Pathways to adolescent social anxiety: Testing interactions between neural social reward function and perceived social threat in daily life.

Recent theories suggest that for youth highly sensitive to incentives, perceiving more social threat may contribute to social anxiety (SA) symptoms. In 129 girls (ages 11-13) oversampled for shy/fearful temperament, we thus examined how interactions between neural responses to social reward (vs. neutral) cues (measured during anticipation of peer feedback) and perceived social threat in daily peer interactions (measured using ecological momentary assessment) predict SA symptoms two years later. No significant interactions emerged when neural reward function was modeled as a latent factor. Secondary analyses showed that higher perceived social threat was associated with more severe SA symptoms two years later only for girls with higher basolateral amygdala (BLA) activation to social reward cues at baseline. Interaction effects were specific to BLA activation to social reward (not threat) cues, though a main effect of BLA activation to social threat (vs. neutral) cues on SA emerged. Unexpectedly, interactions between social threat and BLA activation to social reward cues also predicted generalized anxiety and depression symptoms two years later, suggesting possible transdiagnostic risk pathways. Perceiving high social threat may be particularly detrimental for youth highly sensitive to reward incentives, potentially due to mediating reward learning processes, though this remains to be tested.

Neural activity during negative self-evaluation is associated with negative self-concept and depressive symptoms in adolescent girls.

Self-concept becomes reliant on social comparison, potentially leading to excessive self-focused attention, persistently negative self-concept and increased risk for depression during early adolescence. Studies have implicated neural activation in cortical midline brain structures in self-related information processing, yet it remains unclear how this activation may underlie subjective self-concept and links to depression in adolescence. We examined these associations by assessing neural activity during negative vs. positive self-referential processing in 39 11-to-13-year-old girls. During a functional neuroimaging task, girls reported on their perceptions of self-concept by rating how true they believed positive and negative personality traits were about them. Girls reported on depressive symptoms at the scan and 6 months later. Activation in the dorsomedial and ventrolateral prefrontal cortexes (dMPFC; VLPFC), and visual association area was significantly associated with subjective self-concept and/or depressive symptoms at the scan or 6 months later. Exploratory models showed higher activation in the dMPFC to Self-negative > Self-positive was indirectly associated with concurrent depressive symptoms through more negative self-concept. Higher activation in the visual association area to Self-positive > Self-negative was associated with lower depressive symptoms at follow-up through more positive self-concept. Findings highlight how differential neural processing of negative versus positive self-relevant information maps onto perceptions of self-concept and adolescent depression.

Future Directions in the Mental Health of Transgender Youth: Towards a Social-Affective Developmental Model of Health Disparity.

Mental health disparities in transgender and gender diverse (TGD) youth are well-documented. These disparities are often studied in the context of minority stress theory, and most of this research focuses on experiences of trauma and discrimination TGD youth experience after coming out. However, TGD youth may be targets of violence and victimization due to perceived gender nonconformity before coming out. In this Future Directions, we integrate research on attachment, developmental trauma, and effects of racism and homophobia on mental health to propose a social-affective developmental framework for TGD youth. We provide a clinical vignette to highlight limitations in current approaches to mental health assessment in TGD youth and to illustrate how using a social-affective developmental framework can improve clinical assessment and treatment approaches and deepen our understanding of mental health disparities in TGD people.

Real Change or Performative Anti-Racism? Clinical Psychology Programs' Efforts to Recruit and Retain BIPOC Scholars.

OBJECTIVE: This study assessed perceptions of Clinical Psychology doctoral programs' efforts to recruit and retain faculty and graduate students of color, as well as differences in perceptions based on participants' position within their program (i.e. graduate student versus faculty) and race. METHOD: Participants (n = 297; 35% people of color; 79% female; mean age: 32) were graduate students and faculty from Clinical Psychology doctoral programs who completed an anonymous online survey about their programs' efforts to recruit and retain graduate students and faculty of color; sense of belonging and perceptions of racial discrimination within programs; and experiences of cultural taxation and racism within programs. RESULTS: Faculty (n = 95) reported significantly greater perceptions of recruitment and retention efforts and fewer perceptions of racial discrimination than did graduate students (n = 202). Asian (n = 31), Black (n = 25), and Latinx (n = 35) participants reported significantly fewer perceptions of recruitment and retention efforts, less sense of belonging, and greater perceptions of racial discrimination than did White participants (n = 192). Cultural taxation was common among participants of color, and approximately half (47%) reported they have considered leaving academia - and approximately one third (31%) have considered leaving their program - due to experiences of racism in their program or field. CONCLUSIONS: Cultural taxation and racial discrimination were common among scholars of color in this sample. Whether intentional or not, these experiences contribute to racially-toxic environments and negatively impact the racial diversity of the mental health workforce.

Adolescents' neural reactivity to parental criticism is associated with diminished happiness during daily interpersonal situations.

The goal of this study was to examine the relation between real-world socio-emotional measures and neural activation to parental criticism, a salient form of social threat for adolescents. This work could help us understand why heightened neural reactivity to social threat consistently emerges as a risk factor for internalizing psychopathology in youth. We predicted that youth with higher reactivity to parental criticism (vs neutral comments) in the subgenual anterior cingulate cortex (sgACC), amygdala and anterior insula would experience (i) less happiness in daily positive interpersonal situations and (ii) more sadness and anger in daily negative interpersonal situations. Participants (44 youth aged 11-16 years with a history of anxiety) completed a 10-day ecological momentary assessment protocol and a neuroimaging task in which they listened to audio clips of their parents' criticism and neutral comments. Mixed-effects models tested associations between neural activation to critical (vs neutral) feedback and emotions in interpersonal situations. Youth who exhibited higher activation in the sgACC to parental criticism reported less happiness during daily positive interpersonal situations. No significant neural predictors of negative emotions (e.g. sadness and anger) emerged. These findings provide evidence of real-world correlates of neural reactivity to social threat that may have important clinical implications.

Peer Connectedness and Social Technology Use During COVID-19 Lockdown.

During the COVID-19 pandemic lockdown, adolescents relied on social technology for social connection. Although some research suggests small, negative effects for quantity of social technology use on adolescent mental health, the quality of the interaction may be more important. We conducted a daily diary study in a risk-enriched sample of girls under COVID-19 lockdown to investigate associations between daily social technology use, peer closeness, and emotional health. For 10 days, 93 girls (ages 12-17) completed an online daily diary (88% compliance) assessing positive affect, symptoms of anxiety and depression, peer closeness, and daily time texting, video-chatting and using social media. Multilevel fixed effects models with Bayesian estimation were conducted. At the within-person level, more daily time texting or video-chatting with peers was associated with feeling closer to peers that day, which was associated with more positive affect and fewer depressive and anxiety symptoms that day. At the between-person level, more time video-chatting with peers across the 10 days was indirectly associated with higher average positive affect during lockdown and less depression seven-months later, via higher mean closeness with peers. Social media use was not associated with emotional health at the within- or between-person levels. Messaging and video-chatting technologies are important tools for maintaining peer connectedness during social isolation, with beneficial effects on emotional health.

More time awake after sleep onset is linked to reduced ventral striatum response to rewards in youth with anxiety.

BACKGROUND: Poor sleep and anxiety disorders are highly comorbid in youth, and each predicts altered ventral striatum (VS) response to rewards, which may impact mental health risk. Contrasting evidence suggests previously reported negative associations between sleep health and VS response may be stronger or weaker in youth with anxiety, indicating sensitivity to win/loss information or blunted reward processing, respectively. We cross-sectionally examined the role of sleep in VS response to rewards among youth with anxiety versus a no-psychiatric-diagnosis comparison (ND) group. We expected a group*sleep interaction on VS response to rewards but did not hypothesize directionality. METHODS: As part of the pretreatment battery for a randomized clinical trial, 74 youth with anxiety and 31 ND youth (ages 9-14 years; n = 55 female) completed a monetary reward task during fMRI. During the same pretreatment window, actigraphy and diary-estimated sleep were collected over 5 days, and participants and their parents each reported participants' total sleep problems. We examined group*sleep interactions on VS response to monetary rewards versus losses via three mixed linear models corresponding to actigraphy, diary, and questionnaires, respectively. RESULTS: Each model indicated group*sleep interactions on VS response to rewards. Actigraphy and diary-estimated time awake after sleep onset predicted reduced VS response in youth with anxiety but not ND youth. Parent-reported sleep problems similarly interacted with group, but simple slopes were nonsignificant. CONCLUSIONS: Wake after sleep onset was associated with blunted reward response in youth with anxiety. These data suggest a potential pathway through which sleep could contribute to perturbed reward function and reward-related psychopathology (e.g., depression) in youth with anxiety.

Subgenual Anterior Cingulate Cortex Reactivity to Rejection Vs. Acceptance Predicts Depressive Symptoms among Adolescents with an Anxiety History.

OBJECTIVE: The goal of this study was to examine whether neural sensitivity to negative peer evaluation conveys risk for depression among youth with a history of anxiety. We hypothesized that brain activation in regions that process affective salience in response to rejection, relative to acceptance, from virtual peers would predict depressive symptoms 1 year later and would be associated with ecological momentary assessment (EMA) reports of peer connectedness. METHOD: Participants were 38 adolescents ages 11-16 (50% female) with a history of anxiety, recruited from a previous clinical trial. The study was a prospective naturalistic follow-up of depressive symptoms assessed 2 years (Wave 2) and 3 years (Wave 3) following treatment. At Wave 2, participants completed the Chatroom Interact Task during neuroimaging and 16 days of EMA. RESULTS: Controlling for depressive and anxiety symptoms at Wave 2, subgenual anterior cingulate (sgACC; ß = .39, p = .010) activation to peer rejection (vs. acceptance) predicted depressive symptoms at Wave 3. SgACC activation to rejection (vs. acceptance) was highly negatively correlated with EMA reports of connectedness with peers in daily life (r = - .71, p < .001). CONCLUSION: Findings suggest that elevated sgACC activation to negative, relative to positive, peer evaluation may serve as a risk factor for depressive symptoms among youth with a history of anxiety, perhaps by promoting vigilance or reactivity to social evaluative threats. SgACC activation to simulated peer evaluation appears to have implications for understanding how adolescents experience their daily social environments in ways that could contribute to depressive symptoms.

Modeling sensitivity to social threat in adolescent girls: A psychoneurometric approach.

The Research Domain Criteria (RDoC) project's success rests on the assumption that constructs and data can be integrated across units of analysis and developmental stages. We adopted a psychoneurometric approach to establish biobehavioral liability models of sensitivity to social threat, a key component of potential threat that is particularly salient to the development of adolescent affective psychopathology. Models were derived from measures across four units of analysis in a community sample (n = 129) of 11- to 13-year-old girls oversampled for shy/fearful temperament. To test the ecological validity of derived factors, they were then related to real-world socioaffective processes in peer interactions over a 16-day ecological momentary assessment (EMA) protocol. Our results indicate that measures (i.e., amygdala reactivity to negative social feedback, eye-tracking bias toward social threat, parent- and adolescent-reports of social threat sensitivity) formed unit-specific factors, rather than one unified factor. These findings suggest that these factors were largely unrelated. Amygdala response to social punishment and attention bias toward threatening faces predicted real-world experiences with peers, suggesting that vigilance toward potentially threatening social information could be a mechanism through which vulnerable youth come to experience their peer interactions more negatively. We discuss measurement challenges confronting efforts to quantify developmentally sensitive RDoC constructs across units of analysis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Positive valence systems in youth anxiety development: A scoping review.

Research on pathophysiological mechanisms supporting anxiety development in youth has traditionally focused on the role of threat systems. However, emerging research suggests that the positive valence system (PVS) may also play a strong and unique role in the development and maintenance of anxiety during childhood and adolescence. To better understand the connection between the PVS and anxiety, this scoping review describes current research spanning multiple units of analysis (i.e., self-report, behavior, neural circuits) linking child and adolescent anxiety and risk for anxiety to various PVS constructs (i.e., positive affect, reward responsiveness, reward learning and decision-making). After screening, 78 peer-reviewed articles and dissertations published between 1998 and May 2021 were included in a qualitative review. Though some consistencies in the literature were found, such as high neural reactivity to incentive anticipation in youth at temperamental risk for social anxiety and blunted positive affect in youth with social anxiety disorder, the literature is largely inconsistent. Inconsistencies could be related to the small number of similar studies, small and homogenous study samples, and variability in methodologies employed in this research. It cannot be confirmed whether findings linking PVS constructs to anxiety are unique to anxiety symptoms or better accounted for by co-occurring depressive symptoms. This review concludes with recommendations for robust future research in this area.

Combating the Conspiracy of Silence: Clinician Recommendations for Talking About Racism-Related Events With Youth of Color.

Graphic videos of race-based violence, including police brutality toward Black people and anti-Asian hate crimes, have exploded over the past year. While documentation of these horrific acts has brought visibility to the pervasiveness of racial discrimination, it has also resulted in youth of color being exposed to racial stressors more than ever before across numerous social media and news platforms.1-3 Beyond the significant race-related stress already experienced by youth in school contexts,4 this increased exposure to racism via media is concerning, as both direct and vicarious exposure to racial discrimination can compromise psychological well-being of youth and cause trauma-like symptoms, such as intrusive thoughts, vigilance, and depression.3,5.

Storm Clouds and Silver Linings: Day-to-Day Life in COVID-19 Lockdown and Emotional Health in Adolescent Girls.

OBJECTIVE: We examined risk and protective factors for emotional health problems in adolescent girls during the COVID-19 pandemic. We investigated pre- to early-pandemic changes in symptoms of anxiety and depression, documented daily activities and perceived positive and negative impacts of the pandemic, and linked perceived positive and negative impacts of the pandemic to real-time changes in emotional health. METHODS: The study was a 10-day daily diary study with 93 U.S. adolescent girls (aged 12-17; 68% White non-Hispanic) at temperamental risk for anxiety and depression, conducted in April/May 2020 when all participants were under state-issued stay-at-home orders. Girls provided daily reports of positive and negative affect, depressive and anxious symptoms, activities, and positive and negative impacts resulting from the pandemic. RESULTS: Girls reported engaging in many activities that may contribute to well-being. Mixed effects analyses revealed positive impacts associated with improved same-day emotional health such as more time for family and relaxation and reduced pressure from school/activities. Negative impacts associated with poorer same-day emotional health included problems with online schooling, lack of space/privacy, lack of a regular schedule, and family conflict. CONCLUSION: Findings highlight the importance of providing in-person or quality online schooling, resources and space for learning, promoting daily routines, and spending time with teens while reducing family conflict. The pandemic also appears to have offered many girls a respite from the chronic stress of modern teen life, with time to relax and engage in creative and healthy pursuits showing benefits for daily emotional health, which should be considered following the return to normal life.

Peer Connectedness and Pre-Existing Social Reward Processing Predicts U.S. Adolescent Girls' Suicidal Ideation During COVID-19.

There is major concern about the impact of the COVID-19 pandemic on adolescent suicidal ideation (SI) and peer relationships. We investigated (1) rates of SI and (2) the extent to which peer connectedness and pre-existing neural activation to social reward predicted SI during the initial stay-at-home orders of the pandemic (April-May 2020) in a longitudinal sample of adolescent girls (N = 93; Mage  = 15.06; 69% White non-Hispanic). Daily diary and fMRI methods were used to assess peer connectedness and neural activation to social reward, respectively. Nearly 40% of girls endorsed SI during the initial stay-at-home orders. Greater peer connectedness and neural responsivity to anticipated social reward were associated with a reduced odds of SI during the pandemic among girls.

Neural Responses to Social Reward Predict Depressive Symptoms in Adolescent Girls During the COVID-19 Pandemic.

OBJECTIVE: Adolescent depression is increasing during the COVID-19 pandemic, possibly related to dramatic social changes. Individual-level factors that contribute to social functioning, such as temperament and neural reactivity to social feedback, may confer risk for or resilience against depressive symptoms during the pandemic. METHODS: Ninety-three girls (12-17 years) oversampled for high shy/fearful temperament were recruited from a longitudinal study for a follow-up COVID-19 study. During the parent study (2016-2018), participants completed a functional magnetic resonance imaging task eliciting neural activity to performance-related social feedback. Depressive symptoms were assessed during the parent study and COVID-19 follow-up (April-May 2020). In 65 participants with complete data, we examined how interactions between temperament and neural activation to social reward or punishment in a socio-affective brain network predict depressive symptoms during COVID-19. RESULTS: Depressive symptoms increased during COVID-19. Significant interactions between temperament and caudate, putamen, and insula activation to social reward were found. Girls high in shy/fearful temperament showed negative associations between neural activation to social reward and COVID-19 depressive symptoms, whereas girls lower in shy/fearful temperament showed positive associations. CONCLUSIONS: Girls high in shy/fearful temperament with reduced neural activation to social reward may be less likely to engage socially, which could be detrimental during the pandemic when social interactions are limited. In contrast, girls lower in shy/fearful temperament with heightened neural reactivity to social reward may be highly motivated to engage socially, which could also be detrimental with limited social opportunities. In both cases, improving social connection during the pandemic may attenuate or prevent depressive symptoms.

National Norms and Correlates of the PHQ-8 and GAD-7 in Parents of School-age Children.

Anxiety and depressive disorders are global public health concerns, and research suggests that these disorders are common in parents and can adversely influence family functioning. However, little is known about normative levels of anxiety and depressive symptoms in parents of school-age children. The present study reports on generalized anxiety and depressive symptoms in 1570 parents and guardians of a nationally representative sample of children ages five to twelve years using two widely used and validated questionnaires: the eight-item variant of the Patient Health Questionnaire depression scale (PHQ-8) and the seven-item Generalized Anxiety Disorder scale (GAD-7). Moderate to severe levels of generalized anxiety symptoms were reported in 12.7% of the total sample and moderate to severe levels of depressive symptoms were reported in 14.1% of the sample; 17.7% of the sample reported moderate to severe levels of either generalized anxiety or depressive symptoms. This percentage was higher for females, younger parents and guardians, and parents and guardians reporting lower household incomes. These data, collected online in early 2018, may be useful for researchers and clinicians studying and treating anxiety and depression in parents. Further, these data provide a baseline for researchers currently studying the impact of changes related to the novel coronavirus (COVID-19) pandemic (e.g., school closures) on the mental health of parents of school-age children.

"Don't judge me!": Links between in vivo attention bias toward a potentially critical judge and fronto-amygdala functional connectivity during rejection in adolescent girls.

During adolescence, increases in social sensitivity, such as heightened attentional processing of social feedback, may be supported by developmental changes in neural circuitry involved in emotion regulation and cognitive control, including fronto-amygdala circuitry. Less negative fronto-amygdala circuitry during social threat processing may contribute to heightened attention to social threat in the environment. However, "real-world" implications of altered fronto-amygdala circuitry remain largely unknown. In this study, we used multiple novel methods, including an in vivo attention bias task implemented using mobile eye-tracking glasses and socially interactive fMRI task, to examine how functional connectivity between the amygdala and prefrontal cortex (PFC) during rejection and acceptance feedback from peers is associated with heightened attention towards potentially critical social evaluation in a real-world environment. Participants were 77 early adolescent girls (ages 11-13) oversampled for shy/fearful temperament. Results support the reliability of this in vivo attention task. Further, girls with more positive functional connectivity between the right amygdala and anterior PFC during both rejection and acceptance feedback attended more to potentially critical social evaluation during the attention task. Findings could suggest that dysfunction in prefrontal regulation of the amygdala's response to salient social feedback supports heightened sensitivity to socially evaluative threat during adolescence.

From scanners to cell phones: neural and real-world responses to social evaluation in adolescent girls.

While expanded use of neuroimaging seemed promising to elucidate typical and atypical elements of social sensitivity, in many ways progress in this space has stalled. This is in part due to a disconnection between neurobiological measurements and behavior outside of the laboratory. The present study uses a developmentally salient fMRI computer task and novel ecological momentary assessment protocol to examine whether early adolescent females (n = 76; ages 11-13) with greater neural reactivity to social rejection actually report greater emotional reactivity following negative interactions with peers in daily life. As hypothesized, associations were found between reactivity to perceived social threat in daily life and neural activity in threat-related brain regions, including the left amygdala and bilateral insula, to peer rejection relative to a control condition. Additionally, daily life reactivity to perceived social threat was associated with functional connectivity between the left amygdala and dorsomedial prefrontal cortex during rejection feedback. Unexpectedly, daily life social threat reactivity was also related to heightened amygdala and insula activation to peer acceptance relative to a control condition. These findings may inform key brain-behavior associations supporting sensitivity to social evaluation in adolescence.

Association of Neural Reward Circuitry Function With Response to Psychotherapy in Youths With Anxiety Disorders.

OBJECTIVE: Identifying neural correlates of response to psychological treatment may inform targets for interventions designed to treat psychiatric disorders. This study examined the extent to which baseline functioning in reward circuitry is associated with response to psychotherapy in youths with anxiety disorders. METHODS: A randomized clinical trial of cognitive-behavioral therapy compared with supportive therapy was conducted in youths with anxiety disorders. Before treatment, 72 youths (9-14 years old) with anxiety disorders and 37 group-matched healthy comparison youths completed a monetary reward functional MRI task. Treatment response was defined categorically as at least a 35% reduction in diagnostician-rated anxiety severity from pre- to posttreatment assessment. Pretreatment neural activation in the striatum and medial prefrontal cortex (mPFC) during monetary wins relative to losses was examined in relation to treatment response. RESULTS: Responders, nonresponders, and healthy youths differed significantly in mPFC activation to rewards versus losses at baseline. Youths with anxiety exhibited higher mPFC activity relative to healthy youths, although this may have been driven by differences in depressive symptoms. Planned comparisons between treatment responders (N=48) and nonresponders (N=24) also revealed greater pretreatment neural activation in a cluster encompassing the subgenual anterior cingulate cortex and nucleus accumbens among responders. CONCLUSIONS: Striatal activation to reward receipt may not differentiate youths with anxiety from healthy youths. However, higher striatal responsivity to rewards may allow youths with anxiety to improve during treatment, potentially through greater engagement in therapy. Function in reward circuitry may guide development of treatments for youths with anxiety.

Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders.

Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%-50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9-14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.