NEW RESEARCH
Fear Conditioning in Adolescents With Anxiety Disorders: Results From a Novel Experimental Paradigm

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ABSTRACT

Objective

Considerable research examines fear conditioning in adult anxiety disorders but few studies examine youths. Adult data suggest that anxiety disorders involve elevated fear but intact differential conditioning. We used a novel paradigm to assess fear conditioning in pediatric anxiety patients.

Method

Sixteen individuals with anxiety disorders and 38 healthy comparisons viewed two photographs of actresses displaying neutral expressions. One picture served as the conditioned stimulus (CS), paired with a fearful expression and a shrieking scream (CS+), whereas the other picture served as a CS unpaired with the aversive outcome (CS−). Conditioning was indexed by self-reported fear. Subjects participated in two visits involving conditioning and extinction trials.

Results

Both groups developed greater fear of the CS+ relative to CS−. Higher fear levels collapsed across each CS characterized anxious relative to healthy subjects, but no significant interaction between group and stimulus type emerged. Fear levels at visit 1 predicted avoidance of visit 2. Fear levels to both CS types showed stability even after extinction.

Conclusions

Consistent with adult data, pediatric anxiety involves higher fear levels following conditioning but not greater differential conditioning. Extending these methods to neuroimaging studies may elucidate neural correlates of fear conditioning. Implications for exposure therapies are discussed.

Section snippets

Participants

Sixteen medication-free adolescents with DSM-IV anxiety disorders and 38 healthy adolescents were recruited for the present study through local schools and newspapers (Table 1). This sample size has 75% power to detect group differences with effect sizes of at least 0.80. All of the anxious subjects completed comprehensive clinical assessments on the Schedule for Affective Disorders and Schizophrenia17) conducted by clinicians trained to exhibit acceptable reliability (κ >.75). All of the

Sample Characteristics

Table 1 presents demographic characteristics of the 16 patients and 38 healthy subjects. Groups did not differ on age (t52 = 1.64; p = not significant (n.s.), sex (X2 =.95; p = n.s.), socioeconomic status (t52 = 0.68; p = n.s.), or intelligence (t50 = 0.79; p = n.s.). No significant differences between males and females emerged in fear ratings to either the CS+ or CS− following visit 1 or 2. Older adolescents reported significantly lower fear ratings to the CS+ stimulus at visit 1 (r = −0.30; p

DISCUSSION

Four key findings emerged from our study. First, the current paradigm produced strong levels of differential conditioning, manifested as higher ratings to the CS+ relative to the CS− across all of the subjects. Second, in the context of similar levels of differential learning, overall fear collapsed across CS types was higher among anxious patients than healthy subjects. Furthermore, significant positive correlations between self-reported and parent-reported anxiety symptom scores and fear

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    This research was supported by the NIMH/NIH Intramural Research Program. The authors thank the participants and the research staff who facilitated this work.

    Disclosure: The authors have no financial relationships to disclose.

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