Julian Schmitz

Restricted Autonomic Flexibility in Children with Social Phobia.

BACKGROUND Psychophysiological hyperresponsiveness to social-evaluative stress plays a key role in current theories of social phobia (SP). Owing to the early onset of this disorder, the study of children with SP can help to improve etiological models. However, research to date has failed to clarify whether children with SP are physiologically hyperresponsive to stress or not. In addition, the existence of elevated pre-stressor baseline group differences complicates the interpretation of acute stress responses and therefore poses a challenge for this line of research. Drawing on current models of autonomic control to explain the relationship between baseline and stress responding in SP children and healthy controls (HC), we acquired a broad set of autonomic measures in our study. METHOD To index baseline and stress reactivity and to assess autonomic flexibility, we assessed a comprehensive array of sympathetic and parasympathetic measures in SP children (aged 8 to 12 years; n = 30) and healthy control children (HC, n = 26), while exposing them to the Trier Social Stress Test for Children (TSST-C). RESULTS At baseline, the SP children showed higher levels of sympathetic (heart rate, electrodermal activity) and lower levels of parasympathetic (respiratory sinus arrhythmia, RSA) activation when compared to the HC children. During the TSST-C, the SP children showed similar HR responses but a limited RSA reactivity and a slower HR recovery relative to the HC children. CONCLUSION Our study extends previous research by showing elevated baseline arousal and comparable stress responding in SP children relative to HC children. In addition, based on the autonomic flexibility model, we provide a potential explanation for the null findings of previous studies during stress. The pattern of elevated baseline heart rates and reduced RSA point to restricted autonomic flexibility in children with SP.

Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia

Reports of exaggerated anxiety and physiological hyperreactivity to social-evaluative situations are characteristic of childhood social phobia (SP). However, laboratory research on subjective, autonomic and endocrine functioning in childhood SP is scarce, inconsistent and limited by small sample sizes, limited breadth of measurements, and the use of non-standardized stressor tasks. We exposed 8–12-year-old children with DSM-IV SP (n = 41) and matched healthy control children (HC; n = 40) to the Trier Social Stress Test for Children (TSST-C) while measuring subjective anxiety, heart rate (HR) and salivary alpha-amylase (sAA) as well as salivary cortisol. The SP children showed heightened reactivity to the TSST-C on subjective anxiety compared to the HC children but not a heightened reactivity in HR, sAA or cortisol. However, the SP children showed chronically elevated HR levels throughout the whole laboratory session. Whereas subjective anxiety seems to respond specifically to social-evaluative stress in childhood SP, HR levels may be chronically elevated suggesting a more generalized autonomic hyperreactivity.

You don’t like me, do you? Enhanced ERP responses to averted eye gaze in social anxiety

Social anxiety is associated with an attentional bias toward angry and fearful faces, along with an enhanced processing of faces per se. However, little is known about the processing of gaze direction, a subtle but important social cue. Participants with high or low social anxiety (HSA/LSA) observed eye pairs with direct or averted gaze while subjective ratings and event-related potentials (ERPs) were measured. Behaviorally, all participants rated averted gaze as more unpleasant than direct gaze. Neurally, only HSA participants showed a trend for higher P100 amplitudes to averted gaze and significantly enhanced processing at late latencies (Late positive potential [LPP]), indicative of a specific processing bias for averted gaze. Furthermore, HSA individuals showed enhanced processing of both direct and averted gaze relative to the LSA group at intermediate latencies (Early posterior negativity [EPN]). Both general and specific attentional biases play a role in social anxiety. Averted gaze--potential sign of disinterest--deserves more attention in the attentional bias literature.

Biased Perception and Interpretation of Bodily Anxiety Symptoms in Childhood Social Anxiety

Cognitive models of social phobia (SP) and empirical evidence in adults suggest that affected individuals overestimate arousal symptoms such as heart rate (HR) during social stress and worry about their visibility in public. To date, little is known about these aspects in childhood social anxiety, an important precursor of the disorder. We assessed perception of—and worry about—HR visibility, actual HR, and subjective anxiety during public speaking in high socially anxious (HSA; n = 20) and low socially anxious (LSA; n = 20) Caucasian children, aged 10 to 12 years. Symptom visibility was manipulated by making a nonveridical HR feedback tone audible only to the participant (private condition, HR sounds via headphone) or to participant and observers (public condition, HR sounds via speakers). Further, we assessed interoceptive accuracy in a heartbeat counting task. As expected, HSA children perceived their HR as higher than LSA children in both private and public conditions despite similar actual HR and comparable interoceptive accuracy. Public feedback led to more worry about HR visibility only in HSA but not in LSA children. Biased perception and interpretation of bodily anxiety symptoms during social stress manifests early in social anxiety and might therefore play a crucial role in the aggravation of social anxiety and the development of SP. We discuss implications for current theory, clinical practice, and prevention.

Startling Sweet Temptations: Hedonic Chocolate Deprivation Modulates Experience, Eating Behavior, and Eyeblink Startle

Many individuals restrict their food intake to prevent weight gain. This restriction has both homeostatic and hedonic effects but their relative contribution is currently unclear. To isolate hedonic effects of food restriction, we exposed regular chocolate eaters to one week of chocolate deprivation but otherwise regular eating. Before and after this hedonic deprivation, participants viewed images of chocolate and images of high-calorie but non-chocolate containing foods, while experiential, behavioral and eyeblink startle responses were measured. Compared to satiety, hedonic deprivation triggered increased chocolate wanting, liking, and chocolate consumption but also feelings of frustration and startle potentiation during the intertrial intervals. Deprivation was further characterized by startle inhibition during both chocolate and food images relative to the intertrial intervals. Individuals who responded with frustration to the manipulation and those who scored high on a questionnaire of impulsivity showed more relative startle inhibition. The results reveal the profound effects of hedonic deprivation on experiential, behavioral and attentional/appetitive response systems and underscore the role of individual differences and state variables for startle modulation. Implications for dieting research and practice as well as for eating and weight disorders are discussed.

Self-evaluation, social and cognitive performance in children with social phobia

Cognitive models of Social Phobia (SP) assume that SP is not only associated with negative self-evaluation but also with impaired actual social and cognitive performance. However, relatively little is known about these aspects in children with SP. In our study, we investigated whether children with SP show differences in self-evaluation, as well as in social and cognitive performance during a social-evaluative situation. Therefore, a group of children aged 8 to 12 years with SP (DSM-IV; n = 35) and healthy control (HC) children (n = 35), individually matched by sex and age, was exposed to the Trier Social Stress Test for Children (TSST-C). After the speech task and the math task of the TSST-C, children were asked to evaluate their performance. In addition, observers rated their social performance on different dimensions as well as their cognitive performance. Results showed that children with SP evaluated their performance worse than HC children but did not differ in observer-rated nervous behaviors, micro social skills and cognitive performance. Borderline significant group differences could only be found in observer-rated global impression, illustrating that children with SP may differ from HC children during social stress mainly due to being perceived as having a less positive and friendly social appearance.

The impact of pre-existing anxiety on affective and cognitive processing of a Virtual Reality analogue trauma

Dysfunctional processing of traumatic events may be in particular related to high trait anxiety as a pre-traumatic risk factor for the development of post-traumatic stress disorder (PTSD). However, as this has rarely been investigated in prospective, experimental studies, we aimed to analyse the association between high trait anxiety and affective as well as cognitive processing of stress using a new prospective Virtual Reality analogue trauma paradigm to overcome limitations of retrospective or current analogue designs. Individuals with high and low trait anxiety (N = 80) were exposed to a multi-sensory Virtual Reality emergency scenario while psychophysiological stress response, emotion regulation and intrusive memories were assessed. Our results showed that high trait anxiety individuals display increased (i) subjective stress responses, (ii) emotion dysregulation and (iii) intrusive memories upon VR analogue trauma exposure. In particular, our sample of high trait anxiety individuals displayed limited access to different emotion regulation strategies as well as increased worry and rumination regarding perceived intrusive memories. Considering the complex interplay of multiple risk factors, our findings suggests that peri-traumatic affective processing seems to mediate high trait anxiety and post-traumatic intrusive memories thereby pointing out the central role of peri-traumatic processes for intrusion development. In addition, HA as a modulating pre-traumatic risk factor might further increase the risk of later dysfunctional processing of an analogue trauma by interacting with factors of affective processing during analogue trauma exposure. Implications of these findings which may contribute to a higher risk to develop PTSD are discussed.

Children with social anxiety disorder show blunted pupillary reactivity and altered eye contact processing in response to emotional faces: Insights from pupillometry and eye movements

Cognitive models and adult research associate social anxiety disorder (SAD) with hypervigilant-avoidant processing of social information, such as eye contact. However, processing biases in childhood SAD remain mostly unexplored. We examined 10- to 13-year-old childrens eye contact processing and pupil dilation in response to happy, neutral, and angry faces in three groups: SAD (n = 31), mixed anxiety disorders (MAD; n = 30), and healthy controls (HC; n = 32). Compared to HC, SAD children showed faster first fixations on the eye region of neutral faces and shorter first fixation durations on the eye region of all faces. No differences between the two clinical groups emerged in eye movement results. SAD girls showed reduced pupil dilation in response to happy and angry faces compared to MAD and to happy faces compared to HC. SAD boys showed reduced pupil dilation in response to neutral faces compared to HC. Dimensionally, reduced pupil dilation was linked to social anxiety severity while eye movements were correlated with mixed anxiety and depressive severity. Results suggest that hypervigilant-avoidant eye contact processing and a blunted pupillary reactivity characterize children with SAD. Both transdiagnostic and disorder-specific processing biases are relevant for the understanding of childhood SAD.

Social competence and psychopathology in early childhood: a systematic review

The acquisition of social competence, such as showing prosocial behaviour (fulfilling others’ needs) and social initiative (fulfilling own needs), constitutes one major developmental task in childhood and adolescence. Previous research suggests that in middle childhood, impaired social competences are related to childhood psychopathology, such as externalizing and internalizing disorders. As the period of preschool age is a particularly important time for both the development of social competence and early psychopathological symptoms, we conducted a systematic review to investigate the role of social competence in relation to early childhood psychopathology. Twenty-one clinical as well as subclinical studies published prior to September 2016 were included in a qualitative analysis of the relation between prosocial behaviour, social initiative, and early externalizing and internalizing symptoms in preschool age children (age 3–6). Effect sizes for each study were calculated if required information was available. Our review suggests that from early on in childhood development, externalizing symptoms are accompanied by prosocial behaviour deficits such as lower levels of helping or cooperating, whereas internalizing symptoms may be accompanied by either deficient or excessive levels of prosocial behaviour. Exhibiting social initiative such as initiating contact with others or communicating one’s own needs seems to be impaired in children with internalizing symptoms. Implications for current theory and future research are discussed.

Facial gender but not emotion distinguishes neural responses of 10- to 13-year-old children with social anxiety disorder from healthy and clinical controls

OBJECTIVE The current study examined neural and behavioral responses to angry, happy and neutral faces in childhood social anxiety disorder (SAD). METHOD Behavioral (reaction time and accuracy) and electrocortical measures (P100, N170, EPN, LPP) were assessed during a facial emotion identification task in children (age 10-13) with SAD (n = 32), clinical controls with mixed anxiety disorders (n = 30), and healthy controls (n = 33). RESULTS Overall, there were no group differences in behavioral or neural responses to emotional faces. However, children with SAD showed an attenuated LPP to male relative to female faces, while the opposite pattern emerged in the other two groups. DISCUSSION Stimulus gender, but not facial emotion drove group-specific effects, which became evident in later, more elaborate stages of attention processing. The present study provides preliminary indications of gender effects in childhood SAD which should be further investigated by future studies.