulnerability factor. We were specifically interested in evaluating the effects of a specific stressor (spontaneous panic) as well as general distress on changes in AS over time. A large nonclinical sample of young adults (N = 1296) was prospectively followed over a five week highly stressful period of time (i.e. military basic training). Findings were consistent with the Scar model and suggested that the specific stressor of experiencing a panic attack as well as general stressors creating significant anxiety symptoms uniquely contributed to increased levels of AS (regardless of prior history of panic). Moreover, the experience of spontaneous panic in the context of generally low levels of distress (both anxiety and depression) appeared to be particularly pernicious in terms of resulting in greater increases in AS. In sum, anxiety-related stressors appear to have the potential to 'scar' individuals in regard to this cognitive vulnerability factor.     

Lipid reactivity to stress: II. Biological and behavioral influences.

This study examined behavioral and physiological influences on lipid concentrations during acute and chronic stressors. One hundred men (n = 92) and women (n = 8) were tested during a chronic stressor and during 2 acute stressors. During chronic stress, diet, physical activity, exercise, and sleep were examined. During the acute stressors, catecholamines, cortisol, plasma volume, and cardiovascular responses were examined. None of the behavioral influences could explain the lipid response to chronic stress. Responses of the atherogenic lipids to acute stressors were not solely reflecting hemoconcentration of the plasma but were moderately correlated with cardiovascular, epinephrine, and cortisol reactivity. Diastolic blood pressure reactors to the acute stressors had larger lipid responses to the chronic stressor than did nonreactors. Elevations in blood lipids during stress are not artifacts and may be clinically significant.     

Where does work stress come from? A generalizability analysis of stress in police officers

Differences among workers and workplace stressors both contribute to perceiving work as stressful. However, the relative importance of these sources to work stress is not well delineated. Moreover, the extent to which work stress additionally reflects unique matches between specific workers and particular job stressors is also unclear. In this study, we use generalizability theory to specify and compare sources of variance in stress associated with police work. US police officers (N?=?115) provided ratings of 60 stressors commonly associated with policing duties. Primary and secondary stress appraisal ratings reflected differences among officers in tendencies to generally perceive work stressors as stressful (14–15% officer effect), and also agreement among officers in viewing some stressors as more stressful than others (18–19% stressor effect). However, ratings especially reflected distinct pairings of officers and stressors (38–41% interaction effect). Additional analyses revealed individual differences and stressor characteristics associated with each variance component, including an officer?×?stressor interaction – compared to officers low in neuroticism, highly neurotic officers provided lower primary appraisal ratings of stressors generally seen as not serious, and also higher primary appraisal ratings of stressors that were seen as serious. We discuss implications of the current approach for the continued study of stress at work.