Citation

Gee DG, Kribakaran S. Am. J. Psychiatry 2020; 177(5): 378-380.

Affiliation

Department of Psychology, Yale University, New Haven, Conn.

Copyright

(Copyright © 2020, American Psychiatric Association)

DOI

10.1176/appi.ajp.2020.20020225

PMID

32354263

Abstract

Anxiety disorders are the most prevalent mental health disorders, affecting approximately one in three individuals, and they often onset during development (1). Cognitive-behavioral therapy and selective serotonin reuptake inhibitors can be highly effective for treating anxiety. However, up to 50% of both youths and adults with anxiety do not respond sufficiently to these evidence-based treatments (2), highlighting the critical need to optimize interventions to more effectively reduce the immense burden of anxiety on individuals and society. Given the dynamic course of anxiety across the lifespan (1), as well as marked developmental changes in frontolimbic circuitry implicated in anxiety (3, 4), tailoring interventions based on developmental stage represents a promising approach to maximize efficacy (5).

Difficulty discriminating between cues that predict threat and safety is a core feature of anxiety disorders, leading to fear even in situations and environments that are safe (6). Delineating normative developmental trajectories of threat and safety learning and how such trajectories differ in youths with anxiety may provide critical insight into ways in which mechanisms underlying anxiety vary by age. The ability to distinguish between threat and safety cues improves with age among youths without anxiety disorders (7); however, adolescents without anxiety disorders show diminished extinction (8) and retention of learned safety (9) compared with children and adults without anxiety disorders. Although developmental changes have been less explored in children and adolescents with anxiety disorders, cross-sectional evidence suggests that youths with anxiety exhibit altered neural responses when processing cues that no longer predict threat, compared with both youths without anxiety and adults with anxiety (6, 10). At the same time, findings have been mixed, with some evidence of similar processing in pediatric and adult anxiety disorders (10) ...

Language: en

Keywords

Anxiety Disorders; Development; Fear