Greater sustained anxiety but not phasic fear in women compared to men

Startle reflex studies in rodents indicate that female are more reactive than rats in experimental models of sustained anxiety but not in models of phasic fear (Toufexis, 2007). This study examined evidence for a similar effect in humans. Participants were exposed to three conditions, (1) predictable aversive shocks signaled by a cue, (2) unpredictable shocks, and (3) no shocks. Acoustic startle stimuli were delivered regularly across conditions. Phasic startle potential to the threat cue in the predictable condition was not affected by sex. In contrast, and consistent with basic research, the sustained increase in startle in the predictable and unpredictable conditions was greater in women compared to men. Animal studies suggest that such an effect may be mediated by the effects of sexual dimorphism in limbic structures, including the bed nucleus of the stria terminalis. However, psychosocial factors may also contribute to this effect.     

Reducing chronic anxiety by making the threatening event predictable: An experimental approach

Panic disorder is characterized by both specific, phased fear and generalized, chronic anxiety. Standard extinction procedures are efficient in reducing specific fear. However, methods based on human conditioning research - that are capable of reducing chronic anxiety have not yet been thoroughly investigated. This study evaluates a new way of reducing chronic anxiety by signaling aversive events (or by making them more predictable). Using an experimental approach with healthy participants, specific fear and chronic anxiety were operationalized in a within-subjects fear-potentiated startle paradigm by, respectively, conditioning to a cue by presenting predictable shocks and conditioning to a context induced by unpredictable shocks. The results clearly demonstrate that context conditioning is reduced when a discrete cue is added that predicts the onset of the aversive event. The data suggest that making unpredictable events, such as for example panic attacks, predictable, may reduce the generalized and sustained anxiety that often complicates exposure treatment.     

Sensation seeking and the aversive motivational system

Sensation seeking (SS) has traditionally been viewed as a phenomenon of the appetitive motivational system. The limited SS research exploring contributions from the aversive motivational system reveals greater anxious reactivity to dangerous activities among low sensation seekers. The present study extends this line of work by comparing levels of fear and anxiety during anticipation of predictable and unpredictable aversive stimuli across high- and low-SS groups. Low sensation seekers displayed greater fear-potentiated startle (FPS) to predictable aversive stimuli, and only those low on SS showed FPS and skin conductance response effects during experimental contexts in which aversive stimuli were delivered unpredictably. Findings implicate enhanced apprehensive anticipation among those low on SS as a potential deterrent for their participation in intense and threatening stimulus events.     

Preschoolers' use of dynamic facial, bodily, and vocal cues to emotion

In daily experience, children have access to a variety of cues to others’ emotions, including face, voice, and body posture. Determining which cues they use at which ages will help to reveal how the ability to recognize emotions develops. For happiness, sadness, anger, and fear, preschoolers (3-5 years, N = 144) were asked to label the emotion conveyed by dynamic cues in four cue conditions. The Face-only, Body Posture-only, and Multi-cue (face, body, and voice) conditions all were well recognized (M > 70%). In the Voice-only condition, recognition of sadness was high (72%), but recognition of the three other emotions was significantly lower (34%).     

The Conditioned Attention Theory and Bifactorial Theory on the Learned Helplessness Syndrome in Appetitive Contexts

The purpose of the present experiment was to explore the theory that deficits in learned helplessness, normally produced by inescapable shock or noncontingent events, are eliminated in subsequent learning discrimination when a combination of exteroceptive cues or feedback stimuli and a predictable stimulus are present. We used 48 pigeons in 6 groups: Group P+C+ training with predictable and controllable events; Group P+U— training with predictable and uncontrollable events; Group U—F training with unpredictable and uncontrollable events and feedback stimulus; Group P+U—F training with predictable and uncontrollable events and feedback stimulus; Group U-RE training with unpredictable, uncontrollable and random events; Group CG did not receive any treatment. Our results demonstrated that a combination of feedback stimuli and predictability was found to be the most effective training against effects of noncontingent events in appetitive contexts.     

Preference between onset predictable and unpredictable administrations of 20% carbon-dioxide-enriched air: implications for better understanding the etiology and treatment of panic disorder

Predictability of aversive events impacts the development and maintenance of anxiety, particularly panic disorder. Although animal studies typically have found a preference for signaled (predictable) over unsignaled (unpredictable) aversive events, results of research with human participants have been less clear. Using a panic-relevant paradigm, the authors examined predictability preference with humans as a function of anxiety sensitivity and gender during repeated administrations of 20% carbon-dioxide-enriched air. Participants preferred predictable administrations, with high-anxiety individuals showing greater preference than low-anxiety individuals and women showing greater preference than men. In addition to providing information to better understand human predictability preference for panic-related events, results also may aid in determining the applicability of predictability to the cognitive-behavioral treatment of panic disorder.     

The anxiety disorder spectrum: Fear imagery,physiological reactivity,and differential diagnosis∗

Abstract

This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxiety disorder patients – panic disorder with agoraphobia, generalized anxiety disorder, or anxious patients with comorbid depression – show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxiety disorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.     

Fear-potentiated startle conditioning to explicit and contextual cues in Gulf War veterans with posttraumatic stress disorder

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.     

Trait Anxiety and Fear Responses to Safety Cues: Stimulus Generalization or Sensitization?

Abnormal fear responding to threat cues may contribute to the aetiology and maintenance of persistent fears and pathological anxiety. Chronic anxiety may also involve abnormal fear responding to ??safety?? cues, which do not signal danger. Yet investigations of fear responding to acquired safety cues are scarce and the basis of such responding remains unclear. Moreover, previous studies do not distinguish between stimulus generalization (an associative mechanism based on perceptual similarity between threat and safety cues) and sensitization (a non-associative mechanism whereby fear responses to any novel, intense, or fear-related stimulus are temporarily elevated). This study investigated responses to acquired safety cues in volunteers with varying trait anxiety, using a novel fear conditioning paradigm designed to distinguish between effects of trait anxiety on generalization and sensitization. The paradigm used three conditioned stimuli: a threat cue (CS+) and two safety cues (CS?), one perceptually similar to the CS+ and one perceptually dissimilar. Conditioned fear to these cues was indexed by fear potentiation of the startle blink reflex, skin conductance responses, and self-report. To examine how trait anxiety moderated responses to safety cues, participants were divided into high and low trait anxiety subgroups. Startle, skin conductance, and self-reported fear measures indicated that generalization of fear occurred for the safety cue which resembled the threat cue, but not for the perceptually dissimilar safety cue, consistent with the stimulus generalization hypothesis. There was some evidence that stimulus generalization was exaggerated in anxious individuals. The current study sheds light on the mechanism by which fear responses to safety cues arise in healthy individuals, and offers some insight into the influence of this mechanism in chronic anxiety.     

Temperament moderates the effect of the verbal threat information pathway on children's heart rate responses to novel animals

Temperamental variables such as trait anxiety are risk factors in children for the development of anxiety disorders. This experiment aimed to test whether temperament moderates the effect of verbal threat information on the physiological component of the fear emotion. An experiment is reported in which 6-10 year old children's (N = 54) fear beliefs about novel animals were measured. They were then given threat, positive or no verbal information about these animals following which their heart rate was recorded while they placed their hands in boxes that they believed these animals inhabited. Children also completed a questionnaire measure of trait anxiety. Child-reported temperament moderated the effect that threat information has on the physiological component of the fear emotion. Fear information is, therefore, a possible mechanism through which temperament leads children to acquire animal fears.     

The Effects of Uncontrollable, Unpredictable Aversive and Appetitive Events: Similar Effects Warrant Similar, but not Identical, Explanations?

Exposure to uncontrollable, unpredictable appetitive events produces a variety of cognitive debilitations and vegetative changes, as does exposure to uncontrollable, unpredictable aversive events. Similarities include impaired escape from aversive events, impaired discrimination, finicky consumption, analgesia, and body weight loss. However, in stark contrast, uncontrollable aversive stress causes reduced motor activity where as similar appetitive treatment does not; aversively induced debilitation is causally related to energy regulation, whereas the appetitively induced effects are not. Parallel mechanisms are suggested to explain these effects in terms of a revised anxiety account of the aversive effects, and a frustration account of the appetitive effects. Finally, factors likely to limit important research to resolve the many remaining issues are identified: negative presentation of animal research, political decision making, and ignorance and fear in committees which review the ethics of research.     

Affective individual differences and startle reflex modulation

Potentiation of startle has been demonstrated in experimentally produced aversive emotional states, and clinical reports suggest that potentiated startle may be associated with fear or anxiety. To test the generalizability of startle potentiation across a variety of emotional states as well as its sensitivity to individual differences in fearfulness, the acoustic startle response of 17 high- and 15 low-fear adult subjects was assessed during fear, anger, joy, sadness, pleasant relaxation, and neutral imagery. Startle responses were larger in all aversive affective states than during pleasant imagery. This effect was enhanced among high fear subjects, although followup testing indicated that other affective individual differences (depression and anger) may also be related to increased potentiation of startle in negative affect. Startle latency was reduced during high- rather than low-arousal imagery but was unaffected by emotional valence.     

Age-related changes in cognitive processing of moral and social conventional violations

Moral and conventional violations are usually judged differently: Only moral violations are treated as independent of social rules. To investigate the cognitive processing involved in the development of this distinction, undergraduates (N = 34), adolescents (N = 34), and children (N = 14) read scenarios presented on a computer that had 1 of 3 endings: moral violations, conventional violations, or neutral acts. Participants judged whether the act was acceptable or unacceptable in a condition in which social rules were assumed, or in a condition in which they imagined the absence of rules (rule-removed condition). At all ages reaction times (RTs) were faster for moral than conventional violations when a rule was assumed. RTs in the rule-removed condition were longer than in the rule-assumed condition, only for adults’ moral judgments. In addition to this age difference, adolescents made more normative judgments than children. These findings extend previous work by showing different time courses of processing conventional versus moral violations and revealing age-related differences in the tendency to make normative judgments.     

The development of an attentional bias for angry faces following Pavlovian fear conditioning

Although it is well documented that fear responses develop following aversive Pavlovian conditioning, it is unclear whether fear learning also manifests in the form of attentional biases for fear-related stimuli. Boschen, Parker, and Neumann (Boschen, M. J., Parker, I., & Neumann, D. L. (2007). Changes in implicit associations do not occur simultaneously to Pavlovian conditioning of physiological anxiety responses. Journal of Anxiety Disorders, 21, 788-803.) showed that despite the acquisition of differential skin conductance conditioned responses to angry faces paired (CS+) and unpaired (CS−) with an aversive shock, development of implicit associations was not subsequently observed on the Implicit Association Test. In the present study, participants (N = 76) were assigned either to a Shock or NoShock group and completed a similar aversive Pavlovian conditioning procedure with angry face CS+ and CS− stimuli. Participants next completed a visual probe task in which the angry face CS+ and CS− stimuli were paired with angry face control stimuli and neutral faces. Results confirmed that differential fear conditioning was observed in the Shock group but not in the NoShock group, and that the Shock group subsequently showed a selective attentional bias for the angry face CS+ compared with the CS− and control stimuli during the visual probe task. The findings confirm the interplay between learning-based mechanisms and cognitive processes, such as attentional biases, in models of fear acquisition and have implications for treatment of the anxiety disorders.     

An Open Trial Investigation of a Transdiagnostic Group Treatment for Children With Anxiety and Depressive Symptoms

The current study investigates the feasibility and preliminary outcomes associated with a transdiagnostic emotion-focused group protocol for the treatment of anxiety disorders and depressive symptoms in youth. Twenty-two children (ages 7 to 12; M = 9.79) with a principal anxiety disorder and varying levels of comorbid depressive symptoms were enrolled in an open trial of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Bilek, 2009), an intervention adapted from existent unified protocols for the treatment of emotional disorders among adults and adolescents. Results indicate that participants experienced significant improvements in clinician-rated severity of principal anxiety disorder diagnoses (d = 1.38), the sum of all anxiety and depressive disorder severity ratings (d = 1.07), and child-reported anxiety (d = 0.47) and parent-reported depressive symptoms (d = 0.54) at the posttreatment assessment. EDTP had good retention rates and reports of high satisfaction. Thus, preliminary evidence suggests that EDTP is a feasible and potentially efficacious treatment of youth anxiety disorders and co-occurring depressive symptoms. Children experiencing a range of internalizing symptoms may benefit from this more generalized, emotion-focused treatment modality, as it offers flexibility to families and the mental health clinician, while maintaining a concurrent focus on the provision of cognitive-behavioral treatment skills vital to the amelioration of anxiety and depressive disorder symptoms in youth.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

The diagnostic utility of the Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71)

Objective

This study investigated the diagnostic utility of the 71-item Screen for Child Anxiety Related Emotional Disorders (SCARED-71), as a screening tool for identifying anxiety disorders in youth aged 8-18 years.

Method

The SCARED-71 and the Anxiety Disorder Interview Schedule (ADIS) were administered to clinically referred anxious children (n = 138) and control children (n = 38) as well as their parents.

Results

Results showed that the SCARED-71 differentiated clinically anxious from control children on the total score and on all subscales. Girls generally reported higher levels of anxiety symptoms and there were also significant age effects for various anxiety subscales. Further, reliable cut-off scores were established for the child and parent version of the SCARED-71. The parent version displayed better sensitivity and specificity, and therefore seems to be a more optimal screen for anxiety problems in children and adolescents. Finally, evidence for the predictive validity across anxiety disorders was found.

Conclusion

The SCARED-71 can be used as a screening tool to detect clinically significant anxiety problems in children and adolescents and discriminates reasonably well among specific anxiety disorders.     

Covert narcissism as a predictor of internalizing symptoms after performance feedback in adolescents

The present study examined the association between covert narcissism and internalizing symptoms (i.e., shame, anxiety) in adolescents following an ego threat. Participants were 132 adolescents (101 males, 30 females, 1 not reported), ages 16-19 (M = 16.81 years, SD = .81), attending a residential program. Participants were randomly assigned to one of three feedback conditions (i.e., positive, negative, or neutral). Contrary to the main hypothesis, Time 2 internalizing symptoms tended to be highest for individuals in the positive feedback condition who had higher levels of narcissism. The implications of this study for understanding the role of narcissism in internalizing symptoms are discussed.     

Neural systems involved in fear and anxiety measured with fear-potentiated startle

A good deal is now known about the neural circuitry involved in how conditioned fear can augment a simple reflex (fear-potentiated startle). This involves visual or auditory as well as shock pathways that project via the thalamus and perirhinal or insular cortex to the basolateral amygdala (BLA). The BLA projects to the central (CeA) and medial (MeA) nuclei of the amygdala, which project indirectly to a particular part of the acoustic startle pathway in the brainstem. N-methyl-D-aspartate (NMDA) receptors, as well as various intracellular cascades in the amygdala, are critical for fear learning, which is then mediated by glutamate acting in the CeA. Less predictable stimuli, such as a long-duration bright light or a fearful context, activate the BLA, which projects to the bed nucleus of the stria terminalis (BNST), which projects to the startle pathway much as the CeA does. The anxiogenic peptide corticotropin-releasing hormone increases startle by acting directly in the BNST. CeA-mediated behaviors may represent stimulus-specific fear, whereas BNST-mediated behaviors are more akin to anxiety. NMDA receptors are also involved in extinction of conditioned fear, and both extinction in rats and exposure-based psychotherapy in humans are facilitated by an NMDA-partial agonist called D-cycloserine. ((c) 2006 APA, all rights reserved).     

The role of neuroticism in startle reactions to fearful and disgusting stimuli

It has frequently been observed that negative moods potentiate the startle reflex to unexpected, threatening stimuli. However, recent work from our laboratory suggests that this effect relates primarily to the emotion of fear or anxiety, while stimuli which evoke powerful feelings of disgust can in some circumstances inhibit the startle reflex. In this study we reanalyse data from 42 subjects in whom eye-blink amplitudes to an auditory probe were measured whilst viewing emotionally arousing film clips. Classifying the negative film clips into separate categories of “frightening” vs “disgusting” revealed a previously undetected interaction with EPQ Neuroticism. High N subjects showed greater startle reactions than low N subjects under fearful conditions but low N subjects showed greater startle when disgust was evoked. This suggests that Neuroticism may increase vigilance where evasive action is possible but promote emotional blunting when escape is not an option.