How anxious is too anxious? State and trait physiological arousal predict anxious youth’s treatment response to brief cognitive behavioral therapy

Abstract

Background Exposure therapy is the gold standard for treating childhood anxiety, yet not all youth improve. Children do not always have insight on their distress, which can limit the utility of self-reported units of distress (SUDS) during exposures. Physiological assessment provides an objective means of monitoring emotional arousal. Electrodermal activity (EDA) in particular indexes sympathetic nervous system arousal which is heavily linked to anxiety. The aim of the current study was to examine the feasibility and utility of incorporating EDA assessment in an in-session exposure. We examined concordance between EDA and SUDS, and whether either predicted treatment response. Methods Thirty-four youth who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder completed brief CBT (8 sessions) and completed a survey on trait physiological arousal. EDA and SUDS were collected from 18 youth (9 female, ages 9–14) during a mid-treatment exposure. Changes in anxiety severity were examined post-treatment. Results SUDS were not correlated with trait or state physiological arousal. There was a large association between heightened sympathetic arousal and poorer post-treatment response. Similarly, SUDS indices of greater fear activation and habituation were associated with poorer post-treatment response with a small to moderate effect size. Supplemental analyses among the full sample aligned: trait physiological arousal predicted poorer treatment response. Conclusions The lack of concordance between sympathetic arousal and SUDS indices highlights the limitations of relying solely on SUDS with pediatric populations. EDA provided unique data on youth’s distress during exposures. Thus, results indicate that physiological assessment may exhibit clinical utility for aiding clinicians in monitoring youth’s progress in exposure therapy. Trial Registration ClinicalTrials.gov Identifier: NCT02259036.

Psychotherapy 2.0 - Application Context and Effectiveness of Sensor Technology in Psychotherapy with Children and Adolescents: a Systematic Review (Preprint)

“…The studies were published between 2017 and 2023 and the majority were conducted in Europe [96,97,98,99,100] and the USA [101,102,103,104]. Most of the studies were pilot or feasibility studies, without randomization [96,97,98,99,100,102].…”

“…The studies were published between 2017 and 2023 and the majority were conducted in Europe [96,97,98,99,100] and the USA [101,102,103,104]. Most of the studies were pilot or feasibility studies, without randomization [96,97,98,99,100,102]. Only 3 of the included studies were RCTs [110,112,113] and one pre-registration for an ongoing study could be identified via the "grey literature search" [105].…”

“…The sample size of the studies varied between 5 and 71 participants. Two studies each treated children and adolescents with an autism spectrum disorder [98,104], an anxiety disorder [97,102] and a post-traumatic stress disorder [101,103]. One study each described the treatment of children and adolescents with anorexia nervosa [96], borderline personality disorder [100] and obsessive-compulsive disorder [99].…”

“…In the psychotherapy sessions, ECG sensors [97,98,102,103] were predominantly used to measure HR and HRV in patients or therapists, EDA skin sensors [102] to measure electrodermal activity, movement sensors [100] to measure movement synchrony or to recognize movement patterns, and VR and eye-tracking glasses [96] to identify gaze patterns or to train attentional focusing [105]. In one study each, a multimodal sensor set consisting of various sensors (ECG, eye-tracking glasses, motion sensors) [99] was used to measure and recognize stress reactions and an AI Google Glass [104] was used to train emotion recognition.…”

“…McCormack et al [102] investigated the extent to which self-reported anxiety corresponds with electrodermal activity (EDA) as an indicator of tension in children and adolescents (M Age = 11.38 years, SD = 1.66) with an anxiety disorder by recording the physiological arousal of adolescents during the exposure sessions within a total of 8 hours of CBT treatment. Higher sympathetic arousal was associated with a poorer response to treatment (β = 0.32, t(32) = 2.25, p = .032, CI: 0.09-1.73).…”