The Association Between Parent-to-Child Fear Learning Pathways and Anxiety Sensitivity: A Systematic Review and Meta-analysis

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Although anxiety sensitivity (AS), or the fear of anxiety-related symptoms, has been identified as a risk factor for the development of anxiety psychopathology, the pathways through which this fear is learned have not been fully elucidated. In the current review and meta-analysis, we aimed to systematically examine the association between parent-to-child fear learning pathways (vicarious learning, negative information, reinforcement, and punishment) and AS. A comprehensive search of literature was conducted in PsychINFO, PubMed, Embase, and Web of Science databases, using search terms combining categories related to fear learning pathways, anxiety-related symptoms, parents, children, and adolescents. Based on this search strategy, 28 studies were identified as relevant, of which 11 were included in the systematic review and 10 in the meta-analysis. The overall findings indicated that parent-to-child fear learning pathways are significantly associated with AS. The meta-analysis demonstrated a small but significant association between fear learning pathways and AS, although the type of fear learning pathway did not significantly moderate this relationship. However, age emerged as a significant moderator, suggesting a stronger association in children and adolescents compared to adults. Given that these findings are primarily based on cross-sectional studies, this review underscores the need for longitudinal and experimental research to further clarify the role of parent-to-child fear learning pathways in anxiety sensitivity. Additionally, a better understanding of these pathways may help inform existing interventions and fear prevention strategies, such as those aimed at reducing parental modeling of fearful behaviors or promoting positive verbal messages about anxiety symptoms.