Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C): Development and evaluation of a new instrument measuring anticipatory avoidance-based emotion regulation in anxiety eliciting situations.

Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children (F (5,304) = 12.63, p = .003, ηp2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires.

Measuring extinction learning across the lifespan - Adaptation of an optimized paradigm to closely match exposure treatment procedures.

Here, we tested the feasibility of a new paradigm developed to investigate the mechanisms of exposure-therapy. The protocol was previously developed for the use with adults and optimized to closely model the mechanisms underlying exposure, i.e. extinction learning. We adapted this paradigm for the use with children, and tested its feasibility in children and adult participants. We used an aversive acoustic unconditioned stimulus (US), picture-based rating scales and a child-oriented instruction/practice procedure. Results indicate robust fear acquisition, extinction and reinstatement on a self-report (US-expectancy) and on a physiological (startle reflex) level. We found evidence for the paradigms sensitivity to age and anxiety-dependent individual differences in fear-learning and extinction. We conclude that the present paradigm is capable of modeling the key mechanisms of exposure-therapy, that is extinction-learning, and can be accomplished with children, adolescents and adults, rendering it promising to bridge the gap between experimental protocols and treatment across the lifespan.

Personalized Assessment of Anxiety and Avoidance in Children and Their Parents-Development and Evaluation of the Anxiety and Avoidance Scale for Children.

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

Distinctive body perception mechanisms in high versus low symptom reporters: A neurophysiological model for medically-unexplained symptoms.

OBJECTIVE: The neurophysiological processes involved in the generation of medically-unexplained symptoms (MUS) remain unclear. This study tested three assumptions of the perception-filter model contributing to MUS: (I.) increased bodily signal strength (II.) decreased filter function, (III.) increased perception. METHODS: In this cross-sectional, observational study, trait MUS were assessed by a web-based survey (N = 486). The upper and lower decile were identified as extreme groups of high (HSR; n = 29; 26 women; Mage = 26.0 years) and low symptom reporters (LSR; n = 29; 21 women; Mage = 28.4 years). Mean heart rate (HR) and heart rate variability (HRV), and cortisol awakening response (CAR) were assessed as indicators of bodily signal strength (I.). Heartbeat-evoked potentials (HEPs) were assessed during rest and a heartbeat perception task. HEPs reflect attentional resources allocated towards heartbeats and served as index of filter function (II.). Interoceptive accuracy (IAc) in heartbeat perception was assessed as an indicator of perception (III.). RESULTS: HSR showed higher HR and lower HRV (RMSSD) than LSR (I.), but no differences in CAR. HSR exhibited a stronger increase of HEPs when attention was focused on heartbeats than LSR (II.); there were no group differences in IAc (III.). CONCLUSIONS: The perception-filter model was partially confirmed in that HSR showed altered bodily signals suggesting higher sympathetic activity (I.); higher HEP increases indicated increased filter function for bodily signals (II.). As more attentional resources are mobilized to process heartbeats, but perception accuracy remains unchanged (III.), this overflow could be responsible for detecting minor bodily changes associated with MUS.

Altered Interoceptive Awareness in High Habitual Symptom Reporters and Patients With Somatoform Disorders.

Objective: Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concern noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Methods: Study 1: A total of 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). Thirty-two individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26). Results: HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing. Conclusion: HSR, SFD, and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs.