BACKGROUND:Social anxiety disorder (SAD) is characterized by attentional biases that may contribute to its persistence. While adult models emphasize self-focused and hypervigilant attention, there is limited understanding of how these processes operate in children. This study examined internal and external attentional biases in children with SAD during anticipation of a social stress task-a period when anxiety is typically elevated. METHODS:Forty-two children with a primary SAD diagnosis and 46 healthy controls (HC), aged 9-14 years, completed a reaction time (RT) task with internal (bodily) and external (visual) probes during anticipation of a speech task, while facing a peer video audience. RTs to probes and eye movements toward audience faces were recorded. RESULTS:RTs did not differ between groups. Exploratory analyses revealed that age correlated negatively with RTs in both groups, suggesting developmental effects on processing speed, although no group differences in this relationship were found. Eye-tracking revealed that children with SAD exhibited more frequent and longer fixations on audience faces during the initial phase of the task compared to HCs. CONCLUSIONS:Although RT tasks alone may not detect attentional biases in children with SAD, eye-tracking indicated heightened attention to socially salient cues during anticipation. These findings highlight the importance of multimodal assessment to capture subtle hypervigilance in pediatric SAD.

Abstract Purpose Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change. Methods Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU (n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms. Results Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group. Discussion In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image–focused interventions may be beneficial. Level of evidence Level I, randomized controlled trial. Trial registration The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).

Social anxiety disorder (SAD) is characterized by attentional biases that may contribute to its persistence. While adult models emphasize self-focused and hypervigilant attention, there is limited understanding of how these processes operate in children. This study examined internal and external attentional biases in children with SAD during anticipation of a social stress task—a period when anxiety is typically elevated. Forty-two children with a primary SAD diagnosis and 46 healthy controls (HC), aged 9–14 years, completed a reaction time (RT) task with internal (bodily) and external (visual) probes during anticipation of a speech task, while facing a peer video audience. RTs to probes and eye movements toward audience faces were recorded. RTs did not differ between groups. Exploratory analyses revealed that age correlated negatively with RTs in both groups, suggesting developmental effects on processing speed, although no group differences in this relationship were found. Eye-tracking revealed that children with SAD exhibited more frequent and longer fixations on audience faces during the initial phase of the task compared to HCs. Although RT tasks alone may not detect attentional biases in children with SAD, eye-tracking indicated heightened attention to socially salient cues during anticipation. These findings highlight the importance of multimodal assessment to capture subtle hypervigilance in pediatric SAD.

Stress significantly influences eating behavior, yet individual responses vary. Binge eating - a core feature of Binge Eating Disorder and Bulimia Nervosa - is frequently triggered by acute stress. One proposed mechanism is that stress increases the motivational salience of food cues, which could promote craving and food intake. To test this idea experimentally, this study examined how stress affects attentional bias toward food, and how such changes relate to food craving and food intake in individuals with binge eating behaviors compared with individuals without binge eating. Using a mixed experimental design, 130 participants (68 with binge eating, 62 without binge eating) completed sessions with and without stress induction via a video-conference Trier Social Stress Test. Attentional bias was assessed via the Dot Probe Paradigm and eye tracking, food craving was measured via self-reports, and food intake was measured behaviorally. Stress did not significantly change attentional bias toward food, nor did it affect food intake. Stress did increase craving in the group with binge eating, indicating that stress enhanced the motivational value of food. The absence of corresponding changes in attentional bias suggests that heightened craving under stress does not necessarily translate into measurable shifts in attentional allocation toward food cues, or that stress may influence motivational processes without altering overt attentional patterns. Another possibility is that methodological restraints specific to our study design limited the detection of stress-related changes in attentional processes. Further research is needed to clarify the role of attentional processes in stress-related eating, especially regarding binge eating.

Bulimia nervosa (BN) has been linked to biases in self-body processing. Due to the particular importance of attentional biases, the aim of the current study was to further investigate their robustness in a large sample of females with BN or subthreshold BN (BN group) and a control group with low body dissatisfaction (LBD group) and comparable age and body mass index. Using a combined eye-tracking and electroencephalogram paradigm, we assessed overt attention orienting while viewing images of the self-body and neurophysiological correlates of attentional, emotional, and motivational processes when self-defined most unattractive body parts were fixated first. As hypothesized, the BN group (n = 69) exhibited a stronger attention bias toward self-defined most unattractive body parts compared with the LBD group (n = 37), as indicated by a higher number of fixations and longer fixation time on these regions relative to the self-defined most attractive body parts. Event-related potentials showed a higher mean amplitude of the early posterior negativity in the BN group (n = 59) compared with the LBD group (n = 27), indicating higher emotional salience of self-defined most unattractive body parts. Although the late positive potential is also typically modulated by the intensity of emotional stimuli, there were no group differences in late positive potential amplitude. This could reflect attentional avoidance and reduced elaborative processing at later stages following an initially increased attention allocation in the BN group. Future studies should aim to test this interpretation. Overall, our findings provide evidence for biased self-body processing in individuals with BN. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Children with social anxiety disorder (SAD) often perceive their social performance more negatively than external observers, reinforcing negative self-appraisals. Cognitive models suggest a vicious cycle between such distortions and heightened anxiety. This study tested whether repeated exposure to a social-evaluative task, paired with brief, ecologically valid support strategies, improves self-appraisal in children with SAD compared to baseline without support. Participants were 76 children (SAD: n = 33, Mage = 11.73, SD = 1.46, 64% female; healthy controls [HC]: n = 43, Mage = 11.40, SD = 1.45, 62% female), recruited from an urban setting in Germany. In two sessions one week apart, children delivered a 5-min speech to a peer video audience. In Session 1, they performed without support; in Session 2, they received either brief parental support or a self-instruction during preparation. After each speech, children rated their performance. Observer-rated performance was assessed by three independent, trained coders blind to group, session, and condition. Self-rated performance improved across sessions in both groups, but children with SAD consistently rated themselves more negatively than HC peers. Observer-rated performance did not differ between groups or across sessions. No differential effects emerged between support types. Negative self-appraisal is a core, though partially modifiable, feature of childhood SAD. Repeated exposure to social stress paired with brief support may modestly improve self-perception, though effects may reflect exposure rather than specific support. Targeting distorted self-appraisals remains a key clinical focus.

BACKGROUND:Suicidal ideation and self-injurious behaviors (SISIB) in children and adolescents are a major concern in clinical practice. Yet, little is known about the prevalence rates of SISIB in outpatient clinics and its response to routine psychotherapy. Therefore, the present study aims to assess the prevalence of SISIB and the changes in SISIB in a heterogeneous clinical outpatient sample of children and adolescents undergoing cognitive behavioral therapy in Germany. METHODS:The sample consists of N = 5730 child and adolescent outpatients, 54.05% female, mean age = 12.16 years (SD = 3.51). As metrics of SISIB, two items (Item 18 on self-injurious behavior and Item 91 on suicidal ideation) of the Youth Self Report (YSR/11-18R) and the Child Behavior Checklist (CBCL/6-18R) as caregiver report were used. RESULTS:Pretreatment, suicidal ideation was reported by 33.45% of patients and 15.39% of caregivers. Self-injurious behavior was reported pretreatment by 35.35% of patients and 20.16% of caregivers. Posttreatment, suicidal ideation was reported by 11.32% of patients and 5.25% of caregivers. Self-injurious behavior was reported posttreatment by 19.00% of patients and 9.43% of caregivers. CONCLUSION:SISIB are very common in children and adolescents in outpatient settings. Prevalence rates are higher in self-reports than in caregiver reports, indicating the importance of assessing SISIB in children and adolescents themselves. After routine-care psychotherapy, a substantial proportion of patients report an amelioration of SISIB. These results indicate the importance of monitoring SISIB during treatment and of therapists being aware of risk assessment techniques and psychotherapy interventions targeting SISIB.

OBJECTIVE:The role of the therapeutic alliance (TA) in treatment outcomes of anorexia nervosa (AN) appears to be less substantial than in other disorders. However, the therapeutic process is a complex trajectory with many variables influencing each other. Hence, investigating motivation to change in the bidirectional interplay between TA and outcome among patients with AN may enhance the understanding of these processes. METHOD:In an exploratory analysis of longitudinal data from 173 inpatients with AN assessed at four time points in a specialized in-patient clinic, the interplay of TA and its subscales with motivation was investigated using cross-lagged panel models. Additionally, motivation was tested as a possible moderator and mediator of previously examined relationships between outcome and TA. RESULTS:Autoregressive paths of TA and motivation were highly stable over the course of treatment, while residual covariances varied. Motivation showed moderate but significant cross-lagged effects on subsequent TA, while TA had no effect on subsequent motivation. These associations were observed only when motivation was assessed with an exploratory measure of motivation. No mediation and moderation effect of motivation on relationships between TA and outcome was found. DISCUSSION:Cross-lagged analyses suggested that motivation preceded subsequent levels of TA, whereas TA did not predict subsequent motivation. Given the exploratory nature of the study, these findings should be considered hypothesis-generating and require replication. Future research using more fine-grained methodologies may help to further elucidate the longitudinal interplay between motivation and TA in patients with AN.

Both theoretical models and empirical evidence suggest that children and adolescents with social anxiety disorder (SAD) have difficulties with emotion regulation (ER), but little is known about which deficits are disorder-specific or involved across different anxiety disorders for this age group. Furthermore, the available repertoire of ER strategies as an important component of ER flexibility has so far received little attention in research on this age group. Self-reported use of individual ER strategies, the overall repertoire of used ER strategies, and the ratio of adaptive and maladaptive ER strategies were assessed in children and adolescents (aged 10–15 years) with SAD (n = 60), clinical controls with specific phobia (SP, n = 41), and healthy controls (HCs, n = 63) in a cross-sectional study. Children and adolescents with SAD reported using several maladaptive ER strategies (e.g., giving up) more frequently and several adaptive ER strategies (e.g., problem-oriented action) less frequently than both other groups. No group differences in the amount of used ER strategies (repertoire) were identified, but children and adolescents with SAD were found to report a higher ratio of maladaptive and a lower ratio of adaptive ER strategies compared to both other groups. Results suggest that the extent of emotion dysregulation varies with disorder severity, with deficits being more pronounced in children and adolescents with SAD. Potential approaches for SAD treatment, including a shift in repertoire ratios, are discussed.

Anxiety disorders are the most prevalent mental health problems in childhood and adolescence, highlighting the importance to study their underlying mechanisms. One key process in fear reduction, particularly in exposure-based cognitive behavioral therapy, is extinction learning. While extensively studied in adults, its role in youth remains underexplored. The aim of the present study was to examine fear extinction learning and return of fear in a large sample of children and adolescents (N = 274; age range 8-16 years, M = 11.07, SD = 2.22; 55.8 % female) with separation anxiety disorder, social anxiety disorder, and specific phobia (n = 217) in comparison to non-anxious controls (n = 57). All children participated in a 2-day fear conditioning paradigm. Fear acquisition, extinction, and reinstatement were assessed using subjective (valence, arousal, contingency) and psychophysiological (startle) indicators of emotional reactivity. Successful differential fear acquisition could be observed in both groups. Extinction learning was also successful as the fear response to the CS+ decreased. Contradicting previous findings suggesting impairment in extinction in children with anxiety disorders, we could not find differences in fear extinction learning between anxious and non-anxious children and adolescents; both groups learned to inhibit their fear response when the CS+ no longer predicted the occurrence of the aversive outcome. Further research is needed to disentangle the role of fear extinction learning within childhood anxiety disorders and determine whether children with anxiety disorders generally do not show deficits in extinction learning or whether this deficit is limited to disorder specific stimuli.

BACKGROUND:Many studies have investigated differences in attention allocation to threat between socially anxious individuals and healthy controls in adult and child samples. The extent to which differences exist within the group of socially anxious individuals and whether these have a predictive value for the extent of symptom reduction after cognitive-behavioral therapy (CBT) has been studied less until to date and yielded inconsistent findings, particularly in child samples. METHODS:The present study investigated whether three different indices of biased attention, measured at pretreatment by eye-tracking, were associated with differences in response to a 12-session exposure-based group CBT in a sample of 41 children with social anxiety disorder (SAD). RESULTS:In linear regression analyses neither initial vigilance nor initial maintenance nor attentional avoidance predicted symptom reductions after CBT. Children who no longer met diagnostic criteria after treatment did not differ from those who did not fully remit in terms of initial vigilance and attentional avoidance (d < .36). With regard to initial maintenance of attention to threat, the analysis revealed a large but statistically non-significant effect between both groups (d = .81). CONCLUSION:Initial maintenance of attention to threat may be beneficial for the treatment of social anxiety. However, the evidence in our study is only weak and further research is needed before clear implications can be drawn.

The Trier Social Stress Test (TSST) reliably induces psychosocial stress, but its high resource demands limit its applicability in many research contexts. We evaluated a single-person videoconference TSST (vcTSST) delivered via Zoom using pre-recorded "jury" members. Forty-one healthy, German-speaking students were randomized to vcTSST (n = 21) or a structurally matched control (n = 20). Continuous heart rate and root mean square of successive interbeat differences (RMSSD) were recorded alongside visual analog scales for stress and mood across baseline, anticipation, speech, and arithmetic phases. In the vcTSST, stress and heart rate increased sharply (partial η² = .59 and .60) while mood and RMSSD decreased (partial η² = .23 and .31; all p < .001). Phase × condition interactions revealed significantly higher stress, negative affect, and heart rate in vcTSST versus control (p < .01), with no group difference in RMSSD. No participant detected the pre-recorded jury, confirming deception fidelity. The vcTSST provides a cost-effective, standardized stress paradigm, which can be used in laboratory settings and is easily adaptable for remote applications. Future studies should include neuroendocrine measures, recruit more diverse samples, and validate the protocol in online contexts.

OBJECTIVE:Binge eating disorder (BED) is maintained by increased food-related incentive salience, which is reflected by an attentional bias for food. Oxytocin acutely attenuates this bias in patients with anorexia nervosa and reduces food intake in males with normal or increased body weight. However, results in individuals with BED have been inconclusive. We assessed the acute effect of oxytocin on food stimulus processing and reward-driven eating behavior in females with or without BED in a double-blind, placebo-controlled cross-over study. METHOD:Females with BED (n = 48) and female control participants with overweight (n = 46) or normal weight (n = 40) received intranasal oxytocin (24 IU) and, respectively, placebo, after an overnight fast and a standardized breakfast. In participants with a natural menstrual cycle, sessions were scheduled during consecutive luteal phases. Participants completed a food-related dot-probe task with concurrent eye tracking and a bogus taste test measuring snack intake. RESULTS:Oxytocin compared to placebo increased dwell time bias on food stimuli in the BED relative to the overweight control group, in which this effect was reversed. Contrary to our hypothesis, oxytocin increased calorie intake across groups. Exploratory analyses indicated that the latter effect focused on females taking hormonal contraception. DISCUSSION:These results indicate disorder- and, respectively, sex-specific effects of oxytocin on food-related incentive salience and food intake and point to a role of oxytocin in binge eating pathology. They moreover suggest that sex hormones determine the acute effect of oxytocin on eating behavior in females.

Background: Body image dissatisfaction in childhood is linked to psychopathological risks, such as increased vulnerability to eating disorders. While cognitive-behavioral models suggest body-related cognitions and self-schemas contribute to body dissatisfaction, these mechanisms remain understudied in children. We hypothesized that children with body dissatisfaction would report higher public body awareness and show stronger body- and appearance-related attributions in negative scenarios, particularly when self-referenced.Methods: 431 children aged 8 to 13 years filled in questionnaires on body-related cognitions. Results: Children with body dissatisfaction showed significantly greater public body awareness and made more appearance- and body-related attributions under self-reference, but not under other-reference.Conclusion: These findings support cognitive models of body image dissatisfaction in preadolescents and highlight early-emerging cognitive distortions as potential targets for prevention and intervention.

The development of functional emotion regulation (ER) is crucial for mental health in childhood and adolescence—especially in today’s context of multiple crises, which have led to rising anxiety even in the general population. Although the importance of ER is widely acknowledged, existing assessments have yet to adequately measure state ER, particularly in anxiety-inducing situations. We aimed to develop and evaluate the psychometric properties of the State Emotion Regulation Questionnaire (ERQ State) for adolescents, with a future focus on clinical populations. An online experiment was conducted with 105 German adolescents (Mage = 13.5 years, SDage = 2.4), using four types of anxiety-inducing vignettes (social anxiety, general anxiety, specific phobia, separation anxiety) to examine potential correlations with trait anxiety. Confirmatory factor analyses were performed to refine the ERQ State-short item pool, revealing strong support for its theoretical structure in scenarios related to social anxiety (Vignette 1). However, model fit was less satisfactory for the remaining forms of anxiety (separation anxiety, specific phobia, generalized anxiety; Vignette 2). While further refinement and validation are needed, the ERQ State-short appears to be a promising tool for assessing ER in anxious adolescents, particularly in contexts involving social anxiety.

Disordered eating behaviors (DEBs), including restrictive eating, binge eating and purging, are associated with mental health problems and an increased risk of eating disorders (EDs), which often occur in adolescence and can have serious health consequences. In addition, the increasing rates of overweight and obesity among children and adolescents raise concerns about their associated physical and mental health risks. Attentional biases (ABs) to food- and body-related cues have been proposed as cognitive mechanisms that contribute to the development and maintenance of EDs and are also discussed in the etiology of overweight and obesity. While theoretical models suggest that ABs may contribute to the maintenance of EDs, DEBs, and obesity, empirical evidence in young populations is still limited. This systematic review (PROSPERO: CRD42023399292) examined literature from PsycINFO, PubMed, and Scopus on ABs to food- and body-related stimuli in children and adolescents with overweight, obesity, or ED symptoms, compared to healthy comparisons. A total of 30 peer-reviewed studies published in English since 2003 were included. The evidence on AB for food in young people with overweight and obesity remains inconclusive, and studies provide conflicting results. Similarly, studies in adolescents with AN show heightened attention to low-calorie foods and inconsistent attentional patterns toward high-calorie foods, indicating a complex and heterogeneous picture. Evidence on AB for food in young people with BED is scarce, with one study reporting an attentional bias towards food. For LOC eating, findings were mixed and less conclusive. This suggests that body-related AB may serve as a relevant marker for the psychopathology of EDs, particularly in AN. This review underscores the role of ABs in EDs and overweight/obesity and highlights methodological inconsistencies as well as research gaps, particularly in samples beyond AN and overweight/obesity. Future studies should therefore employ standardized methods, diverse samples, and developmental perspectives to improve understanding of AB in the etiology of these pathologies and inform targeted interventions for at-risk youth. Eating disorders (EDs) and unhealthy eating behaviors can seriously affect young people’s mental and physical health. In addition, the increasing rates of overweight and obesity among adolescents raise concerns about their associated physical and mental health risks. One possible factor influencing eating behavior and body perception is attentional bias (AB) – the tendency to selectively filter certain information, such as food or body-related cues. This review systematically examines studies on AB in young people with EDs, overweight, or obesity. Findings on food-related ABs were inconsistent, with some studies showing increased attention to food in young people with obesity/overweight or EDs compared to comparison participants, while others found no clear differences or even decreased attention to food. In contrast, research on body-related ABs in anorexia nervosa (AN) was more consistent, showing a stronger focus on thin bodies and self-perceived unattractive body areas in young people with AN compared to comparison participants. These findings suggest body-related ABs may play a role in AN, yet, overall, research remains limited and inconsistent. More studies using reliable methods are needed to clarify similarities and differences in ABs across different eating behaviors and to provide a basis for improving prevention and strategies for at-risk children and adolescents.

While the hierarchical model of approach-avoidance motivation suggests a heightened food-specific approach behavior for individuals with binge eating disorder (BED), empirical evidence does not confirm the postulated food approach bias. This discrepancy may be related to the studied samples, which were partially in treatment, but also to the fact that previous studies tested for an approach bias under low cognitive load. Therefore, the present study assessed the food-specific approach behavior in an untreated sample with BED under high and low cognitive load, in comparison to a weight-matched and a normal weight control group. To this end, 50 individuals with BED, 20 individuals with overweight and 21 individuals with normal weight completed an approach avoidance task. In each trial, participants were instructed to either push or pull a slider device, dependent on the orientation of an arrow, which was superimposed on a picture. The underlying picture either depicted a high calorie food item or a neutral stimulus. Cognitive load was manipulated by two flanking arrows that either pointed in the same or the opposite direction to the task-relevant central arrow. First, and contrary to our hypothesis, the food-specific approach bias was not stronger in the group with BED compared to both control groups. Post-hoc tests further revealed no food-specific approach bias in any of the three groups. Moreover, and contrary to our hypothesis, cognitive load did not show a group specific impact on the food approach behavior. However, cognitive load did increase the food approach behavior across groups. The results of this study, in conjunction with previous studies suggest, that there is no clear food approach bias in individuals with BED, at least when movement direction is not explicitly contingent on picture content.