Effortful Control Moderates the Relation Between Negative Emotionality and Child Anxiety and Depressive Symptom Severity in Children with Anxiety Disorders.

The present study investigated the interactive effect of reactive (negative emotionality) and regulatory (effortful control) aspects of temperament in the prediction of child anxiety and depressive symptoms. Clinically anxious children and their mothers completed a battery of questionnaires that included self- and mother-ratings of child effortful control, negative emotionality, anxiety, and depressive symptoms. Multiple regression analyses were conducted to examine the moderating effect of effortful control on the relation between negative emotionality and child anxiety and depressive symptom severity. The interaction between negative emotionality and effortful control was statistically significant and simple slopes revealed that as effortful control increased, the relationship between negative emotionality and anxiety and depressive symptoms weakened. Among anxious children high in negative emotionality, greater effortful control was related to less severe anxiety and depressive symptoms. Future work should evaluate whether targeting effortful control leads to reductions in internalizing symptoms among clinically anxious youth.

Childhood exposure to parental threatening behaviors and anxiety in emerging adulthood: Indirect effects of perceived stress.

BACKGROUND: Although childhood exposure to parental threatening behaviors is associated with elevated anxiety in emerging adulthood, the underlying mechanisms remain unexplored. Perceived stress-a subjective experience comprised of feelings of helplessness (being unable to cope or exert control) and poor self-efficacy (confidence in one's ability to manage stressors)-is one candidate mechanism. The present investigation examined the underlying role of perceived stress in the association between childhood exposure to parental threatening behaviors and anxiety symptom severity in a sample of emerging adults. METHODS: Participants (N = 855; Mage = 18.75 years, SD = 1.05, range 18-24; 70.8% female) were recruited from a large state university and administered a battery of self-report questionnaires assessing constructs of interest. RESULTS: Structural equation modeling (SEM) analyses indicated that only greater childhood exposure to maternal threatening behaviors was directly associated with greater feelings of helplessness and lower self-efficacy. Furthermore, only childhood exposure to maternal threatening behaviors was indirectly associated with anxiety severity through greater feelings of helplessness and lower self-efficacy. In contrast, childhood exposure to paternal threatening behaviors was neither directly nor indirectly associated with anxiety severity. LIMITATIONS: Limitations include a cross-sectional design, use of self-report measures, and a nonclinical sample. Replicating these findings in a clinical sample and testing the hypothesized model in a longitudinal design is necessary. CONCLUSIONS: Findings underscore the need for intervention efforts that screen for and target perceived stress in emerging adults exposed to negative maternal parenting behaviors.

Interpretation biases and depressive symptoms among anxiety-disordered children: The role of individual differences in respiratory sinus arrhythmia.

Individual differences in interpretation biases-the tendency to interpret ambiguous stimuli as threatening-partially explain the presence of comorbid depressive symptoms among anxious youth. Increasing efforts have examined physiological processes that influence the association between interpretation biases and depressive symptoms in this population, and potential gender differences in this relationship. This study examined the moderating role of respiratory sinus arrhythmia (RSA) suppression (i.e., decrease from baseline)-an index of parasympathetic nervous system reactivity-in the association between interpretation biases and depressive symptoms in clinically anxious youth. One-hundred-and-five clinically anxious children (Mage  = 10.09 years, SD = 1.22; 56.7% female; 61.9% racial/ethnic minority) completed measures of self-reported and behaviorally indexed interpretation biases, reported anxiety/depression symptom severity, and participated in a speech task. RSA suppression during the task moderated the association between interpretation biases and depressive symptom severity in the total sample. Separate exploratory moderation analyses were conducted among girls and boys. Among girls, RSA suppression moderated the association between behaviorally indexed interpretation biases and depressive symptoms, and marginally moderated (p = .067) the association between self-reported interpretation biases and depressive symptoms. Among boys, RSA suppression was not a significant moderator. These findings may help identify clinically anxious youth most at-risk for comorbid depressive symptoms.

The explanatory role of anxiety sensitivity in the association between effortful control and child anxiety and depressive symptoms.

The present study examined the underlying role of anxiety sensitivity in the association between effortful control and anxiety and depressive symptoms in a sample of clinically anxious children. It was hypothesized that effortful control would exert an indirect effect through anxiety sensitivity in relation to child anxiety and depressive symptoms. Clinically anxious children (N= 105; Mage = 10.09 years, SD = 1.22; 56.7% female; 61% ethnic minority) and their mothers completed a diagnostic interview and a battery of questionnaires that included self- and mother-ratings of child effortful control, anxiety sensitivity, and anxiety and depressive symptoms. The indirect effect of effortful control via anxiety sensitivity on child anxiety and depressive symptoms was significant across child- and mother-completed measures. Among clinically anxious youth, greater effortful control was related to lower anxiety sensitivity, which was related to lower anxiety and depressive symptoms. Future work should evaluate whether targeting effortful control leads to clinically meaningful reductions in anxiety sensitivity and child anxiety and depressive symptoms.

Parental Emotion-Focused Behaviors Moderate the Relationship Between Perceptual Sensitivity and Fear Reactivity in Anxious Children.

This investigation examined the synergistic role of parental emotion-focused socialization behaviors and children's perceptual sensitivity on children's fear reactivity. A sample of 105 children with anxiety disorders (8-12 years; M = 10.07 years, SD = 1.22; 57% female) and their clinically anxious mothers (M = 39.35 years, SD = 7.05) completed an assessment battery that included a diagnostic interview and questionnaires regarding anxiety symptoms, perceptual sensitivity, and emotion socialization behaviors; children also completed a 5-min, videotaped speech task, and rated their fear levels before and after the task. Analyses revealed a significant interaction between perceptual sensitivity and emotion-focused strategies predicting fear change scores from pre- to post-speech. Higher perceptual sensitivity was related to greater reductions in fear from pre- to post- speech (adjusting for pre-speech fear scores), yet only among anxious children whose mothers reported high use of emotion-focused strategies. Maternal emotion-focused socialization strategies may increase anxious children's ability to modulate their affective responses during stressful situations.

Exposure to Parental Threatening Behaviors and Internalizing Psychopathology in a Trauma-Exposed Inpatient Adolescent Sample: The Role of Difficulties With Goal-Directed Behaviors.

Parental threatening behaviors have emerged as a subset of negative parental behaviors strongly related to internalizing symptoms among youth, yet the underlying mechanisms in this association have remained unexplored. The current investigation examined the role of difficulties engaging in goal-directed behavior while emotionally distressed in the association between exposure to maternal threatening behaviors and internalizing symptoms among trauma-exposed inpatient psychiatric youth. Participants (N = 50; mean [SD] age, 15.1 [0.51] years; age range, 12-17 years) completed measures of emotion dysregulation, exposure to maternal threatening behaviors, depression, anxiety, and posttraumatic stress disorder symptoms, as well as trauma-related functional impairment. Results revealed that inability to engage in goal-directed behavior while distressed significantly explained associations between exposure to maternal threatening behaviors and each of the three symptom classes, but not the association between exposure to maternal threatening behaviors and trauma-related functional impairment. These novel findings underscore the need for interventions that target the capacity for goal-directed behavior in the context of emotional distress, especially among trauma-exposed youth who have experienced parental threatening behaviors.

The relationship between emotional clarity and suicidal ideation among trauma-exposed adolescents in inpatient psychiatric care: does distress tolerance matter?

The present investigation examined associations between low emotional clarity (the extent to which individuals are confused about the specific emotions they are experiencing) and suicidal ideation in a diverse sample of trauma-exposed inpatient adolescents, as well as the moderating role of distress tolerance (DT) in this association. Participants (N = 50; 52.0% female; M = 15.1 years, SD = .51; 44% White) completed measures of emotion dysregulation, posttraumatic stress disorder (PTSD), and suicidal ideation/attempts, as well as a behavioral measure of DT. Controlling for age, gender, presence of mood disorder, and past history of attempts, results revealed a significant interaction between DT and low emotional clarity in relation to suicidal ideation. Specifically, lower emotional clarity was related to suicidal ideation at higher, but not lower, levels of DT. Findings suggest that presence of suicidal ideation among traumatized youth with low emotion clarity is most likely when these emotional deficits are coupled with a high tolerance for cognitive/psychological distress. Given that the ability to withstand distress is arguably a key factor in transitioning individuals from ideation to lethal suicidal behavior, attention to the presence of this construct in the context of clinical practice may be warranted.

Emotional Clarity, Anxiety Sensitivity, and PTSD Symptoms Among Trauma-Exposed Inpatient Adolescents.

Although several investigations-on primarily adult samples-demonstrate a potential role of emotion dysregulation in the etiology and maintenance of posttraumatic stress disorder (PTSD), investigations into the mechanisms that may underlie these associations in general and among adolescents in particular are lacking. The present study examined associations among emotional clarity (i.e., the extent to which individuals are confused about the specific emotions they are experiencing), (Gratz, Journal of Psychopathology Behavioral Assessment 26(1):41-54, 2004) anxiety sensitivity, and DSM-IV PTSD symptom cluster severity (i.e., re-experiencing, avoidance, and hyperarousal symptoms) in a diverse sample of trauma-exposed inpatient adolescents. It was hypothesized that anxiety sensitivity would underlie association between emotional clarity and PTSD symptoms. Participants (N = 50; 52.0% female; M age = 15.1 years, SD = 0.51; 44% White) completed measures of emotion dysregulation, anxiety sensitivity, and PTSD. Lower emotional clarity was significantly associated with greater total PTSD symptoms, as well as re-experiencing, avoidance, and arousal symptoms. Additionally, there were indirect effects for lack of emotional clarity via anxiety sensitivity in relation to total PTSD symptoms [B = 0.17, SE = 0.08, BC 95% CI (0.04, 0.35)], re-experiencing symptoms [B = 0.15, SE = 0.08, BC 95% CI (0.03, 0.36)], avoidance symptoms [B = 0.12, SE = 0.07, BC 95% CI (0.02, 0.29)], and hyperarousal symptoms [B = 0.17, SE = 0.08, BC 95% CI (0.04, 0.36)]. Reversed models were violated, supporting the direction of hypothesized effects. Difficulties recognizing and accurately understanding emotions may increase risk for PTSD symptoms among trauma-exposed youth. Furthermore, anxiety sensitivity may be a promising intervention target among youth at risk for PTSD, especially among those demonstrating poorer emotional clarity.

Posttraumatic Stress Disorder Symptoms Among Trauma-Exposed Inpatient Adolescents: The Role of Emotional Nonacceptance and Anxiety Symptom Severity.

The present investigation examined the role of anxiety symptom severity in the relation between emotional nonacceptance and posttraumatic stress disorder (PTSD) symptoms in a diverse sample of trauma-exposed adolescents admitted for acute psychiatric care at an inpatient state hospital (N = 50; 52.0% women; 44% white; mean [SD] age, 15.1 [0.51] years; range, 12-17 years). Anxiety symptom severity partially accounted for the association between emotional nonacceptance and PTSD total symptoms, and fully accounted for the association between emotional nonacceptance and PTSD symptom cluster severity, even after controlling for covariates. Reverse model testing provided confidence in the direction of hypothesized effects. These findings add to a body of literature underscoring the detrimental effect of nonaccepting reactions to negative emotions in the context of PTSD and provide preliminary support for a possible underlying role of anxiety symptom severity in the association between emotional nonacceptance and PTSD symptoms.

Fearful Temperament, Catastrophizing, and Internalizing Symptoms in Clinically Anxious Youth.

A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children (N = 105; M age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.

Fearful Temperament and Child Social Anxiety Symptoms: Clarifying the Influence of Maternal Punitive Responses.

Fearful temperament-the tendency to exhibit apprehension and/or avoidance in novel situations-is a well-established risk factor for childhood anxiety in general, and social anxiety in particular. Yet, there is little understanding of parent emotion socialization strategies that influence the association between fearful temperament and child social anxiety symptoms. The present investigation addresses this gap in the literature by examining maternal punitive responses to clinically anxious children's negative emotions as a moderator of the covariance between fearful temperament and social anxiety symptom severity. Clinically anxious children ages 8-12 years (N = 105; 57.1% female; 61.9% racial/ethnic minority) and their mothers completed measures assessing child fearful temperament, maternal punitive emotion socialization responses, and child social anxiety symptoms. Children also participated in an anxiety-provoking speech task during which manifest social anxiety was coded by trained observers. Children's fearful temperament coupled with greater maternal punitive responses to children's negative emotions was associated with lower child-reported social anxiety symptoms. Models predicting manifest social anxiety were not significant. Maternal punitive responses to children's negative emotions may encourage clinically anxious youth to approach feared situations and therefore result in lower anxiety. Yet, the potentially negative effects of punitive responses on other aspects of anxious children's socioemotional development warrant scientific attention. Future research should examine the phenomenology of punitive parental responses among parents of anxious youth to better understand their effects on child behavior.

Childhood anxiety sensitivity, fear downregulation, and anxious behaviors: Vagal suppression as a moderator of risk.

Anxiety sensitivity-the fear that anxiety-related sensations will result in catastrophic physical, social, or psychological consequences-is a robust risk factor for clinical anxiety. However, less is known about how anxiety sensitivity may interact with physiological modulation of arousal to predict anxious children's fear responses. The present investigation examined vagal withdrawal as a moderator of the association between anxiety sensitivity and anxious children's ability to downregulate subjective feelings of fear in response to an anxiety-provoking speech task. Observer ratings of anxious behaviors and performance during the task were also examined. It was hypothesized that children's anxiety sensitivity levels would interact with respiratory sinus arrhythmia (RSA) suppression to explain unique variance in subjective fear downregulation, anxious behaviors, and task performance. Participants were 105 children with anxiety disorders (N = 105; M = 10.07 years, SD = 1.22; 57% female) who completed diagnostic interviews, questionnaires, a speech about their family, and an RSA assessment in baseline and speech conditions. Interactions between RSA suppression and anxiety sensitivity predicted unique variance in subjective fear downregulation. Specifically, the greatest difficulties downregulating subjective fear responses were exhibited by children with high anxiety sensitivity and low RSA suppression. Interactions between RSA suppression and anxiety sensitivity did not predict variance in observer ratings of anxious behaviors or task performance. However, higher baseline RSA and speech RSA were significantly associated with fewer anxious behaviors during the speech. Higher baseline RSA was also significantly associated with better speech performance. These findings highlight the importance of vagal withdrawal and its interaction with anxiety sensitivity in predicting downregulation of subjective fear among clinically anxious children. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Interpretation Biases and Childhood Anxiety: The Moderating Role of Parasympathetic Nervous System Reactivity.

This investigation examined vagal modulation of arousal, as indexed by respiratory sinus arrhythmia (RSA), as a moderator of the covariance between interpretation biases and anxiety disorder symptom severity in a diverse sample of clinically anxious youth. A sample of 105 children with anxiety disorders (Mage = 10.07 years, SD = 1.22; range = 8-12 years; 57.1% female; 61.9% ethnic minority) and their mothers completed a battery of measures assessing interpretation biases and anxiety disorder symptom severity. Children also completed a behaviorally-indexed assessment of interpretation biases and participated in an anxiety-provoking speech task. Physiological assessment of RSA was collected at baseline (i.e., baseline RSA) and during the speech task (i.e., challenge RSA). The interaction between challenge RSA and both self-reported and behaviorally-indexed interpretation biases (adjusting for baseline RSA) was significant (ΔR2 = .05 and .04 respectively) in relation to maternal report of child anxiety symptoms. Specifically, among children with low (vs. high) challenge RSA, greater self-reported interpretation biases were significantly associated with maternal report of more severe child anxiety symptoms, and greater behaviorally-indexed interpretation biases were marginally associated with maternal report of more severe child anxiety. Interactions predicting child self-report of anxiety symptoms were not significant. Greater child interpretation biases coupled with lower challenge RSA were associated with maternal report of more severe child anxiety symptoms. Future work should examine whether interventions targeting RSA weaken the association between interpretation biases and anxiety symptoms in youth.

Parental threats and adolescent depression: The role of emotion dysregulation.

Childhood exposure to parental threatening behaviors places adolescents at greater risk for depression. However, the association between parental threatening behaviors and depressive symptoms among trauma-exposed inpatient youth, and potential factors that exacerbate the harmful effects of such parenting, have remained unexplored. One factor that may contribute to depression is low emotional clarity, which is characterized by difficulties recognizing and understanding one's emotions. The current investigation examined the interactive effects of childhood exposure to maternal threatening behaviors and emotional clarity deficits in relation to depressive symptoms among inpatient psychiatric youth who had been exposed to a potentially traumatic event (i.e., exposure to actual or threatened death, serious injury, or sexual violence). Participants (N = 50, Mage = 15.1 years, SD = 0.51, range 12-17) completed measures of emotion dysregulation, childhood exposure to maternal threatening behavior, and depressive symptoms. A significant interaction was found between exposure to maternal threatening behaviors and deficits in emotional clarity in relation to depressive symptom severity. Greater exposure to maternal threatening behaviors was related to more severe depressive symptoms, yet only among children with greater deficits in emotional clarity. Findings underscore the need for interventions that target emotional clarity among trauma-exposed youth who have experienced parental threats.

Effortful control, interpretation biases, and child anxiety symptom severity in a sample of children with anxiety disorders.

INTRODUCTION: Effortful control-the ability to inhibit impulsive reactions in favor of more adaptive responses-is negatively related to child anxiety severity. One potential explanation is that greater effortful control may "slow down" automatic, threat-laden interpretations, thereby lowering children's anxiety. The present investigation tested this hypothesis by examining associations between effortful control (and its subcomponents) and anxiety symptom severity, mediated by interpretation biases, in a diverse sample of clinically anxious youth. METHOD: Participants (N = 105; Mage = 10.09 years, SD = 1.22; 56.7% female; 49% ethnic minority) completed a diagnostic interview; self-report measures of temperament, anxiety, and interpretation biases; a performance-based measure of interpretation biases; and a parent-child interaction task for which an index of behavioral anxiety was computed. RESULTS: Significant indirect effects were found for effortful control, attentional control, and inhibitory control on child self-reported anxiety severity by way of self-reported (but not behaviorally-indexed) interpretation biases. Models predicting behaviorally-indexed child anxiety severity were not significant. DISCUSSION: Greater effortful control may result in enhanced attentional capacities that allow children to assess automatic cognitions more objectively, potentially lowering their anxiety. Future work should evaluate whether targeting malleable temperamental constructs, such as effortful control, leads to clinically meaningful reductions in interpretation biases and child anxiety symptoms.

The role of emotional clarity and distress tolerance in deliberate self-harm in a sample of trauma-exposed inpatient adolescents at risk for suicide.

OBJECTIVE: The purpose of this study was to examine distress tolerance as a moderator of the relationship between emotional clarity and deliberate self-harm (DSH) in a diverse sample of trauma-exposed adolescents in acute psychiatric care at high risk of suicidal behavior. It was hypothesized that distress tolerance would emerge as a significant moderator, such that the association between emotional clarity and DSH would be significant among youth with high, but not low, distress tolerance. METHOD: Participants (N=50; 52.0% female; M=15.1years, SD=0.51; 44% White) completed measures of emotion dysregulation, DSH, history of suicide attempts, as well as a behavioral measure of distress tolerance. RESULTS: Controlling for history of suicide attempts, results revealed a significant interaction between distress tolerance and emotional clarity in relation to DSH. Specifically, emotional clarity difficulties were related to DSH at high, but not low, levels of distress tolerance. CONCLUSIONS: Findings suggest that DSH among trauma-exposed youth with high rates of past suicide attempts is most likely when low emotion clarity is coupled with a high tolerance for emotional distress. Given that DSH significantly increases risk for suicide among youth with psychiatric needs, assessment of emotional clarity and distress tolerance deficits is apt to be warranted to facilitate identification of these youth for targeted intervention.

Mindful attention moderating the effect of experiential avoidance in terms of mental health among Latinos in a federally qualified health center.

The present study examined the moderating role of mindful attention in the relation between experiential avoidance and anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders among a sample of Latinos seeking health services at a primary care facility. Participants included 326 adult Latinos (Mage = 39.79 years, SD = 11.27; 88.9% female; 98.2% used Spanish as their first language). Results provided empirical evidence of an interaction between mindful attention and experiential avoidance for anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders in the studied sample. Specifically, among Latinos with lower (vs higher) levels of mindfulness, greater experiential avoidance was related to greater anxiety/depressive symptoms and number of mood and anxiety disorders. Together, these data provide novel empirical evidence of the clinically relevant interplay between mindful attention and experiential avoidance regarding a relatively wide array of negative emotional symptoms and disorders among Latino primary care patients. Limitations of the study include a largely female sample and cross-sectional data.

Children's behavioral inhibition and anxiety disorder symptom severity: The role of individual differences in respiratory sinus arrhythmia.

Although behavioral inhibition (BI) is clearly identified as a temperamental risk factor for childhood anxiety psychopathology, much less is known about whether the strength of this association may vary as a function of parasympathetic nervous system regulation in children with anxiety disorders. To build upon extant research in this area, the present study examined whether respiratory sinus arrhythmia (RSA) can explicate the conditions in which BI is linked to increased symptom severity among anxiety-disordered children (N = 44; M = 9.61 years, SD = 1.63; 52% female and African American, respectively). We examined RSA responding both during a basal period and during a stressor ("challenge" RSA): interacting with a "mystery guest" who was wearing a mask. As hypothesized, the interaction between BI and both basal and challenge RSA was significantly related to anxiety disorder symptom severity, even after controlling for depressive symptoms. The form of the interaction indicated that highest levels of anxiety disorder symptoms were found among children with high levels of BI and low basal and challenge RSA, respectively. These data provide novel empirical evidence of a clinically-relevant interplay between RSA and BI in relation to anxiety disorder symptom severity among clinical youth. Future work is needed to expand on the specific mechanisms that may be responsible e for the interplay between temperamental and psychobiological risks for childhood anxiety.