Thinking anxious, feeling anxious, or both? Cognitive bias moderates the relationship between anxiety disorder status and sympathetic arousal in youth

Anxious youth and adults share threat-biased interpretations of linguistic and visual ambiguity: A proof of concept study

Interpretation bias, or the threatening appraisal of ambiguous information, has been linked to anxiety disorder. Interpretation bias has been demonstrated for linguistic (e.g., evaluation of ambiguous sentences) and visual judgments (e.g., categorizing emotionally ambiguous facial expressions). It is unclear how these separate components of bias might be associated. We examined linguistic and visual interpretation biases in youth and emerging adults with (n = 44) and without (n = 40) anxiety disorder, and in youth-parent dyads (n = 40). Linguistic and visual biases were correlated with each other, and with anxiety. Compared to non-anxious participants, those with anxiety demonstrated stronger biases, and linguistic bias was especially predictive of anxiety symptoms and diagnosis. Age did not moderate these relationships. Parent linguistic bias was correlated with youth anxiety but not linguistic bias; parent and youth visual biases were correlated. Linguistic and visual interpretation biases are linked in clinically-anxious youth and emerging adults.

Autonomic reactivity during acute social stress: exploratory investigation of an interaction by threat interpretation bias and emotion regulation difficulties

Objective: This preliminary study examined the interactive influences of interpretation bias and emotion dysregulation in predicting autonomic stress response.Methods: Participants (N = 72 college students; ages 18-25, 70% female, 47% Hispanic/Latinx), completed a performance-based assessment of threat interpretation bias and self-report measures of emotion regulation difficulties. Electrodermal activity (EDA; skin conductance level) was collected while participants completed a standardized psychosocial stressor task.Results: Interpretation bias and emotion regulation difficulties interacted to predict EDA trajectories (β = 0.054, SE = .001, CI:.007, .002, p < .001) during acute stress: presence of either interpretation bias toward threat (β = 6.950, SE = 2.826, CI: 1.407, 12.488, p = .013) or emotion regulation difficulties (β = 9.387, SE = 3.685, CI: 2.141, 16.636, p = .011) was associated with greater reactivity and poorer recovery; presence of both was associated with the lowest resting state EDA and blunted reactivity (β = 1.340, SE = 3.085, CI: -4.721, 7.407, p = .66).Conclusions: Preliminary findings support interpretation bias and emotion regulation difficulties, and their distinct interactive patterns, as predictors of autonomic reactivity trajectories during stress. Interpretation bias modification and emotion regulation skills may be important intervention targets for common psychological conditions that are influenced by aberrant psychophysiological processes.

Social Evaluation in Emerging Adults: Associations with Interpretation Bias and Perceived Social Support

Social anxiety symptoms are one of the most common mental health concerns across the lifespan (Bandelow and Michaelis in Dialogues Clin Neurosci 17(3):327-335, 2015. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow ) and are especially relevant during emerging adulthood, when social feedback occurs daily (Auxier and Anderson in Social media use in 2021, 2021. https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/ ) as emerging adults navigate new social environments. Two cognitive processes have been identified as relevant to social anxiety: high threat interpretation bias (i.e., the tendency to appraise threat from ambiguity; Rozenman et al. in Behav Ther 45(5):594-605, 2014. https://doi.org/10.1016/j.beth.2014.03.009 ; J Anxiety Disord 45:34-42, 2017. https://doi.org/10.1016/j.janxdis.2016.11.004 ) is associated with high social anxiety, whereas high perceived social support is associated with low social anxiety. In this study, emerging adults (N = 303) completed an online adaptation of the Chatroom task (Guyer et al. in Arch Gener Psychiatry 65(11):1303-1312, 2008. https://doi.org/10.1001/archpsyc.65.11.1303 ), an experimental paradigm designed to simulate social acceptance and rejection, as well as a performance-based measure of interpretation bias (Word Sentence Association Paradigm; Beard and Amir in Behav Res Ther 46(10):1135-1141, 2008. https://doi.org/10.1016/j.brat.2008.05.012 ), and a self-report measure of perceived social support (Multidimensional Scale of Perceived Social Support; Zimet et al. in J Pers Assess 52(1), 30-41, 1988. https://doi.org/10.1207/s15327752jpa5201_2 ). Social anxiety symptoms did not increase as a function of acceptance or rejection during the Chatroom task. However, there were significant interactions between each cognitive predictor and social anxiety change: emerging adults with low interpretation bias towards threat and emerging adults with high perceived social support both experienced decreases in social anxiety from pre- to post-Chatroom task, regardless of whether they were accepted or rejected during the Chatroom task. If replicated, low interpretation bias and high perceived social support may serve as promotive factors in social interactions for emerging adults.

Analysis of attentional biases in anxiety using 24 facial priming sequences

The processing of emotional facial expressions helps people to adjust to the physical and social environment. Furthermore, mental disorders such as anxiety have been linked to attentional biases in the processing of this type of information. Nevertheless, there are still contradictory results that might be due to the methodology used and to individual differences in the manifestation of anxiety. Our research goal was to use 24 facial priming sequences to analyse attentional biases in the detection of facial expressions of fear, considering the levels and the ways in which individuals express anxiety. With higher levels of cognitive anxiety and general trait anxiety, those sequences that began in the upper half (vs. lower half) elicited a speedier response in the detection of fear. The results are discussed within the context of other techniques and disorders that prompt a deficit in the processing of facial information.

Examining correlates of aggression and mediating effect of psychological distress between exposure to media violence and aggression in lebanese adults

BACKGROUND

Violent media is the most consumed type of media in Lebanon. Many studies have linked exposure to media violence to increased aggression and psychological distress. As Lebanon is going through socio-political turmoil, we aimed to [1] explore the correlates of aggression (i.e., sociodemographic factors, BMI, loneliness, social competence, and psychological distress) in a sample of Lebanese adults from the general population, and [2] to examine the mediating effect of psychological distress in the association between exposure to media violence and aggression in this sample.

METHODOLOGY

Adults were recruited through online convenience sampling. We employed scales to assess content-based media exposure (C-ME), aggression (BPAQ-SF), psychological distress (DASS-8), loneliness (JGLS), and perceived social competence (PSCS).

RESULTS

Exposure to media violence was associated with all four aggression subtypes (verbal, physical, hostility, and anger). Psychological distress partially mediated all these associations; higher exposure to media violence was significantly associated with more psychological distress, which was significantly associated with higher levels of all types of aggression. Moreover, higher exposure to media violence was significantly associated with higher levels of all types of aggression.

CONCLUSION

In the sociopolitical context of Lebanon, violent media could be considered a public hazard. Psychological distress likely potentiates the association between exposure to violent media and aggression. Future research should focus on determining what components of psychological distress underpin this mediation.

Effect of anxiolytic drug silexan on sleep - a narrative review

OBJECTIVES

Silexan is an orally administered, proprietary essential oil from Lavandula angustifolia with significant anxiolytic and sleep improving properties. Here we present a narrative review that provides an overview of the available evidence of the effects of silexan on sleep.

METHODS

We start with a summary of the pharmacological background and continue with presenting sleep-related results from controlled clinical trials with silexan. Then we report on a meta-analysis of item 'insomnia' from the Hamilton Anxiety Scale, which includes data from all randomised, placebo-controlled clinical trials with silexan in which the scale was administered. Finally, we summarise the results of a mediation analysis that was performed to elucidate the pathway of the effect of silexan on sleep.

RESULTS

In randomised, placebo-controlled trials in patients suffering from anxiety disorders silexan had a significant anxiolytic effect and improved sleep along with recovery from anxiety. Mediation analysis demonstrates that more than 98% of the effect of silexan on sleep was mediated by its anxiolytic effect while the direct effect on sleep was marginal.

CONCLUSIONS

Silexan improves sleep as a result of its anxiolytic effect.

Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis

Anxiety is the most common mental health problem in youth. Numerous studies have identified that youth anxiety is associated with interpretation bias or the attribution of threatening meaning to ambiguity. Interpretation bias has been proposed as a mechanism underlying the development and maintenance of pediatric anxiety. Theoretically, interpretation bias should be content-specific to individual youth anxiety symptom domains. However, extant studies have reported conflicting findings of whether interpretation bias is indeed content specific to youth anxiety symptoms or diagnoses. The present meta-analysis aimed to synthesize the literature and answer the question: is the relationship between interpretation bias and anxiety content specific? Search of PubMed and PsycINFO databases from January 1, 1960 through May 28, 2019 yielded 9967 citations, of which 19 studies with 20 comparisons and 2976 participants met eligibility criteria. Meta-analysis with random effects models was conducted to examine an overall effect (Pearson r) between anxiety domain and content-specific interpretation bias in single sample studies, and an overall effect size difference (Cohen's d) in studies comparing anxious to non-anxious youth. Results support a content specific correlation between interpretation bias and anxiety symptom domain in single sample studies (r = 0.18, p = 0.03). However, it is currently undetermined whether this relationship holds in studies that compare the relationship between content-specific interpretation bias and anxiety in anxious versus non-anxious youth. A variety of methodologic considerations across studies are discussed, with implications for further investigation of interpretation bias and youth anxiety.

Physiological Responses to a Haunted-House Threat Experience: Distinct Tonic and Phasic Effects

Threats elicit physiological responses, the frequency and intensity of which have implications for survival. Ethical and practical limitations on human laboratory manipulations present barriers to studying immersive threat. Furthermore, few investigations have examined group effects and concordance with subjective emotional experiences to threat. The current preregistered study measured electrodermal activity in 156 adults while they participated in small groups in a 30-min haunted-house experience involving various immersive threats. Results revealed positive associations between (a) friends and tonic arousal, (b) unexpected attacks and phasic activity (frequency and amplitude), (c) subjective fear and phasic frequency, and (d) dissociable sensitization effects linked to baseline orienting response. Findings demonstrate the relevance of (a) social dynamics (friends vs. strangers) for tonic arousal and (b) subjective fear and threat predictability for phasic arousal.

Like parent, like child: Is parent interpretation bias associated with their child's interpretation bias and anxiety? A systematic review and meta-analysis

BACKGROUND

Anxiety disorders are the most prevalent psychiatric problem across the lifespan, with typical onset during the pediatric period. Prior literature has examined cognitive mechanisms associated with youth anxiety and identified interpretation bias, the threatening appraisal of ambiguity, as a ubiquitous correlate and likely mechanism. A small set of studies have examined interpretation bias and anxiety in parent-child dyads, although results about this potential relationship are conflicted. This systematic review and meta-analysis investigates the association between parent interpretation bias with child interpretation bias and child anxiety.

METHODS

Eight studies met the rigorous inclusion criteria, which required direct assessment of interpretation bias in both youth and parent.

RESULTS

Meta-analysis with a random effects model indicated a small and significant correlation between parent and child interpretation biases (r = 0.14, p < .01), as well as a small and significant correlation between parent interpretation bias and child anxiety (r =  = 0.20, p = .01).

LIMITATIONS

As only eight studies were included in this meta-analysis, reflecting the state of the extant literature, it is possible that, as data accumulate and this work continues in the future, results may or may not be replicated.

CONCLUSIONS

Despite variability in findings across the included empirical studies, the current meta-analysis suggests that a correlational relationship between parent interpretation bias and child bias/anxiety exists. This work has implications for conceptualizing parent interpretation bias as a possible explanatory mechanism underlying youth interpretation bias and anxiety.

Mild-to-moderate schizotypal traits relate to physiological arousal from social stress

Schizotypy denotes psychosis-like experiences, such as perceptual aberration, magical ideation, and social anxiety. Altered physiological arousal from social stress is found in people with high schizotypal traits. Two experiments aimed to determine the relationship of schizotypy to physiological arousal from social stress. Experiment 1 tested the hypotheses that heart rate from social stress would be greater in high, than mild-to-moderate, schizotypal traits, and disorganized schizotypy would explain this effect because of distress from disorganisation. Experiment 1 tested social stress in 16 participants with high schizotypal traits and 10 participants with mild-to-moderate schizotypal traits. The social stress test consisted of a public speech and an informal discussion with strangers. The high schizotypal group had a higher heart rate than the mild-to-moderate schizotypal group during the informal discussion with strangers, but not during the public speech. Disorganized schizotypy accounted for this group difference. Experiment 2 tested the hypothesis that mild-to-moderate schizotypal traits would have a linear relationship with physiological arousal from social stress. Experiment 2 tested 24 participants with mild-to-moderate schizotypal traits performing the abovementioned social stress test while their heart rate and skin conductance responses were measured. Mild-to-moderate schizotypal traits had a linear relationship with physiological arousal during the discussion with strangers. Distress in disorganized schizotypy may explain the heightened arousal from close social interaction with strangers in high schizotypy than mild-to-moderate schizotypy. Mild-to-moderate schizotypal traits may have a linear relationship with HR during close social interaction because of difficulty with acclimatizing to the social interaction.

Brain and Behavior Correlates of Risk Taking in Pediatric Anxiety Disorders

Avoidant behavior is a defining feature of pediatric anxiety disorders. Although prior research has examined it from the perspective of early information processing events, there has been relatively less consideration of the processes by which anxious youth make avoidant decisions and how these choices are reinforced over time. Studies of risk taking are valuable in this regard because they consider how individuals identify the pros and cons of their choices, how they weigh potential gains and losses and estimate their respective probabilities, and how they tolerate the uncertainty intrinsic to any decision. In this review, we place risk taking within existing models of information processing in pediatric anxiety disorders and highlight the particular value of this construct for informing models of developmental psychopathology and individual differences in outcome over time. We review existing behavioral and neurobiological studies of risk taking in anxious youth and conclude by identifying directions for future research.

Ventromedial Prefrontal Cortex Activity and Sympathetic Allostasis During Value-Based Ambivalence

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for "mobilization" whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis.

Adolescent girls' physiological reactivity to real-world peer feedback: A pilot study to validate a Peer Expressed Emotion task

Peer feedback becomes highly salient during adolescence, especially for girls. The way in which adolescents react to social feedback is associated with psychosocial adjustment and mental health. Consequently, researchers are increasingly interested in understanding the physiological and neural underpinnings of adolescent response to feedback by simulating the experience of rejection and acceptance using computer-based paradigms. However, these paradigms typically use nonfamiliar peers and the facade of internet chatrooms or games to present artificial peer feedback. The current study piloted the use of a novel and potentially more ecologically valid peer expressed emotion paradigm in which participants listen to prerecorded clips of ostensible personalized feedback made by their close friend. Physiological data measuring autonomic nervous system response were collected as an index of emotional reactivity/arousal and cognitive-affective processing. Results show promising preliminary evidence validating the task for future use. Participants (N = 18 girls, aged 11-17 years) reported feeling more positive following praise, relative to critical and neutral feedback, and reported feeling more upset following criticism, relative to praise and neutral feedback. Girls exhibited greater pupillary dilation, skin conductance levels (N = 17), and/or heart rate (N = 17) while listening to affectively charged, peer feedback compared with neutral yet personally relevant statements. Girls also exhibited variable physiological response when listening to praising versus critical feedback. Findings from this pilot study validate the use of this novel Peer Expressed Emotion task for the investigation of adolescents' emotional and physiological reactivity in response to real-world peer evaluation. However, it is important to recognize that this study provides only preliminary findings and that future research is needed to replicate the results in larger samples.

The association between current maternal psychological control, anxiety symptoms, and emotional regulatory processes in emerging adults

BACKGROUND AND OBJECTIVES

High levels of psychological control (PC), the (intentional or unintentional) attempt by parents to control their child's emotional experience, have been associated with increased risk for anxiety in youth. However, little is known regarding the association between PC and anxiety in emerging adulthood, a developmental period marked by various life transitions and high risk for the onset of internalizing symptoms, or about the relation between current parental PC and emotional regulatory processes during this stage. The current study examined whether perceived maternal PC was significantly associated with anxiety symptoms and both objective (psychophysiological; respiratory sinus arrhythmia) and subjective (self-reported) emotion regulatory processes.

METHODS

Participants (N = 125; ages 18 to 25) completed self-reports on their anxiety symptoms, emotion regulation abilities, and perceptions of their mother' behavior, and participated in a laboratory stressor, the Trier-Social Stress Test, while psychophysiological data were acquired.

RESULTS

Emerging adults who reported higher maternal PC also reported higher anxiety symptoms and evidenced greater emotion regulation difficulties on both objective and subjective indices than those who reported lower maternal PC. Moreover, the association between PC and anxiety levels was statistically mediated by self-reported emotion regulation difficulties.

LIMITATIONS

Results of this study should be interpreted in light of its limitations, which include it being cross-sectional in nature with a primarily female sample. Further, perceptions of maternal, but not paternal, parenting were examined.

CONCLUSIONS

Findings might have implications for targeting both psychological control and emotion regulation difficulties in personalized anxiety interventions during this high-risk developmental period.

Cognitive bias modification for threat interpretations: Impact on anxiety symptoms and stress reactivity

BACKGROUND

Cognitive bias modification for interpretations (CBM-I) is a computerized intervention that has received increasing attention in the last decade as a potential experimental intervention for anxiety. Initial CBM-I trials with clinical populations suggest the potential utility of this approach. However, most CBM-I experiments have been conducted with unaffected samples, few (one or two) training sessions, and have not examined transfer effects to anxiety-related constructs such as stress reactivity.

METHOD

This study compared a 12-session CBM-I intervention (n = 12) to an interpretation control condition (ICC; n = 12) in individuals (N = 24) with elevated trait anxiety on interpretation bias, anxiety symptom, and stress reactivity outcomes (electrodermal activity, heart rate, and respiratory sinus arrhythmia).

RESULTS

Compared to the ICC group, participants assigned to CBM-I experienced significantly greater improvements in interpretation bias and anxiety symptoms by post-intervention 4 weeks later, with impact on anxiety maintained at 1-month follow-up. While CBM-I and ICC groups did not differ in stress reactivity during an acute stressor at pre-intervention, the CBM-I group evidenced improved stress reactivity at post-intervention compared to ICC on two psychophysiological indices, electrodermal activity and heart rate.

CONCLUSIONS

The results of this pilot study suggest that CBM-I may hold promise for reducing anxiety symptoms, as well as impact psychophysiological arousal during an acute stressor.

Failures of executive function when at a height: Negative height-related appraisals are associated with poor executive function during a virtual height stressor

It is difficult to maintain cognitive functioning in threatening contexts, even when it is imperative to do so. Research indicates that precarious situations can impair subsequent executive functioning, depending on whether they are appraised as threatening. Here, we used virtual reality to place participants at ground level or at a virtual height in order to examine the impact of a threat-related context on concurrent executive function and whether this relationship was modulated by negative appraisals of heights. Executive function was assessed via the Go/NoGo and N-Back tasks, indexing response inhibition and working memory updating respectively. Participants with negative appraisals of heights exhibited impaired executive function on both tasks when performing at a virtual height (i.e., a threat-related context) but not at ground-level, demonstrating the importance of considering the cognitive consequences of individual differences in negative interpretations of emotionally-evocative situations. We suggest that a virtual reality approach holds practical benefits for understanding how individuals are able to maintain cognitive ability when embedded within threatening situations.

A systematic review of the word sentence association paradigm (WSAP)

BACKGROUND AND OBJECTIVES

The Word Sentence Association Paradigm (WSAP) was originally designed to assess and modify interpretive biases (IB) in socially anxious individuals. Researchers have since modified the WSAP for use across various populations. Despite its widespread use, no studies have systematically reviewed the WSAP to determine its validity and reliability.

METHODS

We review variations to the WSAP, populations in which the WSAP has been used, reliability data, and effect sizes across 41 studies published between 2008 and March 2018.

RESULTS

Results indicate that the WSAP has been utilized to target 18 disorders and symptoms in adults and children. Modifications include stimulus content, timing parameters, and presentation order of word and sentence pairs. Reported internal consistency and test-retest reliability suggest good to excellent reliability. Medium to large effect sizes were reported when comparing control samples to those with psychopathology and in pre-post comparisons of the modification version of the WSAP.

LIMITATIONS

Studies varied regarding which indices of the WSAP were presented and specific task parameters used, making it challenging to compare effects.

CONCLUSIONS

The WSAP is a reliable and valid instrument for assessing and modifying interpretive biases with unique characteristics compared with other IB assessment and modification tasks.

Effects of post-exposure naps on exposure therapy for social anxiety

Exposure therapy for social anxiety disorder (SAD) utilizes fear extinction, a memory process enhanced by sleep. We investigated whether naps following exposure sessions might improve symptoms and biomarkers in response to social stress in adults undergoing 5-week exposure-based group SAD therapy. Thirty-two participants aged 18-39 (18 females) with SAD were randomized. Before and after treatment, participants completed the Liebowitz Social Anxiety Scale (LSAS) and underwent a Trier Social Stress Test with psychophysiological monitoring (mpTSST) that included skin conductance (SCL), electromyographic (EMG) and electrocardiographic recording, and an auditory startle procedure while anticipating the social stressor. At sessions 3 and 4, exposure was followed by either a 120-min polysomnographically monitored sleep opportunity (Nap, N = 17) or wakefulness (Wake, N = 15). Primary hypotheses about SAD symptom change (LSAS) and EMG blink-startle response failed to differ with naps, despite significant symptom improvement (LSAS) with therapy. Some secondary biomarkers, however, provided preliminary support for enhanced extinction learning with naps, with trend-level Time (pre-, post-treatment) × Arm interactions and significant reduction from pre- to post treatment in the Nap arm alone for mpTSST SCL and salivary cortisol rise. Because of the small sample size and limited sleep duration, additional well-powered studies with more robust sleep interventions are indicated.

Autonomic arousal in anxious and typically developing youth during a stressor involving error feedback

Anxiety has been proposed to influence psychophysiological reactivity in children and adolescents. However, the extant empirical literature has not always found physiological reactivity to be associated with anxiety in youth. Further, most investigations have not examined psychophysiological reactivity in real time over the course of acute stress. To test the impact of anxiety disorder status on autonomic arousal in youth, we compared youth with primary anxiety disorders (N = 24) to typically developing (TD) youth (N = 22) on heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA) during an acute stressor in which youth received error-related feedback. We also conducted exploratory analyses on youth performance during the task. Youth ages 9-17 participated in the arithmetic portion of the Trier Social Stress Test for Children (Buske-Kirschbaum et al., Psychosom 59:419-426, 1997), during which time they received consecutive, standardized feedback that they made calculation errors. Results indicated that, compared to their TD counterparts, the anxious group demonstrated elevated HR and suppressed HRV during initial provision of error feedback and during the recovery period. No group differences were found for RSA. Additionally, overall TD youth made a greater proportion of errors than anxious youth. Clinically, these findings may provide preliminary support for anxious youth exhibiting physiological reactivity in response to receipt of error-related feedback, and may have implications for understanding biological processes during stress. This work underscores the need for further study of when and how anxiety may influence autonomic reactivity over the course of stress.

The tell-tale heart: physiological reactivity during resolution of ambiguity in youth anxiety

In the past decade, cognitive biases and physiological arousal have each been proposed as mechanisms through which paediatric anxiety develops and is maintained over time. Preliminary studies have found associations between anxious interpretations of ambiguity, physiological arousal, and avoidance, supporting theories that link cognition, psychophysiology, and behaviour. However, little is known about the relationship between youths' resolutions of ambiguity and physiological arousal during acute stress. Such information may have important clinical implications for use of verbal self-regulation strategies and cognitive restructuring during treatments for paediatric anxiety. In this brief report, we present findings suggesting that anxious, but not typically developing, youth select avoidant goals via non-threatening resolution of ambiguity during a stressor, and that this resolution of ambiguity is accompanied by physiological reactivity (heart rate, heart rate variability, and respiratory sinus arrhythmia). We propose future empirical research on the interplay between interpretation bias, psychophysiology, and child anxiety, as well as clinical implications.