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      Biased Perception of Physiological Arousal in Child Social Anxiety Disorder Before and After Cognitive Behavioral Treatment


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          A biased perception of physiological hyperreactivity to social-evaluative situations is crucial for the maintenance of social anxiety disorder (SAD). Alterations in interoceptive accuracy (IAc) when confronted with social stressors may play a role for SAD in children. We expected a biased perception of hyperarousal in children with SAD before treatment and, consequently, a reduced bias after successful cognitive behavioral therapy (CBT).


          In two centers, 64 children with the diagnosis of SAD and 55 healthy control (HC) children (both 9 to 13 years) participated in the Trier Social Stress Test for Children (TSST-C), which was repeated after children with SAD were assigned to either a 12-week group CBT (n = 31) or a waitlist condition (n = 33). Perception of and worry about physiological arousal and autonomic variables (heart rate, skin conductance) were assessed. After each TSST-C, all children further completed a heartbeat perception task to assess IAc.


          Before treatment, children with SAD reported both a stronger perception of and more worry about their heart rate and skin conductance than HC children, while the objective reactivity of heart rate did not differ. Additionally, children with SAD reported heightened perception of and increased worry about trembling throughout the TSST-C compared to HC children, but reported increased worry about blushing only after the stress phase of the TSST-C compared to HC children. Children with and without SAD did not differ in IAc. Contrary to our hypothesis, after treatment, children in the CBT group reported heightened perception of physiological arousal and increased worry on some parameters after the baseline phase of the TSST-C, whereas actual IAc remained unaffected. IAc before and after treatment were significantly related.


          Increased self-reported perception of physiological arousal may play a role in childhood SAD and could be an important target in CBT. However, further studies should examine if this is an epiphenomenon, a temporarily occurring and necessary condition for change, or indeed an unwanted adverse intervention effect.


          • Biased perception of physiological arousal may play a role in child social anxiety disorder (SAD).

          • Faced with standardized social stress, biased perception of heart rate but not skin conductance.

          • No change in biased perception due to cognitive-behavioral treatment.

          • Further research regarding the nature of biased perception (e.g. epiphenomenon) necessary.

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          Most cited references43

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          Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study.

          This meta-analysis of 172 studies (N = 2,263 anxious,N = 1,768 nonanxious) examined the boundary conditions of threat-related attentional biases in anxiety. Overall, the results show that the bias is reliably demonstrated with different experimental paradigms and under a variety of experimental conditions, but that it is only an effect size of d = 0.45. Although processes requiring conscious perception of threat contribute to the bias, a significant bias is also observed with stimuli outside awareness. The bias is of comparable magnitude across different types of anxious populations (individuals with different clinical disorders, high-anxious nonclinical individuals, anxious children and adults) and is not observed in nonanxious individuals. Empirical and clinical implications as well as future directions for research are discussed. (c) 2007 APA, all rights reserved.
            • Record: found
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            Is Open Access

            Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness.

            Interoception refers to the sensing of internal bodily changes. Interoception interacts with cognition and emotion, making measurement of individual differences in interoceptive ability broadly relevant to neuropsychology. However, inconsistency in how interoception is defined and quantified led to a three-dimensional model. Here, we provide empirical support for dissociation between dimensions of: (1) interoceptive accuracy (performance on objective behavioural tests of heartbeat detection), (2) interoceptive sensibility (self-evaluated assessment of subjective interoception, gauged using interviews/questionnaires) and (3) interoceptive awareness (metacognitive awareness of interoceptive accuracy, e.g. confidence-accuracy correspondence). In a normative sample (N=80), all three dimensions were distinct and dissociable. Interoceptive accuracy was only partly predicted by interoceptive awareness and interoceptive sensibility. Significant correspondence between dimensions emerged only within the sub-group of individuals with greatest interoceptive accuracy. These findings set the context for defining how the relative balance of accuracy, sensibility and awareness dimensions explain cognitive, emotional and clinical associations of interoceptive ability.
              • Record: found
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              Heart beat perception and emotional experience.


                Author and article information

                Clin Psychol Eur
                Clin Psychol Eur
                Clinical Psychology in Europe
                June 2020
                30 June 2020
                : 2
                : 2
                : e2691
                [a ]Institute of Psychology, Albert Ludwigs University of Freiburg , Freiburg, Germany
                [b ]Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
                [c ]Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
                [d ]Department of Psychology, University of Bremen , Bremen, Germany
                [5]Philipps-University of Marburg, Marburg, Germany
                Author notes
                Julia Asbrand, Department of Child and Adolescent Clinical Psychology and Psychotherapy, Institute of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany. Phone: +49 30 2093 9334. julia.asbrand@ 123456hu-berlin.de

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY) 4.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 16 January 2020
                : 11 March 2020
                Funded by: DFG;
                Award ID: HE 3342/4-2
                Award ID: TU 78/5-2
                This research was supported by a grant from the DFG given to the last authors (HE 3342/4-2, TU 78/5-2).
                Research Articles

                bodily arousal,social phobia,cbt,therapy,interoceptive awareness,heartbeat perception


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