Investigating the Link between Neural and Real-World Responses to Social Threat in Adolescents at High Risk for Social Anxiety

Adolescence is associated with increases in sensitivity to social evaluation, which may be supported by normative developmental changes in brain function. However, heightened neural reactivity to negative social evaluation, such as peer rejection, may place adolescents at increased risk for social anxiety. The present study used novel, ecologically valid methods to test the hypothesis that heightened neural reactivity to peer rejection is associated with symptoms of social anxiety in early adolescent girls. Further, we examined whether this association might be explained by heightened emotional reactivity to social threat in daily life. Ninety-nine adolescent girls (ages 11-13 years) oversampled for shy/fearful temperament, a risk factor for future social anxiety, completed a 16-day ecological momentary assessment protocol in which they reported on their emotional responses to daily negative experiences with peers (i.e., daily experiences of social threat). Following this assessment, girls completed a social interactive task, in which they were accepted or rejected by their peers and completed control trials, in a magnetic resonance imaging scanner. Girls also reported on their social anxiety symptoms. Brain regions that activated significantly to peer rejection relative to either peer acceptance or a control were tested as predictors of social anxiety symptoms and daily experiences of social threat. Associations between neural activation to peer rejection (relative to acceptance or a control) and social anxiety symptoms were not supported. However, activation in the left caudate nucleus to peer rejection (relative to a control) was significantly associated with daily experiences of social threat, and a significant indirect effect of daily experiences of social threat on the association between left caudate activation to peer rejection and social anxiety symptoms was found. These associations were not significantly moderated by perceived friendship quality or pubertal status. Findings may suggest that adolescent girls with higher caudate activity to rejection are more likely to attend to and recall social threatening interactions, and that greater recall of social threat is associated with social anxiety. However, the cross-sectional design limits any causal interpretations that can be drawn from the indirect effect model. Future research is needed to test these questions using a longitudinal design

Testing a Neurobiological Susceptibility to Social Context Model Linking Neural Reward Processing and Social Stress to Social Anxiety in Adolescent Girls

Social anxiety disorder (SAD) is one of the most common and impairing disorders in adolescence, particularly for girls, and remains one of the most challenging disorders to treat. A better understanding of the mechanisms supporting the development of SAD in adolescence is important for identifying new targets for intervention. Emerging research and theory rooted in a neurobiological susceptibility to social context framework suggest that interactions between neural reward function and adverse social environments are key for understanding the etiology of SAD. Backed by this research and theory, this project employed ecologically-valid methods at multiple levels of analysis to examine how perceptions of socially threatening interactions with peers in daily life (assessed using ecological momentary assessment) interact with neural reward function to confer risk for social anxiety symptoms in 129 girls (ages 11-13) at temperamental risk for SAD. In support of the primary hypothesis, activation in the basolateral amygdala (BLA) to the anticipation of socially rewarding (vs. neutral) feedback interacted with daily social threat at baseline to predict social anxiety symptom severity two years later. A positive association between social threat and social anxiety symptoms was only seen for girls with high BLA activity. Findings were specific to the BLA (vs. a more distributed social reward network) and to neural activation to social reward (vs. threat) anticipation. Unexpectedly, interactions between daily social threat and BLA activation to social reward anticipation at baseline also predicted symptoms of generalized anxiety and depression two years later, suggesting that these processes may serve as transdiagnostic risk factors for internalizing disorders. Findings suggest that socially threatening experiences are particularly detrimental during adolescence for youth highly sensitive to reward contingencies, potentially due to effects on reward learning processes. More generally, results add to a growing literature highlighting the importance of neural reward function in the development of social anxiety and other internalizing disorders during adolescence

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

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

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

The goal of this study was to examine the relationship between real-world socioemotional 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 (versus neutral comments) in the subgenual anterior cingulate cortex (sgACC), amygdala, and anterior insula would experience (a) less happiness in daily positive interpersonal situations and (b) more sadness and anger in daily negative interpersonal situations. Participants (44 youth ages 11-16 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, anger) emerged. These findings provide evidence of real-world correlates of neural reactivity to social threat that may have important clinical implications

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

Combatting the conspiracy of silence: Clinician recommendations for talking about racism and racism-related events with youth of color

This manuscript provides recommendations to clinicians on how to support youth of color and their families following highly publicized acts of racial violence and related events

Talking about Racism in the Context of the Trial against George Floyd’s Murderer: Practical Recommendations for Professionals, Parents, & Clinicians

In the weeks following the killing of George Floyd and media coverage of the killings of Breonna Taylor and Ahmaud Arbery, the Black Lives Matter movement and other protests for racial justice swept the world. Demonstrations occurred in more than 700 cities internationally and across all 50 states in the United States. Notably, demands for the dismantling of systemic racism extended far beyond police brutality to include inequities in health, housing, economic opportunity, and other sectors. In academia, faculty, students, and staff called attention to the ways in which “universities remain ivory towers perpetuating institutionalized forms of racism, oppression, and inequity” (p. 13, Galán et al., 2021; Gray, Joseph, Glover, & Olayiwola, 2020), while psychologists highlighted the ways in which direct and vicarious exposure to racial violence and discrimination may compromise mental health and contribute to racial trauma. Although Pew Research Center surveys in June 2020 showed increased recognition of racism as a problem and increased public support for the Black Lives Matter movement, support for these issues has since returned to pre-June levels among White people (Pew Research Center, 2020). However, the trial for Derek Chauvin - the White, former Minneapolis police officer charged with third-degree murder and second-degree manslaughter for the murder of George Floyd – is scheduled to start March 8, 2021. With Chauvin’s trial certain to garner wide-spread media coverage and protests, it is likely that we will see another uptick in conversations and concerns regarding racial inequities. While conversation and action towards dismantling racism are always welcomed and needed, we must stop the practice of only recognizing a problem when it is in our face, sprawled across social media feeds, news segments, and websites. These reactive practices do little to dismantle oppressive systems, especially when they are followed by complacency that often settles in as news headlines transition to the next “hot topic” and our positions of power and privilege allow us to go on with our lives, as if the racist systems and practices we vehemently opposed just a week earlier have suddenly been abolished. So, before our Twitter accounts, the New York Times, USA Today, and every other newspaper outlet bombard us with headlines, reminding us of why protests swept our country last summer, let us be intentional with reflecting on: (1) larger systems of oppression and racism that this trial represents and the ways in which we have been complicit (or active contributors) to their perpetuation, and (2) the effect that this trial may have on our Black colleagues, students, clients, and friends. We offer the following recommendations for health providers, educators, parents, and social media users

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

ObjectiveIdentifying 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.MethodsA 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.ResultsResponders, 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.ConclusionsStriatal 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