Generalization of Conditioned Fear in Children and Adolescents with Anxiety Disorders

The main question of this study is how generalization of conditioned fear looks like in an underage anxiety patient population. Previous studies have examined fear generalization in healthy adults, adult anxiety patients and healthy children, but to our knowledge only one study so far has examined fear generalization in underage anxiety patients. The aim of this study is therefore to further contribute to the fear generalization research field in child and adolescent psychiatry with a large sample of underage anxiety disorder patients. The study uses a fear conditioning and generalization paradigm, the measures used to examine fear generalization are the skin conductance rate as an objective measure and self-reported ratings of arousal, valence and contingency as a subjective component. Fear generalization is illustrated through generalization gradients. For the first time, a large underage patient group of 49 probands has been examined on the generalization of conditioned fear and the results are hypothesis-generating. The study confirms the hypothesis that the fear conditioning and generalization paradigm is successful in an underage sample. Moreover, the results show that the patient group has a significantly higher fear reaction after acquisition compared to healthy controls in terms of the subjective ratings of arousal and contingency. Concerning the fear generalization phase, the results show an overall higher level of fear reaction in the patient group compared to the healthy controls for the ratings of arousal and contingency as illustrated by an upward shift of the generalization gradient. The study therefore confirms the hypothesis that underage anxiety patients have a higher fear reaction during generalization in terms of arousal and contingency ratings compared to healthy children. The study, however, refutes the hypothesis that underage anxiety patients generalize more than their healthy counterparts. The extent of fear generalization in the patient group concerning the ratings is similar to the control group, with linear and quadratic slope elements, as illustrated by the parallel course of the respective generalization gradients. The hypothesis that both subjective and objective measures gain similar results is also rejected. The most accurate measure of fear reaction is arousal, followed by contingency. The objective measure of SCR, however, does not depict any difference in fear reaction between the respective stimuli, nor between patients and controls. It needs to be further examined in larger studies and compared to other physiological measures. The study furthermore rejects the hypothesis that discrimination learning is successful in reducing fear reaction or fear generalization as the respective task shows no effect on either of the two. To sum up, the study shows that anxiety patients have higher overall fear levels in terms of arousal and contingency ratings during generalization. It however refutes the assumption that underage anxiety patients generalize more than their healthy counterparts. This leads to the conclusion, that underage patients show no overgeneralization of conditioned fear in any measure and that the difference between underage patients and controls is mainly quantitative rather than qualitative.