Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives.

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Enhanced late positive potential to conditioned threat cue during delayed extinction in anxious youth.

BACKGROUND: Deficits in threat learning relate to anxiety symptoms. Since several anxiety disorders arise in adolescence, impaired adolescent threat learning could contribute to adolescent changes in risk for anxiety. This study compared threat learning among anxious and non-anxious youth using self-reports, peripheral psychophysiology measures, and event-related potentials. Because exposure therapy, the first-line treatment for anxiety disorders, is largely based on principles of extinction learning, the study also examined the link between extinction learning and treatment outcomes among anxious youth. METHODS: Clinically anxious (n = 28) and non-anxious (n = 33) youth completed differential threat acquisition and immediate extinction. They returned to the lab a week later to complete a threat generalization test and a delayed extinction task. Following these two experimental visits, anxious youth received exposure therapy for 12 weeks. RESULTS: Anxious as compared to non-anxious youth demonstrated elevated cognitive and physiological responses across acquisition and immediate extinction learning, as well as greater threat generalization. In addition, anxious youth showed enhanced late positive potential response to the conditioned threat cue compared to the safety cue during delayed extinction. Finally, aberrant neural response during delayed extinction was associated with poorer treatment outcomes. CONCLUSIONS: The study emphasizes differences between anxious and non-anxious youth in threat learning processes and provides preliminary support for a link between neural processing during delayed extinction and exposure-based treatment outcome in pediatric anxiety.

Mechanisms underlying interoceptive exposure: belief disconfirmation or extinction? A preliminary study.

Interoceptive exposure, or exposure to one's feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in a lab-based, analog study with individuals high in AS. Participants (n = 59) were randomized into three groups: a cognitive-behavioral intervention emphasizing belief disconfirmation (CbI), a behavioral intervention emphasizing exposure (BI), and a control condition. Self-report measures assessing AS, catastrophizing of bodily sensations, and subjective units of distress (SUDS) were collected before, during and after the intervention. Participants also completed online questionnaires at a one-month follow-up. Following the CbI but not BI, a decrease was observed in both AS and catastrophizing interpretations. Furthermore, only the CbI group exhibited a decrease in SUDS ratings, whereas the BI group exhibited a significant increase. Notably, these effects were not maintained at a one-month follow-up. Findings suggest that cognitive interventions without repeated behavioral exposure may be sufficient in reducing self-reported anxiety-related symptoms and catastrophic misinterpretations, though not at maintaining them. This raises questions regarding the role of pure behavioral mechanisms in exposure.

Effects of increased attention allocation to threat and safety stimuli on fear extinction and its recall.

BACKGROUND AND OBJECTIVES: Attention plays an important role in the treatment of anxiety. Increased attention to threat has been shown to yield improved treatment outcomes in anxious patients following exposure-based therapy. This study examined whether increasing attention to learned stimuli during fear extinction, an experimental analogue for exposure-based treatments, could improve extinction learning and its maintenance. METHODS: Sixty-five healthy adults were randomized into experimental or control conditions. All completed a differential fear conditioning task. During extinction, a subtle attentional manipulation was implemented in the experimental group, designed to increase participants' attention to both threat and safety cues. Three days later, an extinction recall test was conducted using the original cues and two perceptually similar morphs. RESULTS: Fear conditioning was achieved in both behavioral and psychophysiological measures. In addition, between-group differences emerged during extinction. The experimental group exhibited increased attention to stimuli and lower fear responses in physiological measure than the control group. Similarly, during extinction recall, the experimental group exhibited lower startle responses than the control group. Last, across groups, attending to the safety cue during extinction was associated with lower self-reported risk of the two generalization morphs displayed during extinction recall. LIMITATIONS: Skin conductance response (SCR) was not measured during extinction recall. Future research should include both SCR and additional generalization morphs so as to allow for the examination of more subtle individual differences. CONCLUSIONS: Results indicate that the attentional manipulation increased attention allocation to stimuli during extinction; this, in turn, affected fear-related physiological response.

The effects of age and trait anxiety on avoidance learning and its generalization.

Avoidance is an important self-protective behavior, but excessive avoidance is maladaptive and a core feature of anxiety disorders. Given that several of these disorders emerge in adolescence, maladaptive avoidance learning might be a risk factor in subsequent psychopathology. The current study investigated the effects of age and trait anxiety on avoidance learning and related processes. Adults and youth completed a differential fear-conditioning task. Thereafter, during avoidance conditioning, participants learned to press a button cancelling an upcoming aversive sound. Next, during extinction, no aversive sound was presented, and the avoidance button was removed. Last, in the generalization test, a series of morphs ranging in similarity from the safety cue to the danger cue were presented, and the avoidance button was reintroduced. Self-reported safety-danger ratings and skin conductance responses were collected. Developmental differences emerged in safety-danger ratings during avoidance conditioning; while adults exhibited a gradual decrease in differential danger ratings, among youth, this response was moderated by trait anxiety levels. Following extinction, participants returned to avoid the danger cue and perceptually similar morphs. Moreover, avoidance response to some generalized stimuli was associated with trait anxiety levels. These findings highlight the importance of examining avoidance learning in relation to anxiety symptoms throughout development.

Reducing avoidance in adults with high spider fear using perceptual discrimination training.

BACKGROUND: Fear overgeneralization is a central feature of anxiety disorders and can lead to excessive avoidance. As perceptual discrimination is a key component of fear overgeneralization, a perceptual discrimination training task was created aimed at improving perceptual discrimination and reducing fear overgeneralization. METHODS: Participants with high spider fear were randomized into training or placebo conditions. After completing their assigned task, perceptual discrimination was tested. Thereafter, participants completed a behavioral avoidance test, consisting of five stimuli ranging from a paper spider to a live tarantula. Last, participants completed a threat/safety discrimination task using schematic morphs ranging from a flower to a spider, while self-report and skin conductance responses were collected. RESULTS: The training group showed better perceptual discrimination during the test than did the placebo group. Furthermore, as stimuli became increasingly similar to a live spider, participants in the training group exhibited decreased avoidance behavior. Finally, participants in the training group indicated that schematic morphs were less similar to a spider and showed less physiological arousal than did the placebo group. CONCLUSIONS: Together, these results attest to the possible clinical relevance of the perceptual discrimination training.

Reducing fear overgeneralization in children using a novel perceptual discrimination task.

Fear generalization, while adaptive, can be detrimental when occurring in excess. To this end a perceptual discrimination training task was created with a goal of decreasing fear overgeneralization. The current study tested the effectiveness of the training task among typically-developing children. Participants (n = 73) were randomly assigned into a training, placebo or no task group. Following a differential fear-conditioning task, participants in the first two groups underwent the discrimination training or placebo task. An assessment task was then administered. Finally, all participants completed a fear generalization test, consisting of 11 morphs ranging in perceptual similarity from the threat cue to the safety cue. Physiological and self-report measures were collected. Fear-conditioning was achieved in both physiological and self-report measures. Further, in the assessment task, the training group showed better perceptual discrimination than did the placebo group. Last, the training group exhibited less overgeneralization of affective stimuli as indicated by a physiological measure than did the two control conditions. Findings suggest that the perceptual discrimination training task effectively moderated fear overgeneralization in children. This adds to previous evidence of the task's effectiveness among adults.

A novel perceptual discrimination training task: Reducing fear overgeneralization in the context of fear learning.

Generalization is an adaptive learning mechanism, but it can be maladaptive when it occurs in excess. A novel perceptual discrimination training task was therefore designed to moderate fear overgeneralization. We hypothesized that improvement in basic perceptual discrimination would translate into lower fear overgeneralization in affective cues. Seventy adults completed a fear-conditioning task prior to being allocated into training or placebo groups. Predesignated geometric shape pairs were constructed for the training task. A target shape from each pair was presented. Thereafter, participants in the training group were shown both shapes and asked to identify the image that differed from the target. Placebo task participants only indicated the location of each shape on the screen. All participants then viewed new geometric pairs and indicated whether they were identical or different. Finally, participants completed a fear generalization test consisting of perceptual morphs ranging from the CS + to the CS-. Fear-conditioning was observed through physiological and behavioural measures. Furthermore, the training group performed better than the placebo group on the assessment task and exhibited decreased fear generalization in response to threat/safety cues. The findings offer evidence for the effectiveness of the novel discrimination training task, setting the stage for future research with clinical populations.

Stability and transitions in posttraumatic growth trajectories among cancer patients: LCA and LTA analyses.

OBJECTIVES: The objectives of the current study were to identify (a) different post cancer treatment adaptation profiles; (b) factors that predict these adaptation profiles; and (c) transitions in post cancer-treatment adaptation profiles and trajectories in a sample (N = 198) of female breast cancer patients over a 2-year period. METHOD: Latent class analysis (LCA) was used to idenitfy profiles of post cancer treatment adaptation, based on a combined pattern of responses to observable indicators of distress, coping strategies, and posttraumatic growth. latent transition analysis (LTA) was used to track trajectories, based on the probabilities of transitions among latent classes. RESULTS: Four postcancer treatment adaptation profiles were found: (a) distressed, (b) resistant, (c) constructive growth, and (d) struggling growth. CONCLUSIONS: The majority of transitions between different adaptation profiles occurred between 6 and 12 months after treatment. These findings offer theoretical and practice implications regarding posttraumatic growth in breast-cancer patients by distinguishing between profiles of adaptation and highlights a previously unidentified profile-struggling growth. These results contribute to the theoretical understanding of the complex relationship between growth, distress, and coping. (PsycINFO Database Record