Anxiety, emotion, and cognition
Here, I address four studies, all addressing anxiety or social anxiety. Abrams (2022) published “What Neuroscience Tells Us About the Teenage Brain” in APA’s Six Things Psychologists are Talking About. I am editing the piece to focus on anxiety:
There is growing recognition that what was previously seen as immaturity is actually a cognitive, behavioral, and neurological flexibility that allows teens to explore and adapt to their shifting inner and outer worlds. Adolescence—spanning from puberty until the mid-20s—describes the transitional period between childhood and adulthood. During this period, the brain grows and changes in a number of ways. Gray matter in the cerebral cortex tends to thin, while white matter that connects various regions of the brain generally increases in volume. Functional connections between regions, which researchers measure with brain scans that track oxygen usage in blood, also undergo widespread changes during adolescence.
For example, adolescents tend to benefit less from fear extinction efforts than adults. According to Casey, this suggests that they may respond poorly to exposure therapy, a key component of cognitive behavioral therapy (CBT) for anxiety, which recruits the prefrontal cortex to reprogram fear memories. It may therefore be possible to optimize CBT to work better for adolescents by using strategies that bypass the prefrontal cortex, instead working to alter memories using other circuitry, including emotion- and memory-focused regions such as the hippocampus and amygdala. This process is often referred to as “memory reconsolidation” or “reconsolidation update.”
Based on ongoing research by Casey and others about the trajectory of development in regions related to cognitive control, including the prefrontal cortex, APA has launched a task force to review new findings that may inform extending Roper v. Simmons, a Supreme Court decision that abolished the use of the death penalty for those under 18, to cover individuals into their early 20s.
Looking forward, researchers in the field emphasize the importance of continuing to challenge assumptions about adolescence—around risk-taking, emotionality, and more—to ensure that the science remains robust and can ultimately support interventions for healthy development.
“We’re not going to change adolescents’ brains, nor should we want to,” Telzer said. “What we can do is optimize what we know to create social contexts and environments that provide the most enriching experiences for them.”
Next, Boulton & Macaulay (2022) published “Parenting About Challenges and Adolescents’ Social Anxiety, Disrupted Classroom Concentration, and Resilience Knowledge: The mediating role of authentic self-esteem” in Families, Systems, & Health. Here’s an edited abstract:
A large theoretical and empirical literature indicates that parenting practices affect young people’s well-being and resilience, but there is much still to learn about psychological mechanisms, especially beyond infancy/early childhood. A recent model of authentic self-esteem argues that it arises out of experiences of challenge situations shared with parents and that it can subsequently act as a protective factor that supports well-being and resilience among young people. The aim of the current study is to test (a) if parenting about challenges can predict 3 indices of adolescents’ well-being, namely their social anxiety, disrupted classroom concentration, and ability to spontaneously generate resilient strategies; and more substantially, (b) if authentic self-esteem can mediate those associations if found. Adolescents (N = 836) completed a questionnaire that measured all the study variables via self-report with the exception that unprompted open questions were used to gauge their ability to spontaneously generate resilient strategies. Parental discussions of challenges did significantly predict all 3 well-being indices, and authentic self-esteem was found to mediate all these relationships. These results support the view that parenting about challenges is a practice that supports well-being and resilience in adolescents. It appears to do so through promoting the development of authentic self-esteem, a capacity to evaluate the self in a positive manner in the context of challenges. The theoretical and practical significance of these findings are discussed.
What I like about these first two studies is both emphasize that adolescents with anxiety must have ‘scaffolded’ experiences with supportive adults. The third study focuses on EFT: Shahar (2013) published “Emotion-Focused Therapy for the Treatment of Social Anxiety: An overview of the model and a case description” in Clinical Psychology & Psychotherapy. Although this is an older study and I talked about EFT, I think this fits with this post. Here’s the edited abstract:
Although cognitive-behavioral therapies (CBT) are effective for social anxiety disorder (SAD), a substantial number of patients do not respond to CBT or remain considerably symptomatic at the end of treatment. Therefore, more treatment options for SAD are necessary in order to improve patient care.
Emotion-focused therapy (EFT) offers an emotion-based case formulation of SAD, in which social anxiety is conceptualized as secondary to primary maladaptive shame. A primary goal in EFT for SAD is to access and evoke shame in order to transform it. It views emotions as fundamentally adaptive and
privileges attention to, and exploration of, emotional experiences. EFT has been demonstrated to be efficacious with depression, interpersonal trauma and marital discord, but application to anxiety disorders is in its initial stages. The primary change processes in EFT for social anxiety include improving emotion awareness, reducing experiential avoidance and the activation and transformation of shame that underlies the symptomatic anxiety. Such processes lead to less self-criticism, to more self-compassion and self-soothing and to a more favorable perception of the self.
In the last study, we look at a very different delivery model for dealing with anxiety. Bisby et al. (2022) published “Sudden Gains in Therapist-Guided Versus Self-Guided Online Treatments for Anxiety or Depression” in Journal of Consulting and Clinical Psychology. Here’s the edited abstract:
Sudden gains are large, rapid, and sustained symptom improvements, and are associated with improved treatment outcomes across a range of mental health problems. Current theories suggest that therapists are required for sudden gains to be sustained, and to result in improved treatment outcomes. We compared the prevalence and consequences of sudden gains in therapist-guided versus self-guided internet-delivered treatments for anxiety and depression. Samples from four previous randomized controlled trials were analyzed: generalized anxiety disorder (n = 259), panic disorder (n = 109), social anxiety disorder (n = 175), and major depressive disorder (n = 209). The prevalence, timing, and reversal rates of sudden gains were compared across therapist-guided and self-guided groups. Generalized estimating equations were used to examine the impact of guidance level and sudden gain status on posttreatment outcomes. Sudden gains were similarly prevalent in therapist-guided and self-guided treatments. In all four diagnostic samples, sudden gains most frequently occurred between Weeks 2 and 3 of treatment, and the rate of reversals did not differ based on the presence of guidance. The association between sudden gains and treatment outcome varied by disorder, such that sudden gains were associated with improved outcomes (irrespective of guidance condition) for participants with social anxiety disorder and major depression, but not generalized anxiety disorder or panic disorder. Sudden gains can occur, and are maintained, during internet-delivered psychotherapy even in the absence of therapist guidance. Furthermore, sudden gains may be associated with different patterns of symptom improvement depending on diagnostic presentation.
I like this study because it offers yet another approach to addressing anxiety, especially social anxiety, and provides helpful information for monitoring progress using telehealth approaches.