Understanding adolescent fear extinction: Identifying profiles and Connections to anxiety

Anxiety disorders, the most prevalent mental health conditions, often emerge during adolescence. Core features include difficulties in regulating or extinguishing learned fear. However, compared to adults, less is known about fear extinction and its relationship with anxiety in youth. Most studies rely on group-level averages of single fear indicators, such as skin conductance responses (SCR) or self-reported fear, which may overlook individual variation, introduce bias, and miss critical manifestations like behavioral avoidance. Using a validated Pavlovian fear extinction paradigm, we applied k-means clustering to identify distinct fear extinction profiles in adolescents, examining their reliability and validity in relation to conditioned fear indicators and anxiety symptoms. A diverse community sample of 119 adolescents (54% female; M±SD age=13±2.25 years; 39% Black, 38% White, 5.7% Hispanic) completed a fear conditioning task, followed by a 10-minute delay and fear extinction. Anxiety symptoms were measured using the SCARED questionnaire. Complementary measures of conditioned fear included SCR, fear ratings, and behavioral avoidance. K-means clustering (k=3) identified distinct fear profiles, and their validity was evaluated through comparisons of fear indicators and associations with anxiety symptoms. Three fear profiles emerged: (1) high subjective fear (N=27), (2) high physiological but low behavioral fear (N=28), and (3) low physiological fear (N=49). Anxiety symptoms were lowest in Profile 3 (21.31±13.97) and remained significantly associated with profile membership after adjusting for sex. Distinct fear profiles in adolescents relate dimensionally to anxiety risk, emphasizing the need to move beyond single fear indicators to understand fear extinction and anxiety development.