Perception of Threat in Children With Social Phobia: Comparison to Nonsocially Anxious Children Before and After Treatment

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Interpretation Bias and Anticipated Distress in the Face of Ambiguity: Predictors of Change in Cognitive Behavioral Therapy for Youth Anxiety

This study examined associations among children's anxiety, interpretation bias, and anticipated distress before and after cognitive behavioral therapy (CBT) and investigated baseline levels of interpretation bias and anticipated distress as well as changes in these cognitive biases following treatment as predictors of treatment outcome. Clinically anxious youth (N = 39) were treated with brief CBT augmented with a smartphone app. Children completed measures assessing their anxiety, interpretation bias, and anticipated distress at baseline, post-treatment, and 2-month follow-up. Children's anxiety, interpretation bias, and anticipated distress significantly decreased following treatment. Anticipated distress was associated with higher anxiety at all time points; however, interpretation bias was not significantly associated with anxiety before or after treatment. Reductions in anticipated distress following treatment predicted concurrent and prospective reductions in anxiety. Reduced anticipated distress following treatment may contribute to enhanced treatment outcomes and may be more strongly related to the maintenance of youth anxiety than interpretation bias.

The role of emotion regulation in socially anxious children and adolescents: a systematic review

While numerous studies suggest that emotion dysregulation is important in maintaining social anxiety among adults, the role of emotion regulation in children and adolescents with social anxiety is not yet well understood. In this systematic review, we use the process model of emotion regulation as a framework for understanding emotion regulation in children and adolescents with social anxiety. We performed a systematic literature search in the electronic data bases Medline and PsycINFO. Additional studies were identified by hand search. We identified 683 studies, screened their titles and abstracts, viewed 142 studies, and included 55 of these. Study results indicate that children and adolescents with social anxiety disorder or high social anxiety show emotion dysregulation across all five domains of emotion regulation, such as enhanced social avoidance, more safety behaviors, repetitive negative thinking, biased attention and interpretation of social information, and reduced emotional expression. While enhanced social avoidance seems to be specific to childhood social anxiety, other maladaptive emotion regulation strategies, such as repetitive negative thinking, seem to occur transdiagnostically across different childhood anxiety disorders. Implications for current theory, interventions and future research are discussed.

Do Social Threat Cognitions Decrease With School-Based CBT and Predict Treatment Outcome in Adolescents With Social Anxiety Disorder?

Evidence suggests that Social Anxiety Disorder (SAD) is less responsive to cognitive behavioral treatment (CBT) compared to other anxiety disorders. Therefore, exploring what might facilitate clinical benefit is essential. Social threat cognitions, characterized by exaggerated perceptions of negative evaluation by others, may be one important avenue to examine. The current study investigated whether youths' social threat cognitions decreased with Skills for Academic and Social Success (SASS), a group, school-based CBT designed for SAD, and whether decreases predicted SAD severity and treatment response. Participants included 138 high school students with SAD randomly assigned to SASS, or a nonspecific school counseling intervention. SASS participants showed significantly decreased social threat cognitions at 5-month follow-up. Treatment responders had significantly greater reductions in social threat cognitions compared to nonresponders at post-intervention and follow-up. These findings suggest that social threat cognitions may be important to assess and monitor when treating youth with SAD.

The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model

BACKGROUND

Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD.

METHODS

A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model.

RESULTS

A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model.

LIMITATIONS

There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model.

CONCLUSIONS

The IAM model provides a framework for future investigations into the development and persistence of SAD.

Perceived threat in childhood: a review of research and implications for children living in violent households

The current study is a review of existing literature on perceived threat across childhood (0-19 years). There is strong evidence from this body of research that threat detection emerges in infancy and is present throughout childhood, with meaningful links to child adjustment. The wide range of methodologies employed to assess threat include biological measures (event-related potential and functional magnetic resonance imaging), observational data (gaze duration and response time), and a range of ways of gathering cognitive data (threat appraisal). Across methodologies, a uniform finding is that children who have higher threat attenuation are at increased risk for the development of anxiety disorders. It also seems that children's attention to threatening stimuli may vary across development, with heightened attention in infancy and early childhood. These findings have meaningful extensions for children who are living in violent families. Since many children living in violent homes are exposed to the threat of violence beginning in infancy, these children may be at heightened risk as compared to their nonexposed peers for the development of maladaptive patterns of threat detection and response. There is some evidence that this long-standing pattern of vigilance toward threat in key developmental periods may in part explain the increased risk of the development of anxiety disorders and posttraumatic stress disorder following exposure to violence.

Cognitive bias in action: evidence for a reciprocal relation between confirmation bias and fear in children

BACKGROUND AND OBJECTIVES

Some cognitive models propose that information processing biases and fear are reciprocally related. This idea has never been formally tested. Therefore, this study investigated the existence of a vicious circle by which confirmation bias and fear exacerbate each other.

METHODS

One-hundred-and-seventy-one school children (8-13 years) were first provided with threatening, ambiguous, or positive information about an unknown animal. Then they completed a computerized information search task during which they could collect additional (negative, positive, or neutral) information about the novel animal. Because fear levels were repeatedly assessed during the task, it was possible to examine the reciprocal relationship between confirmation bias and fear.

RESULTS

A reciprocal relation of mutual reinforcement was found between confirmation bias and fear over the course of the experiment: increases in fear predicted subsequent increases in the search for negative information, and increases in the search for negative information further enhanced fear on a later point-in-time. In addition, the initial information given about the animals successfully induced diverging fear levels in the children, and determined their first inclination to search for additional information.

LIMITATIONS

As this study employed a community sample of primary school children, future research should test whether these results can be generalized to clinically anxious youth.

CONCLUSIONS

These findings provide first support for the notion that fearful individuals may become trapped in a vicious circle in which fear and a fear-related confirmation bias mutually strengthen each other, thereby maintaining the anxiety pathology.

Psychometric properties of the social phobia and anxiety inventory-child version in a Swedish clinical sample

The social phobia and anxiety inventory for children (SPAI-C) is a 26 item, empirically derived self-report instrument developed for assessing social phobic fears in children. Evidence for satisfactory psychometric properties of the SPAI-C has been found in multiple community studies. Since its development, however, no study has presented an extensive psychometric evaluation of SPAI-C in a sample of carefully diagnosed children with social phobia. The present study sought to replicate and expand previous studies by administrating the SPAI-C to a sample of 59 children that fulfilled DSM-IV criteria for social phobia, and 49 children with no social phobia diagnosis. An exploratory factor analysis resulted in a three factor solution reflecting: (1) fear of social interactions, (2) fear of public performance situations, and (3) physical and cognitive symptoms connected with social phobia. These factors appear to parallel domains of social phobia also evident in adults. The SPAI-C total scale and each factor was found to possess good internal consistency, good test-retest reliability and was generally strongly correlated with both self-report and clinician measures of anxiety and fears. The discriminative properties of the total scale were satisfactory.