The Association Between Parent-to-Child Fear Learning Pathways and Anxiety Sensitivity: A Systematic Review and Meta-analysis

Abstract

Although anxiety sensitivity (AS), or the fear of anxiety-related symptoms, has been identified as a risk factor for the development of anxiety psychopathology, the pathways through which this fear is learned have not been fully elucidated. In the current review and meta-analysis, we aimed to systematically examine the association between parent-to-child fear learning pathways (vicarious learning, negative information, reinforcement, and punishment) and AS. A comprehensive search of literature was conducted in PsychINFO, PubMed, Embase, and Web of Science databases, using search terms combining categories related to fear learning pathways, anxiety-related symptoms, parents, children, and adolescents. Based on this search strategy, 28 studies were identified as relevant, of which 11 were included in the systematic review and 10 in the meta-analysis. The overall findings indicated that parent-to-child fear learning pathways are significantly associated with AS. The meta-analysis demonstrated a small but significant association between fear learning pathways and AS, although the type of fear learning pathway did not significantly moderate this relationship. However, age emerged as a significant moderator, suggesting a stronger association in children and adolescents compared to adults. Given that these findings are primarily based on cross-sectional studies, this review underscores the need for longitudinal and experimental research to further clarify the role of parent-to-child fear learning pathways in anxiety sensitivity. Additionally, a better understanding of these pathways may help inform existing interventions and fear prevention strategies, such as those aimed at reducing parental modeling of fearful behaviors or promoting positive verbal messages about anxiety symptoms.

Keywords: Anxiety sensitivity; Fear; Learning pathway; Meta-analysis; Systematic review.

Fig. 1

PRISMA flowchart of the systematic search

Fig. 2

Illustration of fear learning pathways. Illustration of vicarious fear pathway, in which the child observes the fear reaction of a parent experiencing anxiety symptom (e.g., difficulty breathing). Illustration of negative information pathway, in which the parent verbally transmits threat information about anxiety symptoms by informing the child about their fear and belief about the dangerousness of anxiety symptoms. Illustration of parental reinforcement of anxious behavior (e.g., parents supporting their child in avoiding responsibilities such as going to school and giving child attention by providing special treatment in response to child’s complaint such as nausea or heart palpitations). Illustration of parental punishment of anxious behavior (e.g., parents not taking their child’s complaints seriously and showing disapproval)

Fig. 3

Forest plot of effect sizes

Fig. 4

Conceptual model illustrating associations between parent-to-child learning pathways and anxiety sensitivity (AS). Solid lines represent significant associations identified in previous research, such as the link between parents’ AS and their own psychopathology (Olatunji & Wolitzky-Taylor, ; Schmidt et al., ; Taylor et al., 1996). The significant relationship between AS and subsequent psychopathology in children is also depicted in the upper right corner of the figure (Noël & Francis, ; Weems et al., 1997). Dashed lines represent associations observed in the current meta-analysis, which found a significant relationship between parent-to-child fear learning pathways (e.g., vicarious fear, negative information, and reinforcement/punishment) and AS. The strength of these associations varied based on the recency of reported learning experiences and offspring age, with stronger associations observed in younger populations (children and adolescents). However, gender and ethnic composition did not significantly moderate these associations