Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C): Development and evaluation of a new instrument measuring anticipatory avoidance-based emotion regulation in anxiety eliciting situations.

Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children (F (5,304) = 12.63, p = .003, ηp2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires

Identifying characteristics of non-completers in fear conditioning paradigms with children and adolescents

The number of studies on fear conditioning in children and adolescents has increased in recent years. Most of these studies exclusively focus on data of completers while dropout rates, reasons for dropout, and specific characteristics of non-completers are underreported. This study systematically investigated data of 283 children and adolescents between 8 and 17 years (M = 11.10, SD = 2.14) undergoing a differential fear conditioning paradigm using a female scream as unconditioned stimulus (US). The sample included 230 children and adolescents with a current primary anxiety disorder (separation anxiety disorder, social anxiety disorder, and specific phobia) and 53 non-anxious controls. The dropout rate was 24.1%. The most common reason to discontinue was being afraid of the US (59.1%) followed by the startle probe being too loud (15.2%). Logistic regressions revealed that younger age and a present anxiety disorder predicted dropout. There seem to be distinct characteristics potentially predicting dropout from fear conditioning paradigms. Thus, interpretability and generalizability of those paradigms are limited when non-completers are not considered. Future research should conscientiously look at these data more closely and investigate paradigms that work independent of age and diagnostic status

Personalized assessment of anxiety and avoidance in children and their parents

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder ($\it N$ = 148), social anxiety disorder ($\it N$ = 110) or specific phobia ($\it N$ = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment

Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C)

Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's $\omega$ = .94) for all scales as well as positive correlations with anxiety symptoms (all $\it rs$ > .17, all $\it ps$ < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children ($\it F$ (5,304) = 12.63, $\it p$ = .003, $\eta$$_{p}^{2}$ = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires

Tryptophan metabolism is inversely regulated in the tumor and blood of patients with glioblastoma

Tryptophan (Trp)-catabolic enzymes (TCEs) produce metabolites that activate the aryl hydrocarbon receptor (AHR) and promote tumor progression and immunosuppression in glioblastoma. As therapies targeting TCEs or AHR become available, a better understanding of Trp metabolism is required. Methods: The combination of LC-MS/MS with chemical isobaric labeling enabled the simultaneous quantitative comparison of Trp and its amino group-bearing metabolites in multiple samples. We applied this method to the sera of a cohort of 43 recurrent glioblastoma patients and 43 age- and sex-matched healthy controls. Tumor volumes were measured in MRI data using an artificial neural network-based approach. MALDI MSI visualized Trp and its direct metabolite N-formylkynurenine (FK) in glioblastoma tissue. Analysis of scRNA-seq data was used to detect the presence of Trp metabolism and AHR activity in different cell types in glioblastoma. Results: Compared to healthy controls, glioblastoma patients showed decreased serum Trp levels. Surprisingly, the levels of Trp metabolites were also reduced. The decrease became smaller with more enzymatic steps between Trp and its metabolites, suggesting that Trp availability controls the levels of its systemic metabolites. High tumor volume associated with low systemic metabolite levels and low systemic kynurenine levels associated with worse overall survival. MALDI MSI demonstrated heterogeneity of Trp catabolism across glioblastoma tissues. Analysis of scRNA-seq data revealed that genes involved in Trp metabolism were expressed in almost all the cell types in glioblastoma and that most cell types, in particular macrophages and T cells, exhibited AHR activation. Moreover, high AHR activity associated with reduced overall survival in the glioblastoma TCGA dataset.Conclusion: The novel techniques we developed could support the identification of patients that may benefit from therapies targeting TCEs or AHR activatio

Identifying characteristics of non-completers in fear conditioning paradigms with children and adolescents

The number of studies on fear conditioning in children and adolescents has increased in recent years. Most of these studies exclusively focus on data of completers while dropout rates, reasons for dropout, and specific characteristics of non-completers are underreported. This study systematically investigated data of 283 children and adolescents between 8 and 17 years ($\it M$ = 11.10, $\it SD$ = 2.14) undergoing a differential fear conditioning paradigm using a female scream as unconditioned stimulus (US). The sample included 230 children and adolescents with a current primary anxiety disorder (separation anxiety disorder, social anxiety disorder, and specific phobia) and 53 non-anxious controls. The dropout rate was 24.1%. The most common reason to discontinue was being afraid of the US (59.1%) followed by the startle probe being too loud (15.2%). Logistic regressions revealed that younger age and a present anxiety disorder predicted dropout. There seem to be distinct characteristics potentially predicting dropout from fear conditioning paradigms. Thus, interpretability and generalizability of those paradigms are limited when non-completers are not considered. Future research should conscientiously look at these data more closely and investigate paradigms that work independent of age and diagnostic status