Child restraint systems: Understanding confidence in proper use and addressing the need for education.

Objective: To quantify the extent of proper local child restraint system (CRS) use and to better understand changes to the level of self-reported confidence with increased CRS installations. With the goal being to improve safety for children travelling in personal vehicles across London, ON and the region. Methods: Public CRS clinics were initiated by Injury Prevention staff after they obtained the Child Passenger Safety Technician certification. Additionally, an online survey was commissioned targeting Ontario parents who had installed at least one CRS in the last five years. Results: From September 2018 to September 2019, 96 comprehensive CRS checks were performed, with 29% of systems found to be installed correctly. Survey results showed a high level of reported confidence with CRS installation (N = 514, 70% female, 43% one child). Parents who had installed only one CRS reported higher confidence in their first install, compared to parents who had installed two or more systems. Conclusions: The error rate with CRS installation and use seen in London, Ontario and the region, is similar to that reported in previous research. Survey results showed high levels of self-reported confidence in CRS use, especially for parents who have installed only one CRS. There presents a need to better understand the root cause of the discrepancy between level of confidence and proper CRS use and to expand our understanding of CRS knowledge retention and transferability to subsequent systems.

Social avoidance behavior modulates motivational responses to social reward-threat conflict signals: A preliminary fMRI study.

Social avoidance behavior (SAB) produces impairment in multiple domains and contributes to the development and maintenance of several psychiatric disorders. Social behaviors such as SAB are influenced by approach-avoidance (AA) motivational responses to affective facial expressions. Notably, affective facial expressions communicate varying degrees of social reward signals (happiness), social threat signals (anger), or social reward-threat conflict signals (co-occurring happiness and anger). SAB is associated with dysregulated modulation of automatic approach-avoidance (AA) motivational responses exclusively to social reward-threat conflict signals. However, no neuroimaging research has characterized SAB-related modulation of automatic and subjective AA motivational responses to social reward-threat conflict signals. We recruited 30 adults reporting clinical, moderate, or minimal SAB based on questionnaire cutoff scores. SAB groups were matched on age range and gender. During fMRI scanning, participants completed implicit and subjective approach-avoidance tasks (AATs), which involved more incidental or more explicit evaluation of facial expressions that parametrically varied in social reward signals (e.g., 50%Happy), social threat signals (e.g., 50%Angry), or social reward-threat conflict signals (e.g., 50%Happy + 50%Angry). In the implicit AAT, SAB was associated with slower automatic avoidance actions and weaker amygdala-pgACC connectivity exclusively as a function of social reward-threat conflict signals. In the subjective AAT, SAB was associated with smaller increases in approach ratings, smaller decreases in avoidance ratings, and weaker dlPFC-pgACC connectivity exclusively in response to social reward-threat conflict signals. Thus, SAB is associated with dysregulated modulation of automatic and subjective AA motivational sensitivity to social reward-threat conflict signals, which may be facilitated by overlapping neural systems.

Anterior Insula Activation During Cardiac Interoception Relates to Depressive Symptom Severity in HIV-Positive and HIV-Negative Postmenopausal Women.

OBJECTIVE: This study aimed to determine whether subclinical symptoms of depression in postmenopausal women are associated with blood oxygen level-dependent (BOLD) activity within the anterior insula during cardiac interoceptive awareness and whether this association differs for persons living with the human immunodeficiency virus (PWH). METHOD: Twenty-three postmenopausal (mean [standard deviation] age = 56.5 [4.8] years) and 27 HIV-negative women (mean [standard deviation] age = 56.4 [8.0]) underwent functional magnetic resonance imaging while performing a heartbeat detection task. BOLD activation within the bilateral anterior insula based on the contrast of a heartbeat detection condition with and without a distracting tone was entered along with age, HIV status, and psychological stress into two multivariate regression models with self-reported depressive symptom severity as the outcome. RESULTS: Depressive symptoms did not vary by HIV status, nor was there a main effect or interaction for PWH on insula BOLD activation. Depressive symptoms were positively associated with psychological stress for the left ( ß = 0.310, t (49) = 2.352, p = .023) and right brain models ( ß = 0.296, t (49) = 2.265, p = .028) as well as the magnitude of BOLD activation in the left insula ( ß = 0.290, t (49) = 2.218, p = .032) and right insula ( ß = 0.318, t (49) = 2.453, p = .018), respectively. Exploratory analyses revealed that greater magnitude of BOLD activation attributed to exteroceptive noise (tone) was also correlated with self-reported distrust and preoccupation with interoceptive sensations. CONCLUSIONS: Results support an active interference model for interoceptive awareness wherein greater BOLD signal in the anterior insula in the presence of distracting exteroceptive stimuli may reflect greater prediction error, a feature of depression.

Computational modeling of threat learning reveals links with anxiety and neuroanatomy in humans.

Influential theories implicate variations in the mechanisms supporting threat learning in the severity of anxiety symptoms. We use computational models of associative learning in conjunction with structural imaging to explicate links among the mechanisms underlying threat learning, their neuroanatomical substrates, and anxiety severity in humans. We recorded skin-conductance data during a threat-learning task from individuals with and without anxiety disorders (N=251; 8-50 years; 116 females). Reinforcement-learning model variants quantified processes hypothesized to relate to anxiety: threat conditioning, threat generalization, safety learning, and threat extinction. We identified the best-fitting models for these processes and tested associations among latent learning parameters, whole-brain anatomy, and anxiety severity. Results indicate that greater anxiety severity related specifically to slower safety learning and slower extinction of response to safe stimuli. Nucleus accumbens gray-matter volume moderated learning-anxiety associations. Using a modeling approach, we identify computational mechanisms linking threat learning and anxiety severity and their neuroanatomical substrates.

The Reliability and Validity of Response-Based Measures of Attention Bias.

Background: Attention bias to threat is a fundamental transdiagnostic component and potential vulnerability factor for internalizing psychopathologies. However, the measurement of attentional bias, such as traditional scores from the dot-probe paradigm, evidence poor reliability and do not measure intra-individual variation in attentional bias. Methods: The present study examined, in three independent samples, the psychometric properties of a novel attentional bias (AB) scoring method of the dot-probe task based on responses to individual trials. For six AB scores derived using the response-based approach, we assessed the internal consistency, test-retest reliability, familial associations, and external validity (using Social Anxiety Disorder, a disorder strongly associated with attentional bias to threatening faces). Results: Compared to traditional AB scores, response-based scores had generally better internal consistency (range of Cronbach's alphas: 0.68-0.92 vs. 0.41-0.71), higher test-retest reliabilities (range of Pearson's correlations: 0.26-0.77 vs. -0.05-0.35), and were more strongly related in family members (range of ICCs: 0.11-0.27 vs. 0-0.05). Furthermore, three response-based scores added incremental validity beyond traditional scores and gender in the external validators of current and lifetime Social Anxiety Disorder. Conclusions: Findings indicate that response-based AB scores from the dot-probe task have better psychometric properties than traditional scores.

Development and validation of the Attention Bias Questionnaire (ABQ).

OBJECTIVES: Various psychopathologies are associated with threat-related attention biases, which are typically measured using mechanized behavioral tasks. While useful and objective, behavioral measures do not capture the subjective experience of biased attention in daily-living. To complement extant behavioral measures, we developed and validated a self-report measure of threat-related attention bias - the Attention Bias Questionnaire (ABQ). METHODS: The ABQ consists of nine items reflecting the subjective experience of attention bias towards threats. To enable personalized relevance in threat-content, the general term "threat" was used, and respondents were instructed to refer to specific things that threaten them personally. In a set of five studies, the ABQ was developed and validated. Internal consistency, discriminant validity, test-retest reliability, and convergent validity were tested. RESULTS: The ABQ emerged as a coherent and stable measure with two sub-scales: Engagement with Threat and Difficulty to Disengage from Threat. ABQ scores were positively correlated with trait anxiety, social anxiety, PTSD, and depression, as well as behaviorally measured attention bias. CONCLUSION: Assessing the subjective experience of threat-related attention bias can enrich existing knowledge about the cognitive mechanisms underlying psychopathology and complement extant behavioral bias measures in research and clinical evaluation.

Repetitive negative thinking and depressive symptoms are differentially related to response inhibition: The influence of non-emotional, socio-emotional, and self-referential stimuli.

Identifying transdiagnostic correlates of response inhibition deficits is important for understanding risk for internalizing disorders. Little work has compared the relationships between internalizing symptoms and repetitive negative thinking (RNT) with response inhibition across non-emotional and emotional domains, and no work has compared these relationships for inhibition of socio-emotional relative to self-referential stimuli. Undergraduate students (N = 71, 18.44 ± 0.71 years) selected on extremes of internalizing symptoms completed the Perseverative Thinking Questionnaire (PTQ) and a Go/No-Go paradigm using non-emotional stimuli, other individuals' sad facial expressions, and participants' own sad facial expressions. Participants exhibited more commission errors for sad facial expressions than non-emotional trials, though commission errors for others' and participants' own sad facial expressions did not differ. Depressive symptoms were associated with poorer inhibition of non-emotional stimuli; however, PTQ scores were associated with more successful inhibition of non-emotional stimuli. Our results provide evidence that transdiagnostic RNT as assessed by the PTQ may be related to better inhibition in non-emotional domains, but negative emotional stimuli may interfere with successful inhibition for those with high RNT, while depressive symptoms were linked to poorer inhibition of non-emotional stimuli. These findings have implications for internalizing disorders, which often are accompanied by RNT.

Characterizing the time course of automatic action tendencies to affective facial expressions and its dysregulation in social anxiety disorder.

Affective facial expressions elicit automatic approach or avoidance action tendencies, which are dysregulated in Social Anxiety Disorder (SAD). However, research has not dissociated the initiation and execution phases of automatic action tendencies, which may be distinctly modulated by affective faces and SAD. In Study 1, fifty adults completed a modified Approach-Avoidance Task (AAT) that characterized the time course of automatic approach or avoidance actions elicited by affective faces. In the initiation phase, happy faces elicited greater automatic approach tendencies compared to angry faces, an effect that linearly weakened across the execution phase. In Study 2, 44 adults with a principal diagnosis of SAD and 22 healthy comparison (HC) adults completed a similar AAT. Compared to the HC group, the SAD group exhibited an inconsistent time course of automatic action tendencies to neutral faces. Specifically, SAD was characterized by relatively weak initiation of automatic approach tendencies, but relatively stronger execution of automatic approach tendencies. In contrast, the HC group exhibited relatively similar initiation and execution of automatic approach tendencies to neutral faces. Together, these results demonstrate that the initiation and execution of automatic action tendencies are differentially modulated by affective faces and SAD.

Neural Responses to a Putative Set-shifting Task in Children with Autism Spectrum Disorder.

While much progress has been made toward understanding the neurobiology of social and communication deficits associated with autism spectrum disorder (ASD), less is known regarding the neurobiological basis of restricted and repetitive behaviors (RRBs) central to the ASD diagnosis. Symptom severity for RRBs in ASD is associated with cognitive inflexibility. Thus, understanding the neural mechanisms underlying cognitive inflexibility in ASD is critical for tailoring therapies to treat this understudied yet pervasive symptom. Here we used a set-shifting paradigm adopted from the developmental cognitive neuroscience literature involving flexible switching between stimulus categories to examine task performance and neural responses in children with ASD. Behaviorally, we found little evidence for group differences in performance on the set-shifting task. Compared with typically developing children, children with ASD exhibited greater activation of the parahippocampal gyrus during performance on trials requiring switching. These findings suggest that children with ASD may need to recruit memory-based neural systems to a greater degree when learning to flexibly associate stimuli with responses. LAY SUMMARY: Children with autism often struggle to behave in a flexible way when faced with unexpected challenges. We examined brain responses during a task thought to involve flexible thinking and found that compared with typically developing children, those with autism relied more on brain areas involved in learning and memory to complete the task. This study helps us to understand what types of cognitive tasks are best suited for exploring the neural basis of cognitive flexibility in children with autism. Autism Res 2020, 13: 1501-1515. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Neural mechanisms underlying heterogeneous expression of threat-related attention in social anxiety.

Theoretical frameworks propose that threat-related attention, which is typically assessed using the dot-probe paradigm, plays a key role in social anxiety. Within the dot-probe paradigm, novel computational approaches demonstrate that anxious individuals exhibit multiple patterns of threat-related attention on separate trials. However, no research has leveraged such novel computational methods to delineate the neural substrates of threat-related attention patterns in social anxiety. To address this issue, fifty-three socially anxious adults (22.38 ± 3.12, 33 females) completed an fMRI-based dot-probe paradigm. A novel, response-based computation approach revealed conjoint patterns of vigilant orientation, avoidant orientation, slow disengagement, and fast disengagement, which were masked by standard computation measures. Compared to vigilant orientation and fast disengagement, avoidant orientation and slow disengagement were greater in magnitude, respectively. Mirroring behavioral findings, avoidant orientation and slow disengagement elicited greater deactivation of several regions within the Default Mode Network and stronger connectivity between the right amygdala and superior temporal sulcus. Taken together, these results suggest that distinct neural processes facilitate the heterogeneous expression of threat-related attention in social anxiety.

Social avoidance behaviour modulates automatic avoidance actions to social reward-threat conflict.

Social avoidance behaviour (SAB) significantly interferes with social engagement and characterises various psychopathologies. Dual-process models propose that social behaviour is directed in part by automatic action tendencies to approach or avoid social stimuli. For example, happy facial expressions often elicit automatic approach actions, whereas angry facial expressions often elicit automatic avoidance actions. When motivation to approach and avoid co-occurs, automatic action tendencies may be uniquely modulated to direct social behaviour. Although research has examined how psychopathology modulates automatic action tendencies, no research has examined how SAB modulates automatic action tendencies. To address this issue, one hundred and three adults (65 females, 20.72 ± 5.06 years) completed a modified approach-avoidance task (AAT) with ambiguous facial stimuli that parametrically varied in social reward (e.g. 50%Happy), social threat (e.g. 50%Angry), or social reward-threat conflict (e.g. 50%Happy/50%Angry). SAB was not associated with automatic actions to any single parametric variation of social reward and/or social threat. Instead, SAB was associated with a quadratic (i.e. U-shaped) pattern in which automatic avoidance actions to social reward-threat conflict were faster relative to unambiguous social reward and social threat. Moreover, this association was independent of internalizing and social anxiety symptoms. These results provide insight into mechanisms underlying SAB, which offers clinical implications.

Age Differences in the Neural Correlates of Anxiety Disorders: An fMRI Study of Response to Learned Threat.

OBJECTIVE: Although both pediatric and adult patients with anxiety disorders exhibit similar neural responding to threats, age-related differences have been found in some functional MRI (fMRI) studies. To reconcile disparate findings, the authors compared brain function in youths and adults with and without anxiety disorders while rating fear and memory of ambiguous threats. METHODS: Two hundred medication-free individuals ages 8-50 were assessed, including 93 participants with an anxiety disorder. Participants underwent discriminative threat conditioning and extinction in the clinic. Approximately 3 weeks later, they completed an fMRI paradigm involving extinction recall, in which they rated their levels of fear evoked by, and their explicit memory for, morph stimuli with varying degrees of similarity to the extinguished threat cues. RESULTS: Age moderated two sets of anxiety disorder findings. First, as age increased, healthy subjects compared with participants with anxiety disorders exhibited greater amygdala-ventromedial prefrontal cortex (vmPFC) connectivity when processing threat-related cues. Second, age moderated diagnostic differences in activation in ways that varied with attention and brain regions. When rating fear, activation in the vmPFC differed between the anxiety and healthy groups at relatively older ages. In contrast, when rating memory for task stimuli, activation in the inferior temporal cortex differed between the anxiety and healthy groups at relatively younger ages. CONCLUSIONS: In contrast to previous studies that demonstrated age-related similarities in the biological correlates of anxiety disorders, this study identified age differences. These findings may reflect this study's focus on relatively late-maturing psychological processes, particularly the appraisal and explicit memory of ambiguous threat, and inform neurodevelopmental perspectives on anxiety.

Anticipatory Threat Responding: Associations With Anxiety, Development, and Brain Structure.

BACKGROUND: While translational theories link neurodevelopmental changes in threat learning to pathological anxiety, findings from studies in patients inconsistently support these theories. This inconsistency may reflect difficulties in studying large patient samples with wide age ranges using consistent methods. A dearth of imaging data in patients further limits translational advances. We address these gaps through a psychophysiology and structural brain imaging study in a large sample of patients across the lifespan. METHODS: A total of 351 participants (8-50 years of age; 209 female subjects; 195 healthy participants and 156 medication-free, treatment-seeking patients with anxiety) completed a differential threat conditioning and extinction paradigm that has been validated in pediatric and adult populations. Skin conductance response indexed psychophysiological response to conditioned (CS+, CS-) and unconditioned threat stimuli. Structural magnetic resonance imaging data were available for 250 participants. Analyses tested anxiety and age associations with psychophysiological response in addition to associations between psychophysiology and brain structure. RESULTS: Regardless of age, patients and healthy comparison subjects demonstrated comparable differential threat conditioning and extinction. The magnitude of skin conductance response to both conditioned stimulus types differentiated patients from comparison subjects and covaried with dorsal prefrontal cortical thickness; structure-response associations were moderated by anxiety and age in several regions. Unconditioned responding was unrelated to anxiety and brain structure. CONCLUSIONS: Rather than impaired threat learning, pathological anxiety involves heightened skin conductance response to potential but not immediately present threats; this anxiety-related potentiation of anticipatory responding also relates to variation in brain structure. These findings inform theoretical considerations by highlighting anticipatory response to potential threat in anxiety.

Parsing Heterogeneity of Executive Function in Typically and Atypically Developing Children: A Conceptual Replication and Exploration of Social Function.

Executive function (EF), the set of cognitive processes that govern goal-directed behavior, varies within developmental samples and clinical populations. Here, we perform a conceptual replication of prior work (Dajani et al. in Sci Rep 6:36566, 2016) in an independent sample of typically developing children (n = 183) and children with autism spectrum disorder (n = 104). Consistent with previous work, the latent profile analysis of parent-report EF measures provided evidence for three EF classes, which exhibited differential proportions of diagnostic groups. Additionally, children in the impaired EF group exhibited greater levels of social impairment. These results highlight the heterogeneity of EF ability among clinical and non-clinical populations and the link between EF and social abilities.

A psychometric comparison of anxiety-relevant attention measures.

BACKGROUND AND OBJECTIVES: Preferential attention to threat, emotional response inhibition, and attentional control each purportedly play a key role in anxiety disorders. Divergent psychometric properties among attention measures may produce differential detection of anxiety-related associations and treatment-related changes. However, no studies have directly compared the psychometric properties of these attention measures in the same sample. DESIGN: Eighty-five young adults (M = 19.41 years, SD = 1.47, 48 Females) completed a cognitive task battery and a subset of 60 participants (M = 19.42 years, SD = 1.48, 33 Females) completed the task battery again approximately two weeks later. METHOD: To assess preferential attention to threat, emotional response inhibition, and attentional control, the cognitive task battery included a dot-probe task, emotion and gender Stroop tasks, and a flanker task. Tasks varied in how attention was directed and if emotional stimuli were included. Internal consistency and test-retest reliability were compared across measures. RESULTS: Within the same sample, internal consistency and reliability differed across attention measures. Explicit attention measures (emotional Stroop and flanker) exhibited stronger internal consistency and greater test-retest reliability compared to implicit measures (dot-probe and gender Stroop). CONCLUSIONS: These results inform clinical research using attention measures to assess anxiety-related differences and treatment response.

Objective measurement of head movement differences in children with and without autism spectrum disorder.

Background: Deficits in motor movement in children with autism spectrum disorder (ASD) have typically been characterized qualitatively by human observers. Although clinicians have noted the importance of atypical head positioning (e.g. social peering and repetitive head banging) when diagnosing children with ASD, a quantitative understanding of head movement in ASD is lacking. Here, we conduct a quantitative comparison of head movement dynamics in children with and without ASD using automated, person-independent computer-vision based head tracking (Zface). Because children with ASD often exhibit preferential attention to nonsocial versus social stimuli, we investigated whether children with and without ASD differed in their head movement dynamics depending on stimulus sociality. Methods: The current study examined differences in head movement dynamics in children with (n = 21) and without ASD (n = 21). Children were video-recorded while watching a 16-min video of social and nonsocial stimuli. Three dimensions of rigid head movement-pitch (head nods), yaw (head turns), and roll (lateral head inclinations)-were tracked using Zface. The root mean square of pitch, yaw, and roll was calculated to index the magnitude of head angular displacement (quantity of head movement) and angular velocity (speed). Results: Compared with children without ASD, children with ASD exhibited greater yaw displacement, indicating greater head turning, and greater velocity of yaw and roll, indicating faster head turning and inclination. Follow-up analyses indicated that differences in head movement dynamics were specific to the social rather than the nonsocial stimulus condition. Conclusions: Head movement dynamics (displacement and velocity) were greater in children with ASD than in children without ASD, providing a quantitative foundation for previous clinical reports. Head movement differences were evident in lateral (yaw and roll) but not vertical (pitch) movement and were specific to a social rather than nonsocial condition. When presented with social stimuli, children with ASD had higher levels of head movement and moved their heads more quickly than children without ASD. Children with ASD may use head movement to modulate their perception of social scenes.

Improving the psychometric properties of dot-probe attention measures using response-based computation.

BACKGROUND AND OBJECTIVES: Abnormal threat-related attention in anxiety disorders is most commonly assessed and modified using the dot-probe paradigm; however, poor psychometric properties of reaction-time measures may contribute to inconsistencies across studies. Typically, standard attention measures are derived using average reaction-times obtained in experimentally-defined conditions. However, current approaches based on experimentally-defined conditions are limited. In this study, the psychometric properties of a novel response-based computation approach to analyze dot-probe data are compared to standard measures of attention. METHODS: 148 adults (19.19 ±â€¯1.42 years, 84 women) completed a standardized dot-probe task including threatening and neutral faces. We generated both standard and response-based measures of attention bias, attentional orientation, and attentional disengagement. We compared overall internal consistency, number of trials necessary to reach internal consistency, test-retest reliability (n = 72), and criterion validity obtained using each approach. RESULTS: Compared to standard attention measures, response-based measures demonstrated uniformly high levels of internal consistency with relatively few trials and varying improvements in test-retest reliability. Additionally, response-based measures demonstrated specific evidence of anxiety-related associations above and beyond both standard attention measures and other confounds. LIMITATIONS: Future studies are necessary to validate this approach in clinical samples. CONCLUSIONS: Response-based attention measures demonstrate superior psychometric properties compared to standard attention measures, which may improve the detection of anxiety-related associations and treatment-related changes in clinical samples.

Differences in neural response to extinction recall in young adults with or without history of behavioral inhibition.

Behavioral inhibition (BI) is a temperament identified in early childhood that is associated with risk for anxiety disorders, yet only about half of behaviorally inhibited children manifest anxiety later in life. We compared brain function and behavior during extinction recall in a sample of nonanxious young adults characterized in childhood with BI (n = 22) or with no BI (n = 28). Three weeks after undergoing fear conditioning and extinction, participants completed a functional magnetic resonance imaging extinction recall task assessing memory and threat differentiation for conditioned stimuli. While self-report and psychophysiological measures of differential conditioning and extinction were similar across groups, BI-related differences in brain function emerged during extinction recall. Childhood BI was associated with greater activation in subgenual anterior cingulate cortex in response to cues signaling safety. This pattern of results may reflect neural correlates that promote resilience against anxiety in a temperamentally at-risk population.

Complementary Features of Attention Bias Modification Therapy and Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders.

OBJECTIVE: In the treatment of anxiety disorders, attention bias modification therapy (ABMT) and cognitive-behavioral therapy (CBT) may have complementary effects by targeting different aspects of perturbed threat responses and behaviors. ABMT may target rapid, implicit threat reactions, whereas CBT may target slowly deployed threat responses. The authors used amygdala-based connectivity during a threat-attention task and a randomized controlled trial design to evaluate potential complementary features of these treatments in pediatric anxiety disorders. METHOD: Prior to treatment, youths (8-17 years old) with anxiety disorders (N=54), as well as healthy comparison youths (N=51), performed a threat-attention task during functional MRI acquisition. Task-related amygdala-based functional connectivity was assessed. Patients with and without imaging data (N=85) were then randomly assigned to receive CBT paired with either active or placebo ABMT. Clinical response was evaluated, and pretreatment amygdala-based connectivity profiles were compared among patients with varying levels of clinical response. RESULTS: Compared with the CBT plus placebo ABMT group, the CBT plus active ABMT group exhibited less severe anxiety after treatment. The patient and healthy comparison groups differed in amygdala-insula connectivity during the threat-attention task. Patients whose connectivity profiles were most different from those of the healthy comparison group exhibited the poorest response to treatment, particularly those who received CBT plus placebo ABMT. CONCLUSIONS: The study provides evidence of enhanced clinical effects for patients receiving active ABMT. Moreover, ABMT appears to be most effective for patients with abnormal amygdala-insula connectivity. ABMT may target specific threat processes associated with dysfunctional amygdala-insula connectivity that are not targeted by CBT alone. This may explain the observation of enhanced clinical response to CBT plus active ABMT.

Fear conditioning and extinction in pediatric obsessive-compulsive disorder.

BACKGROUND: Fear acquisition and extinction are central constructs in the cognitive-behavioral model of obsessive-compulsive disorder (OCD), which underlies exposure-based cognitive-behavioral therapy. Youths with OCD may have impairments in fear acquisition and extinction that carry treatment implications. METHODS: Eighty youths (39 OCD, 41 healthy controls [HC]) completed clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. RESULTS: During habituation, participants with OCD exhibited a stronger orienting SCR to initial stimuli relative to HC participants. During acquisition, differential fear conditioning was observed for both groups as evidenced by larger SCRs to the visual conditioned stimulus paired with an aversive unconditioned stimulus (CS+) compared with a CS-; OCD participants exhibited a larger SCR to the CS+ relative to HC participants. The absolute magnitude of the unconditioned fear response was significantly larger in participants with OCD, compared with HC participants. During extinction, OCD participants continued to exhibit a differential SCR to the CS+ and CS-, whereas HC participants exhibited diminished SCR to both stimuli. CONCLUSIONS: Participants with OCD exhibit a different pattern of fear extinction relative to HC participants, suggestive of greater fear acquisition and impaired inhibitory learning.