Biased perception of physiological arousal in child social anxiety disorder before and after cognitive behavioral treatment

Abstract

Background A biased perception of physiological hyperreactivity to social-evaluative situations is crucial for the maintenance of social anxiety disorder (SAD). Alterations in interoceptive accuracy (IAc) when confronted with social stressors may play a role for SAD in children. We expected a biased perception of hyperarousal in children with SAD before treatment and, consequently, a reduced bias after successful cognitive behavioral therapy (CBT). Method In two centers, 64 children with the diagnosis of SAD and 55 healthy control (HC) children (both 9 to 13 years) participated in the Trier Social Stress Test for Children (TSST-C), which was repeated after children with SAD were assigned to either a 12-week group CBT (n = 31) or a waitlist condition (n = 33). Perception of and worry about physiological arousal and autonomic variables (heart rate, skin conductance) were assessed. After each TSST-C, all children further completed a heartbeat perception task to assess IAc. Results Before treatment, children with SAD reported both a stronger perception of and more worry about their heart rate and skin conductance than HC children, while the objective reactivity of heart rate did not differ. Additionally, children with SAD reported heightened perception of and increased worry about trembling throughout the TSST-C compared to HC children, but reported increased worry about blushing only after the stress phase of the TSST-C compared to HC children. Children with and without SAD did not differ in IAc. Contrary to our hypothesis, after treatment, children in the CBT group reported heightened perception of physiological arousal and increased worry on some parameters after the baseline phase of the TSST-C, whereas actual IAc remained unaffected. IAc before and after treatment were significantly related. Conclusions Increased self-reported perception of physiological arousal may play a role in childhood SAD and could be an important target in CBT. However, further studies should examine if this is an epiphenomenon, a temporarily occurring and necessary condition for change, or indeed an unwanted adverse intervention effect.

Taking a Closer Look at Social Performance in Childhood Social Anxiety Disorder: Biopsychosocial Context Considerations and Effects of Cognitive Behavior Therapy

“…This study was part of a larger project that consisted of experimental studies related to research questions of visual attention allocation or psychophysiological processes under (social) stress and it also aimed to measure treatment success by including several outcome variables (state anxiety, negative cognitions, physiological arousal, perception of and worry about physiological symptoms, perception of academic performance, negative postevent processing, parental cognitions, parental fear of negative child evaluation, and related treatment outcome predictions). We reported the majority of the a priori-defined outcome variables and secondary outcomes in earlier papers (treatment outcome [ 31 ]; changes in postevent processing based on treatment [ 32 ]; stability of the cortisol response despite treatment [ 33 ], physiological arousal [ 34 ] and perception of physiological arousal treatment [ 35 ]). To ensure maximal transparency, all articles include cross-references to other reports on measures used to investigate potential treatment-related effects.…”

The role of developmental caregiving programming in modulating our affiliation tendency and the vulnerability to social anxiety and eating disorders

“…Psychological investigation shows that socially anxious individuals are affected by anomalous interoceptive functioning. Two studies where children (9–13 years old) were exposed to adults’ judgment when completing a task found those high in SA had deficient interoceptive awareness (IAw) with subjective evaluation not corresponding to objective perceptive abilities, but unaltered interoceptive accuracy (IAc) ( Schmitz et al, 2012 ; Asbrand et al, 2020 ). As expected, these children were characterized by excessive attention to bodily signals.…”

Interoception, Stress, and Physical Symptoms in Stress-Associated Diseases

“…Experimental approaches to induce acute stress in interoception research include mental arithmetic tasks (Eichler & Katkin, 1994; Fairclough & Goodwin, 2007; Gray et al, 2007; Herbert et al, 2010; Kindermann & Werner, 2014; Steptoe & Vögele, 1992; Sturges & Goetsch, 1996), public speaking tasks (Schandry & Specht, 1981; J. Schmitz et al, 2012), or its anticipation (Durlik et al, 2014; Stevens et al, 2011), a combination of both as implemented in the Trier Social Stress Test (TSST; Asbrand et al, 2020; Maeda et al, 2019), cold pain stimulation (Shao et al, 2011), and a combination of cold pain and social evaluation, such as implemented in the Socially-Evaluated Cold Pressor Test (SECPT; Schaan et al, 2019; Schulz, Lass-Hennemann, et al, 2013; Schulz et al, 2011). The paradigms to induce acute stress, which includes a socially-evaluative component, also evoke an HPA axis response (Kirschbaum et al, 1993; Schwabe et al, 2008), whereas the effects of the remaining paradigms may be limited to the SAM axis.…”