Social safety learning in adolescents with and without clinical anxiety.

Clinical anxiety disorders are one of the most prevalent disorders in modern
society. Exposure-based cognitive behavioral therapy (CBT) has received the
most empirical support for treating anxiety disorders in children and
adolescents, however response rates are still only around 50%. A very important
mechanism for exposure-based CBT is safety learning, in which adolescents have
relatively more difficulty. Tapping into adolescent-specific ports-of-entry,
such as peer influence, might therefore help enhance treatment effectiveness.
In the current study, we will investigate whether peer influence might enhance
adequate safety learning by comparing vicarious safety learning to
non-vicarious safety learning in adolescents with and without clinical anxiety.
Golkar et al. (2013) already showed first evidence that vicarious safety
learning, as compared to non-vicarious safety learning, may be related to more
efficient down regulation of anxiety in an adult population, hence we aim to
replicate these results in two samples: typically developing and clinically
anxious adolescents.

The general aim of this project is to better understand the mechanisms involved
in safety learning, specifically in adolescents with and without clinical
anxiety. First, we aim to investigate differences in vicarious and
non-vicarious safety learning. Second, we aim to investigate whether
adolescents with clinical anxiety show delayed safety learning, compared to
typically developing adolescents. Third, we aim to investigate vicarious and
non-vicarious safety learning in relation to CBT treatment outcomes in the
clinical anxiety group.

The current study is a within x between subjects design. Participants are
randomly assigned to the vicarious non-vicarious safety learning condition. We
will compare the effects of vicarious versus non-vicarious safety learning, as
measured physically (by means of skin conductance response) and subjectively
(self-reported level of distress and US expectancy ratings). We will compare
two groups: clinical anxiety and typically developing adolescents. Lastly, in
the clinical anxiety group, the relation between safety learning (physical and
subjective) and treatment effectiveness of CBT treatment as usual (by means of
reduction in anxiety symptoms), is investigated on within subject level.

The burden to participants is considered to be minimal, as the study consists
only of questionnaires and one behavioural task. For the typically developing
adolescents, the study consists of one session, which includes the safety
learning task and questionnaires. For the clinically anxiety group, the study
consists of six sessions. The first session is equal to the typically
developing group, consisting of the safety learning task and questionnaires.
The other five session consists of questionnaires that are conducted during and
after treatment as usual. All session will take between 20-60 minutes. Risk of
participation is also considered to be minimal, because the behavioural task is
based on validated safety learning paradigms used with children and adolescents
(Britton et al., 2013; Lau et al., 2011;), and in clinically anxious
adolescents (Lau et al., 2008; Waters, Henry & Neumann, 2009), which were shown
to be safe to use.