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

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

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

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

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

Complementary Features of Attention Bias Modification Therapy and Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders

In the treatment of anxiety disorders, attention bias modification therapy (ABMT) and cognitive-behavioral therapy (CBT) may have complementary effects by targeting different aspects of perturbed threat responses and behaviors. ABMT may target rapid, implicit threat reactions, whereas CBT may target slowly deployed threat responses. The authors used amygdala-based connectivity during a threat-attention task and a randomized controlled trial design to evaluate potential complementary features of these treatments in pediatric anxiety disorders. Prior to treatment, youths (8-17 years old) with anxiety disorders (N=54), as well as healthy comparison youths (N=51), performed a threat-attention task during functional MRI acquisition. Task-related amygdala-based functional connectivity was assessed. Patients with and without imaging data (N=85) were then randomly assigned to receive CBT paired with either active or placebo ABMT. Clinical response was evaluated, and pretreatment amygdala-based connectivity profiles were compared among patients with varying levels of clinical response. Compared with the CBT plus placebo ABMT group, the CBT plus active ABMT group exhibited less severe anxiety after treatment. The patient and healthy comparison groups differed in amygdala-insula connectivity during the threat-attention task. Patients whose connectivity profiles were most different from those of the healthy comparison group exhibited the poorest response to treatment, particularly those who received CBT plus placebo ABMT. The study provides evidence of enhanced clinical effects for patients receiving active ABMT. Moreover, ABMT appears to be most effective for patients with abnormal amygdala-insula connectivity. ABMT may target specific threat processes associated with dysfunctional amygdala-insula connectivity that are not targeted by CBT alone. This may explain the observation of enhanced clinical response to CBT plus active ABMT

A Call to Action for an Antiracist Clinical Science

Clinical psychological science is a field committed to reducing the negative impact of psychiatric illness through innovative research and psychological treatments. Unfortunately, the impact of racial injustices that pervade American society and permeate our academic institutions is felt not only by the individuals who work in our departments as faculty, staff, and students, but also by those who seek our services as mental health providers. Representing the collective work of numerous graduate students and postdoctoral trainees from multiple institutions, this call to action instantiates the need for prompt and consistent efforts towards dismantling institutionalized racism and inequity in clinical science. Specifically, we articulate the multiple roles our field plays in perpetuating racial oppression and outline concrete demands and recommendations for structural reform in the following key areas: (1) the mental health needs of Black, Indigenous, and People of Color (BIPOC) students, (2) clinical training and supervision, (3) curriculum and pedagogical approaches, (4) research and methods, and (5) the recruitment, retention, and success of graduate students and faculty