Autonomic arousal in childhood anxiety disorders: Associations with state anxiety and social anxiety disorder

Anna Alkozei,Cathy Creswell,Peter J Cooper,John J.B Allen

doi:10.1016/j.jad.2014.11.056

Abstract

BackgroundPsychophysiological theories suggest that individuals with anxiety disorders may evidence inflexibility in their autonomic activity at rest and when responding to stressors. In addition, theories of social anxiety disorder, in particular, highlight the importance of physical symptoms. Research on autonomic activity in childhood (social) anxiety disorders, however, is scarce and has produced inconsistent findings, possibly because of methodological limitations. MethodThe present study aimed to account for limitations of previous studies and measured respiratory sinus arrhythmia (RSA) and heart rate (HR) using Actiheart heart rate monitors and software (Version 4) during rest and in response to a social and a non-social stressor in 60 anxious (30 socially anxious and 30 ‘other’ anxious), and 30 nonanxious sex-and age-matched 7–12 year olds. In addition, the effect of state anxiety during the tasks was explored. ResultsNo group differences at rest or in response to stress were found. Importantly, however, with increases in state anxiety, all children, regardless of their anxiety diagnoses showed less autonomic responding (i.e., less change in HR and RSA from baseline in response to task) and took longer to recover once the stressor had passed. LimitationsThis study focused primarily on parasympathetic arousal and lacked measures of sympathetic arousal. ConclusionThe findings suggest that childhood anxiety disorders may not be characterized by inflexible autonomic responding, and that previous findings to the contrary may have been the result of differences in subjective anxiety between anxious and nonanxious groups during the tasks, rather than a function of chronic autonomic dysregulation.

Highlights

Anxiety disorders, and social anxiety disorder in particular, are common in childhood, are frequently chronic if left untreated, and are associated with emotional distress as well as impairment in social and academic functioning (Essau et al, 2000; Ezpeleta et al, 2001; Mychailyszyn et al, 2010; Newman et al, 1996)
Even though childhood anxiety can be treated effectively through the use of Cognitive Behavior Therapy (CBT), in approximately 40% of cases CBT does not lead to a substantial reduction of anxiety symptoms (In-Albon and Schneider, 2007) and, notably, the presence of social anxiety disorder has been found to be associated with especially poor treatment outcomes from generic treatments (Hudson et al, 2010)
This leads to the intriguing possibility that more prolonged experience of anxiety might lead to changes in autonomic activity at rest

Summary

Introduction

Social anxiety disorder in particular, are common in childhood, are frequently chronic if left untreated, and are associated with emotional distress as well as impairment in social and academic functioning (Essau et al, 2000; Ezpeleta et al, 2001; Mychailyszyn et al, 2010; Newman et al, 1996). In relation to activity of the parasympathetic nervous system in particular, the model predicts that, in comparison to nonanxious populations, individuals with anxiety disorders will (i) display increased heart rate (HR) and diminished respiratory sinus arrhythmia (RSA) (respiratory linked heart-rate variability (HRV)) at baseline, (ii) fail to substantially increase HR and decrease RSA in response to a stressor, and (iii) recover more slowly once the stressor has passed. Psychophysiological theories suggest that individuals with anxiety disorders may evidence inflexibility in their autonomic activity at rest and when responding to stressors. Conclusion: The findings suggest that childhood anxiety disorders may not be characterized by inflexible autonomic responding, and that previous findings to the contrary may have been the result of differences in subjective anxiety between anxious and nonanxious groups during the tasks, rather than a function of chronic autonomic dysregulation

Objectives

Methods

Results

Discussion

Conclusion