PhD ceremony. L.J.Kreuze, MSc. Anger in youth with anxiety relationship with reinforcement sensitivity, parental rejection and treatment outcome. Relationship with reinforcement sensitivity, parental rejection and treatment outcome.

Anxiety disorders are among the most prevalent disorders in children and young people (CYP). Around 20-30% of CYP with anxiety disorders also expresses oppositional behaviors. This subgroup presents with more severe mental health problems, worse psychosocial functioning, profits less from current treatments and has an increased risk of continued mental health problems later in life.

In this dissertation, I investigated two pathways that may explain how CYP with anxiety disorders can develop behavioral problems. First, these comorbid behavioral problems may arise as a defensive response in for the CYP threatening situations, where they cannot avoid; especially for CYP with relatively high punishment sensitivity this may lead to behavioral problems. As a second possibility, behavioral problems could arise from frustration in situations where expected and desired rewards are not attained; especially for CYP with relative high reward sensitivity this may lead to behavioral problems. Additionally I investigated whether comorbid behavioral problems – via experiencing rejection from the environment – play a role in the maintenance of anxiety complaints. Lastly, it was investigated whether the treatment for anxiety would also reduce behavioral problems when they arise from experienced threat. For those where the behavioral problems arise out of frustration due to expected rewards that are not attained, it was expected that regular treatment for anxiety would not decrease the behavioral problems.

This dissertation project provided consistent evidence for the role of frustration of not attaining expected rewards in comorbid behavioral problems. For the role of defensive responses herein, results were not univocal. In addition, the findings indicated that behavioral problems in adolescence indeed increased the risk of anxiety symptoms in young adulthood, although this appeared unrelated to experiencing more rejection from their parents. Importantly, behavioral problems generally decreased after anxiety-focused treatment, however not all CYP with behavioral problems had a reduction of their behavioral problems following treatment for anxiety. This seemed especially the case when the behavioral problems were not so much related to sensitivity for threat, but to the sensitivity for not attaining expected rewards. For CYP with this comorbid profile it seems important to add additional treatment modules focusing on the comorbid behavioral problems.

Dissertation: http://hdl.handle.net/(...)af-9fcd-5013914df670