School of Applied Psychology, Griffith University, Brisbane, Australia.
Department of Psychology, University of California, Los Angeles, USA.
Clin Psychol Rev. 2016 Dec;50:50-66. doi: 10.1016/j.cpr.2016.09.008. Epub 2016 Sep 23.
The tendency to disproportionately allocate attention to threat stimuli, to evaluate ambiguous or benign situations as overly threatening, and to exhibit overgeneralised and indiscriminate conditioned fear responses to threat and safe stimuli are hallmark clinical correlates of pathological anxiety. Investigation of these processes in children and adolescents suggests that anxiety-related differences increase with age, and that the specific conditions under which anxious children differ from non-anxious peers are poorly understood. Furthermore, research on cognitive biases and fear conditioning in anxious children and adolescents has progressed as quite distinct lines of investigation. Greater integration of key tenets from each perspective could advance knowledge and provide new directions for improving treatments. The purpose of this paper is threefold. First, we provide a qualitative review of the key principles from cognitive and conditioning theories of anxiety and the associated empirical research, including the underlying neurophysiological basis of these processes in anxious children and adolescents, in order to delineate the conditions under which anxiety-specific differences in threat-related cognitive biases and overgeneralised conditioned fear manifest in children and adolescents. Second, we synthesize these theoretical and empirical insights to propose a cognitive-learning formulation of anxiety in children and adolescents. We propose that conditioning and cognitive factors linked to differences in engagement of underlying neural circuits across development contribute to an internal representation of a wide range of stimuli as threatening, to which anxious children and adolescents adopt maladaptive attention regulation patterns of predominantly threat monitoring or threat avoidance. These maladaptive attention regulation patterns differentiate anxious children and adolescents in terms of predominantly high cognitive distress (e.g., worry and rumination) and high behavioural avoidance respectively. Third, we consider the clinical implications of the cognitive-learning formulation for understanding outcomes from current treatments and provide suggestions for improving treatment outcomes.
过度关注威胁刺激、将模棱两可或良性情况评估为过度威胁，以及对威胁和安全刺激表现出过度泛化和无差别的条件恐惧反应，这些都是病理性焦虑的临床特征。对儿童和青少年的这些过程的研究表明，与焦虑相关的差异随年龄增长而增加，并且焦虑儿童与非焦虑同龄人之间的具体差异条件理解不足。此外，对焦虑儿童和青少年的认知偏差和恐惧条件作用的研究已经作为相当不同的研究方向取得了进展。从每个角度吸取关键原则的更大融合可以促进知识的发展，并为改善治疗提供新的方向。本文的目的有三。首先，我们提供了对焦虑的认知和条件作用理论的关键原则以及相关的实证研究的定性回顾，包括焦虑儿童和青少年中这些过程的潜在神经生理基础，以便描绘出与威胁相关的认知偏差和过度泛化的条件恐惧在儿童和青少年中表现出焦虑特异性差异的条件。其次，我们综合了这些理论和实证见解，提出了儿童和青少年焦虑的认知学习公式。我们提出，与发展过程中潜在神经回路参与差异相关的条件作用和认知因素，导致对广泛刺激的威胁的内部表示，焦虑的儿童和青少年采用了适应不良的注意力调节模式，主要是威胁监测或威胁回避。这些适应不良的注意力调节模式以主要高认知困扰（例如，担忧和沉思）和高行为回避来区分焦虑的儿童和青少年。第三，我们考虑了认知学习公式对理解当前治疗结果的临床意义，并提供了改善治疗结果的建议。
