Thinking anxious, feeling anxious, or both? Cognitive bias moderates the relationship between anxiety disorder status and sympathetic arousal in youth

Abstract

Cognitive bias and physiological arousal are two putative markers that may underlie youth anxiety. However, data on relationships between cognitive bias and arousal are limited, and typically do not include behavioral measurement of these constructs in order to tap real-time processes. We aimed to examine the relationship between performance-based cognitive bias and sympathetic arousal during stress in clinically anxious and typically-developing youth. The sample included children and adolescents ages 9 to 17 (Mean age = 13.18, SD = 2.60) who either met diagnostic criteria for primary generalized anxiety, social phobia, or separation anxiety (N=24) or healthy controls who had no history of psychopathology (N=22). Youth completed performance-based measures of attention and interpretation bias. Electrodermal activity was assessed while youth participated in the Trier Social Stress Test for Children (TSST-C; Buske-Kirschbaum, Jobst, & Wustmans, 1997). A mixed models analysis indicated significant linear and non-linear changes in skin conductance, with similar slopes for both groups. Interpretation bias, but not attention bias, moderated the relationship between group status and sympathetic arousal during the TSST-C. Arousal trajectories did not differ for anxious and healthy control youth who exhibited high levels of threat interpretation bias. However, for youth who exhibited moderate and low levels of interpretation bias, the anxious group demonstrated greater arousal slopes than healthy control youth. Results provide initial evidence that the relationship between anxiety status and physiological arousal during stress may be moderated by level of interpretation bias for threat. These findings may implicate interpretation bias as a marker of sympathetic reactivity in youth. Implications for future research and limitations are discussed.

Autonomic arousal in anxious and typically developing youth during a stressor involving error feedback

“…In the context of a conflicted literature, these data support theories of autonomic reactivity that propose increases in HR and decreases in HRV during stress [32–34], particularly for clinically anxious youth [14, 15]. Adding to the literature, the present data provide preliminary support that reactivity differences between anxious and TD youth may occur during early phases of acute stress (in this case, error-related feedback), and that anxious youth may not recover from stress as quickly.…”

“…Following consent/assent procedures, youth and parent completed a diagnostic interview. As this study took place within a larger study of youth cognitive and physiological factors that might contribute to anxiety [15], youth also participated in other tasks not relevant to this investigation. Following the diagnostic interview, youth completed two other tasks not relevant to this investigation.…”

“…However, empirical studies of physiological reactivity during acute stress in clinically anxious and typically developing (TD) youth have produced mixed findings. Some work has demonstrated that clinically anxious youth exhibit greater reactivity than TD youth during stress [14, 15]. Other studies suggest that clinically anxious youth exhibit higher baseline levels of arousal than their TD counterparts, although the two groups demonstrate comparable changes in arousal during stress [16, 17].…”

Cognitive bias modification for threat interpretations: Impact on anxiety symptoms and stress reactivity

“…Interpretation bias was assessed with the word‐sentence association paradigm (Beard & Amir, 2008) using stimuli previously developed and tested in youth and young adults (Rozenman, Amir, & Weersing, 2014; Rozenman et al, 2017; Rozenman, Weersing, & Amir, 2011). This task assesses the degree to which individuals appraise ambiguous information in neutral versus threatening ways.…”

“…Of particular importance to transfer effects of CBM‐I for anxiety symptoms, interpretation bias has been linked to psychophysiological reactivity in anxious youth (Rozenman, Vreeland, & Piacentini, 2017) and adults with elevated anxiety symptoms (Gonzalez, Rozenman, Goger, & Velasco, in preparation). This empirical relationship supports theoretical models of anxiety, which propose both cognitive and physiological mechanisms (Barlow, Allen, & Choate, 2004; MacLeod, Campbell, Rutherford, & Wilson, 2004).…”