Temperament and Attention as Core Mechanisms in the Early Emergence of Anxiety

Abstract

Anxiety is a pervasive, impairing, and early appearing form of psychopathology. Even when anxiety remits, children remain at a two- to threefold increased risk for the later emergence of a mood disorder. Therefore, it is imperative to identify and examine underlying mechanisms that may shape early emerging patterns of behavior that are associated with anxiety. One of the strongest and first visible risk factors is childhood temperament. In particular, children who are behaviorally inhibited or temperamentally shy are more likely to exhibit signs of anxiety by adolescence. However, not all shy children do so, despite the early risk. We know that attention mechanisms, particularly the presence of attention biases toward or away from threat, can play a critical role in the emergence of anxiety. The current chapter will bring together these separate lines of research to examine the ways in which attention can modulate the documented link between early temperament and later anxiety. In doing so, the chapter will highlight multiple levels of analysis that focus on the behavioral, cognitive, and neural mechanisms in the temperament-attention-anxiety network. The chapter will help identify both markers and mechanisms of risk, supporting future work aimed at improving theory and intervention by focusing on attention biases to environmental threat.

Fig. 1

Schematic representation of the relation between early risk, patterns of attention bias, and socioemotional outcomes. The developmental trajectory flows from left to right. Red denotes factors associated with anxiety and internalizing problems; blue denotes factors associated with psychological adjustment. Behavioral inhibition (left box, red and blue) is a temperamental risk factor for anxiety, but children with behavioral inhibition may or may not go on to develop anxiety. Attention bias toward threat acts as a tether pulling development toward anxiety and internalizing problems. Preventive intervention with ABM may enhance attention regulation, dislodging the developmental trajectory from the tether of threat bias and promoting psychological adjustment. The neural system underlying this process is indicated at the right; the ventrolateral prefrontal cortex (blue) exerts executive control over amygdala functioning, a process weakened in anxiety. Strengthening of this regulatory system may be the neural mechanism through which ABM exerts its effects on threat bias.